Proposing a mechanistic model of clinician training and consultation.

Abstract

To make evidence-based treatments deliverable, effective, and scalable in community settings, it is critical to develop a workforce that can deliver evidence-based treatments as designed with skill. However, the science and practice of clinician training and consultation lags behind other areas of implementation science. In this paper, we present the Longitudinal Education for Advancing Practice (LEAP) model designed to help span this gap. The LEAP model is a mechanistic model of clinician training and consultation that details how training inputs, training and consultation strategies, and mechanisms of learning influence training outcomes. We first describe the LEAP model and then discuss how key implications of the model can be used to develop effective training and consultation strategies.

Measurement training and feedback system for implementation of evidence-based treatment for adolescent externalizing problems: protocol for a randomized trial of pragmatic clinician training

“…In Aim 1, by comparing Baseline versus Implementation data, we can examine the effectiveness of the MTFS-I training component for enhancing EBT fidelity across study sites, yielding proof-of-concept data in accord with the well-established Stage Model of behavioral treatment development [27]. In Aim 2, by experimentally comparing Training Only versus Training + Feedback + Consultation, we can test the added value of MBC procedures combined with expert consultation procedures [26] for enhancing MTFS-I benefits. Also the quasi-experimental analysis of Baseline data (averaged across all study therapists) versus Training Only condition data will shed light on the unique effects of the online training component, which is the most pragmatic feature of the overall MTFS-I package.…”

“…In keeping with evidence-informed guidelines for effective clinical facilitation (see [26]), MTFS-I consultation will focus on four interrelated strategies: discussion about recently viewed video vignette(s) (invoking retrieval practice and microlearning mechanisms), review of recently distributed feedback reports (cognitive rehearsal with increasing challenge), review of therapist-prepared case summaries combined with action planning for upcoming sessions (behavioral and cognitive rehearsal with variability), and live review of segments from submitted audiotapes (behavioral rehearsal with increasing challenge). Review of feedback reports will capitalize on data-driven decision-making, which has been shown to increase performance and productivity across a range of industry, education, and clinical service settings [38].…”

“…The observational coder training and implementation feedback components contained in MTFS-I are functionally symbiotic: Training is meant to ensure that clinicians generate valid self-report data to anchor feedback reports, and feedback reports supply motivational context for dedicated participation in self-monitored training. The putative learning mechanisms—cognitive, behavioral, attitudinal [26]—activated by the two intervention components await confirmation and articulation via direct testing. It is critical to note that MTFS-I is not intended to be a “replacement approach” in which clinicians are trained to implement new EBTs, but rather an “augmentation approach” aimed at enhancing expertise for EBTs already endorsed and practiced to some degree [13].…”

Leaping ahead in clinical training.

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| INTRODUCTIONIn the advent of increased demands for evidence-based practice (EBP) 1 in clinical settings, McLeod et al (2018) present a laudable model through which such treatments can be disseminated to clinicians. The model provides not only detailed steps for training but also a framework to rigorously and continuously evaluate effectiveness of training, uptake of information, retention, and usefulness in practice.

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“…Given the dearth of literature on how therapists learn therapeutic skills, LEAP is a promising step forward toward increasing training in and research on how clinicians learn.What powers can impel the use of EBP into routine clinical practice? One essential power is having a practice workforce that is trained in the provision of the EBP, as McLeod et al (2018) detail in their thoughtful paper suggesting the longitudinal education for advanced practice (LEAP 2 ) model. As one example of a practical "takehome" message from McLeod and colleagues consider the five core strategies for training that are presented and discussed (i.e., engage, behavioral rehearsal, cognitive rehearsal, error training, and approximate work conditions).…”