Improving practice in community-based settings: a randomized trial of supervision – study protocol

Abstract

BackgroundEvidence-based treatments for child mental health problems are not consistently available in public mental health settings. Expanding availability requires workforce training. However, research has demonstrated that training alone is not sufficient for changing provider behavior, suggesting that ongoing intervention-specific supervision or consultation is required. Supervision is notably under-investigated, particularly as provided in public mental health. The degree to which supervision in this setting includes ‘gold standard’ supervision elements from efficacy trials (e.g., session review, model fidelity, outcome monitoring, skill-building) is unknown. The current federally-funded investigation leverages the Washington State Trauma-focused Cognitive Behavioral Therapy Initiative to describe usual supervision practices and test the impact of systematic implementation of gold standard supervision strategies on treatment fidelity and clinical outcomes.Methods/DesignThe study has two phases. We will conduct an initial descriptive study (Phase I) of supervision practices within public mental health in Washington State followed by a randomized controlled trial of gold standard supervision strategies (Phase II), with randomization at the clinician level (i.e., supervisors provide both conditions). Study participants will be 35 supervisors and 130 clinicians in community mental health centers. We will enroll one child per clinician in Phase I (N = 130) and three children per clinician in Phase II (N = 390). We use a multi-level mixed within- and between-subjects longitudinal design. Audio recordings of supervision and therapy sessions will be collected and coded throughout both phases. Child outcome data will be collected at the beginning of treatment and at three and six months into treatment.DiscussionThis study will provide insight into how supervisors can optimally support clinicians delivering evidence-based treatments. Phase I will provide descriptive information, currently unavailable in the literature, about commonly used supervision strategies in community mental health. The Phase II randomized controlled trial of gold standard supervision strategies is, to our knowledge, the first experimental study of gold standard supervision strategies in community mental health and will yield needed information about how to leverage supervision to improve clinician fidelity and client outcomes.Trial registrationClinicalTrials.gov NCT01800266

Barriers to and Facilitators in the Implementation of Cognitive-Behavioral Therapy for Youth Anxiety in the Community

“…Many providers already receive supervision in the community, although the content of this supervision is largely unknown (41). The potential for already existing and available supervision to provide support for the implementation of evidence-based practices is an important area for future research (42). …”

Clinician Use of Standardized Assessments Following a Common Elements Psychotherapy Training and Consultation Program

“…As mentioned, the CBT+ Initiative includes some supervisor-level supports (e.g., yearly supervisor training, listserv, monthly supervisor call), and SA use is one of the covered topics, among many, related to supervising clinicians in EBP. An ongoing RCT in Washington State (Dorsey et al, 2013) is testing the use of routine symptom and fidelity monitoring during supervision against symptom and fidelity monitoring plus behavioral rehearsal of upcoming EBP elements. Outcomes from this study may yield information surrounding the role of supervisors in encouraging EBA processes, specifically SA administration and feedback (one of the behavioral rehearsals involves practicing SA feedback).…”

Implementing for Sustainability: Promoting Use of a Measurement Feedback System for Innovation and Quality Improvement

“…From a management perspective, the value of efficiently and rapidly spreading the ''golden thread'' of readily usable and clinically salient information that drives treatment and decision-making throughout an organization cannot be understated. For example, MFSs have been recommended as a promising tool to improve supervision effectiveness (Dorsey et al 2013;Lambert and Hawkins 2001;Sparks et al 2011;Worthen and Lambert 2007). A MFS is ultimately a client empowerment tool by making the client's 'voice' accessible to all aspects of clinical care including supervision.…”