A survey of evidence-based practice, training, supervision and clinician confidence relating to post-traumatic stress disorder (PTSD) therapies in UK child and adolescent mental health professionals

Abstract

Background: Post-Traumatic Stress Disorder (PTSD) in children and adolescents has received increasing recognition in recent decades. Despite development of treatments and improved dissemination efforts, research has identified a number of barriers to implementing these approaches. Objective: This study sought to understand what interventions mental health professionals working with children and adolescents utilised to treat PTSD, their training and supervision, their confidence in assessing and treating PTSD, and how these factors relate to clinicians characteristics (e.g. age, gender, professional background). Method: The study comprised an internet-delivered survey of clinicians working in child and adolescent mental health services in the UK (N = 716). Results: Many clinicians (>40%) had not received training in working with PTSD, with considerable variation between professional background. Lack of training and supervision was associated with reduced clinician confidence in treating children with PTSD (possible range 0-10; training M = 7.54, SD = 1.65, no training M = 5.49, SD = 2.29; supervision M = 7.53, SD = 1.63, no supervision M = 5.98, SD = 2.35). Evidence-based therapies for PTSD such as Trauma-Focused Cognitive-Behavioural Therapy and Eye Movement Desensitisation and Reprocessing were only endorsed modestly by clinicians (58.4% and 37.5%, respectively). Regression analyses identified that lack of training and supervision were significant barriers to the use of evidence-based interventions. Other predictors of clinician confidence and use of evidence-based interventions included profession and years of experience. Participants almost universally wanted more training in working with PTSD. Conclusions: Evidence-based treatments are not currently universally delivered by mental health professionals in the UK, with certain professions particularly lacking training and confidence with this condition. Training around trauma and PTSD may be an ongoing need to boost and maintain confidence in working with PTSD in youth.

A meta-analysis of dropout from evidence-based psychological treatment for post-traumatic stress disorder (PTSD) in children and young people

“…This finding is promising in that it supports the vision espoused by the World Health Organization (WHO) of nonspecialised healthcare workers being critical in meeting the demand for mental health interventions around the world (mhGap Intervention Guide for mental, neurological and substance use disorders in non-specialized health settings; WHO, 2010 ). It is encouraging to note that while professionals have identified the need for additional training as a potential barrier to implementing trauma-focused treatments (Finch et al, 2020b ), these needs may be met with relatively modest input given the success of these studies in utilizing lay facilitators.…”

“…It has been widely noted, however, that despite this strong evidence base, there continues to be an under-utilization of these approaches in clinical settings (Borntrager, Chorpita, Higa-mcmillan, Daleiden, & Starace, 2013 ; Clark, Sprang, Freer, & Whitt-Woosley, 2010 ; Eslinger, Sprang, Ascienzo, & Silman, 2020 ; Finch, Ford, Grainger, & Meiser-Stedman, 2020a ; Finch, Ford, Lombardo, & Meiser-Stedman, 2020b ). Rates of young people dropping out from treatment for PTSD are significant (Dorsey et al, 2017 ).…”

Predictors of Clinician‐Reported Self‐Efficacy in Treating Trauma‐Exposed Youth

“…This construct was measured using a single item adapted from prior work (Williams & Smith, 2016): “How confident are you in your ability to provide effective treatment for trauma‐exposed youth?” Respondents scored their answers using a scale of 0 ( not at all confident ) to 10 ( extremely confident ). A similar scale has been used in similar work examining clinician confidence with treatment delivery (Finch, Ford, Lombardo, et al., 2020), with demonstrated predictive validity (Williams & Smith, 2016).…”

“…Respondents scored their answers using a scale of 0 (not at all confident) to 10 (extremely confident). A similar scale has been used in similar work examining clinician confidence with treatment delivery (Finch, Ford, Lombardo, et al, 2020), with demonstrated predictive validity (Williams & Smith, 2016).…”

“…To date, only one study of which we are aware has specifically examined predictors of clinician self‐efficacy among clinicians working with trauma‐exposed youth. Finch, Ford, Lombardo, and colleagues (2020) surveyed a large sample of clinicians in the United Kingdom about their perceived self‐efficacy in treating PTSD. The authors found that having training, receiving supervision, and being a clinical psychologist, psychiatrist, or social worker was associated with higher ratings of self‐efficacy relative to nonspecialized mental health practitioners, nurses, or occupational therapists.…”