Effectiveness of training methods for delivery of evidence-based psychotherapies: a systematic review

Abstract

Background Extensive efforts have been made to train mental health providers in evidence-based psychotherapies (EBPs); there is increasing attention focused on the methods through which providers are trained to deliver EBPs. Evaluating EBP training methods is an important step in determining which methods are most effective in increasing provider skill and improving client outcomes. Methods We searched MEDLINE (Ovid) and PsycINFO for randomized controlled trials published from 1990 through June 2019 that evaluated EBP training methods to determine the effectiveness of EBP training modalities on implementation (provider and cost) and client outcomes. Eligible studies (N = 28) were evaluated for risk of bias, and the overall strength of evidence was assessed for each outcome. Data was extracted by a single investigator and confirmed by a second; risk of bias and strength of evidence were independently rated by two investigators and determined by consensus. Results Overall, EBP training improved short-term provider satisfaction, EBP knowledge, and adherence compared to no training or self-study of training materials (low to moderate strength of evidence). Training in an EBP did not increase treatment adoption compared to no training or self-study. No specific active EBP training modality was found to consistently increase provider EBP knowledge, skill acquisition/adherence, competence, adoption, or satisfaction compared to another active training modality. Findings were mixed regarding the additive benefit of post-training consultation on these outcomes. No studies evaluated changes in provider outcomes with regards to training costs and few studies reported on client outcomes. Limitations The majority of included studies had a moderate risk of bias and strength of evidence for the outcomes of interest was generally low or insufficient. Few studies reported effect sizes. The ability to identify the most effective EBP training methods was limited by low strength of evidence for the outcomes of interest and substantial heterogeneity among studies. Conclusions EBP training may have increased short-term provider satisfaction, EBP knowledge, and adherence though not adoption. Evidence was insufficient on training costs and client outcomes. Future research is needed on EBP training methods, implementation, sustainability, client outcomes, and costs to ensure efforts to train providers in EBPs are effective, efficient, and durable. Trial registration The protocol for this review is registered in PROSPERO (CRD42018093381).

An equivalence analysis of provider education in youth mental health care

“…One recent review of training effectiveness excluded studies in which the majority of those trained did not have advanced degrees 75 . Another recent review of training effectiveness found that half of the included studies included trainees or unlicensed individuals, but did not specify educational levels of participants 76 . All providers, regardless of experience, likely need some level of ongoing support to continue delivering EBTs with high fidelity 73,75‐77 .…”

“…Sustainment studies typically focus on whether the EBT is still in use, with more research needed to understand how to maintain fidelity and delivery quality over long periods of time 68‐73 . It is possible that individuals with less mental health training and experience prior to EBT training may need more ongoing supervision than those with advanced degrees, or may differ in the benefits they receive from different training and supervision approaches 10,40,74‐77 …”

“…Another recent review of training effectiveness found that half of the included studies included trainees or unlicensed individuals, but did not specify educational levels of participants 76 . All providers, regardless of experience, likely need some level of ongoing support to continue delivering EBTs with high fidelity 73,75‐77 . In this study, all providers who were trained in AF‐CBT received extensive training followed by a brief period of consultation (6 months), but agencies likely varied in the level and type of implementation support provided.…”

Online Training of Community Therapists in Observational Coding of Family Therapy Techniques: Reliability and Accuracy

“…It remains an unfortunate truth that methods for training therapists to implement EBIs in usual care have not produced substantial impacts on EBI adoption, delivery, or quality (Beidas et al, 2019;Valenstein-Mah et al, 2020). Perhaps teaching therapists to be more reliable and accurate coders of EBI techniques can yield benefits that are cognitive (e.g., increased knowledge of EBI techniques and when they can be used), attitudinal (e.g., stronger confidence and motivation to use EBIs), and/or behavioral (e.g., enhanced capability to deliver EBIs via observational modeling and instrumental learning) in nature (McLeod et al, 2018).…”

“…Manualized EBIs use standardized clinician training protocols, often in conjunction with ongoing expert consultation and provider certification procedures, to ensure high-fidelity model delivery and continuous quality improvement. Yet, over three decades of research show that whereas EBI training and consultation can increase EBI satisfaction and immediate skill acquisition among community practitioners, they do not reliably or appreciably increase practitioner use of EBIs with their clients, especially after interactions with experts cease (Beidas et al, 2019;Valenstein-Mah et al, 2020). Moreover, training and quality procedures for manualized EBIs can be prohibitively costly and resource-intensive to sustain in everyday care.…”