Clinician training, then what? Randomized clinical trial of child STEPs psychotherapy using lower-cost implementation supports with versus without expert consultation.

Abstract

Implementation of evidence-based treatments in funded trials is often supported by expert case consultation for clinicians; this may be financially and logistically difficult in clinical practice. Might less costly implementation support produce acceptable treatment fidelity and clinical outcomes? Method: To find out, we trained 42 community clinicians from four community clinics in Modular Approach to Therapy for Children (MATCH), then randomly assigned them to receive multiple lower-cost implementation supports (LC) or expert MATCH consultation plus lower-cost supports (CLC). Clinically referred youths (N ϭ 200; ages 7-15 years, M ϭ 10.73; 53.5% male; 32.5% White, 27.5% Black, 24.0% Latinx, 1.0% Asian, 13.5% multiracial, 1.5% other) were randomly assigned to LC (n ϭ 101) or CLC (n ϭ 99) clinicians, and groups were compared on MATCH adherence and competence, as well as on

Therapist Experiences and Attitudes About Implementing Internet-Delivered Parent-Child Interaction Therapy During COVID-19

“…COVID-19 has not only provided an opportunity to increase access to telehealth mental health services, but also remote training and consultation models, which might be more costeffective for low-resource settings. Further research is needed to identify how low-cost implementation strategies impact client, fidelity, and health equity outcomes, in order to increase access to evidence-based services for communities of color (Weisz et al, 2020;Woodward et al, 2019).…”

How low can you go? Examining the effects of brief online training and post-training consultation dose on implementation mechanisms and outcomes for measurement-based care

“…Many reviews indicate that post-training consultation (i.e., ongoing support following training, provided by an expert with the goal of improving implementation and practice of an EBP) [ 1 ] or other supports are necessary, but the strength of the evidence remains mixed [ 2 – 5 ]. Recent literature points to the limitations of “workshop only” trainings and suggests that they are likely to have a greater impact on the adherence and competence of practitioners when augmented with practice-specific implementation supports and/or ongoing consultation to promote workplace-specific adaptations and skill application [ 6 – 8 ]. As such, initial training and post-training consultation are two cornerstone—and complementary—implementation strategies to support the implementation of evidence-based practices [ 9 , 10 ].…”

Modular Psychotherapy Outcomes for Youth With Different Latent Profiles of Irritability and Emotion Dysregulation

“…Next, the two LPA-derived classes were specified as predictors of clinical outcome trajectories via latent growth curve (LGC) models. Our overall approach to these analyses draws from the log-transformed modeling strategy used in several prior randomized trial studies (9,48,57), including the primary outcomes of the present study (49). That is, we estimated outcome trajectories as longitudinal models wherein our metric of time was the natural logarithm of the number of days since baseline +1.…”

“…Differential diagnosis for youth irritability can involve over a dozen different diagnostic categoriescutting across internalizing, externalizing, neurodevelopmental, and other domains-of which irritability is a core symptom or associated feature. Interventions such as MATCH rely heavily on assessment data for (a) the initial routing of the treatment plan to target a core problem area, and (b) ongoing progress-monitoring for treatment personalization and outcomes evaluation (48,49). Thus, effective intervention for severe irritability begins with an effective assessment to clarify the presentation and focus of treatment (9,45).…”

“…The present study seeks to help fill these gaps regarding the treatment of severe irritability and emotion dysregulation. Specifically, we use data from a community-based implementation trial of MATCH among 200 youth referred for various emotional and behavioral problems (49). In this sample, the number of youth who received MATCH was more than 3× larger than that analyzed in our previous study (9), allowing for a closer and more sophisticated analysis of outcomes.…”