Statewide CBT Training for Clinicians and Supervisors Treating Youth: The New York State Evidence Based Treatment Dissemination Center

Abstract

In recent years, several states have undertaken efforts to disseminate evidence-based treatments to agencies and clinicians in their children's service system. In New York, the Evidence Based Treatment Dissemination Center adopted a unique translation-based training and consultation model in which an initial 3-day training was combined with a year of clinical consultation with specific clinician and supervisor elements. This model has been used by the New York State Office of Mental Health for the past 3 years to train 1,210 clinicians and supervisors statewide. This article describes the early adoption and initial implementation of a statewide training program in cognitive-behavioral therapy for youth. The training and consultation model and descriptive findings are presented; lessons learned are described. Future plans include a focus on sustainability and measurement feedback of youth outcomes to enhance the continuity of this program and the quality of the clinical services.

The occasional case against broad dissemination and implementation: Retaining a role for specialty care in the delivery of psychological treatments.

“…Recognizing the critical need to improve the broad quality of mental health care, a number of health care delivery systems have developed large-scale dissemination and implementation efforts (Bruns & Hoagwood, 2008; Clark, 2012; Clark et al, 2009; Daleiden, Chorpita, Donkervoet, Arensdorf, & Brogan, 2006; Gleacher et al, 2011; McHugh & Barlow, 2010, 2012; Ruzek, Karlin, & Zeiss, 2012), and a number of treatment development groups have demonstrated some encouraging gains in promoting research-supported treatments in practice settings (e.g., Beidas, Edmunds, Marcus, & Kendall, 2012; Lochman et al, 2009; Kendall & Khanna, 2008). Formal evaluations of large-scale dissemination and implementation programs are ongoing, but early efforts do reveal some consistent findings.…”

“…Competency components—including ongoing expert consultation or supervision after initial didactics—are essential for trainees to acquire the skills necessary to administer treatments with fidelity and skill (Beidas, Mehta, Atkins, Solomon, & Merz, 2013; Crits-Christoph et al, 1998; Herschell, McNeil, & McNeil, 2004; McHugh & Barlow, 2010, 2012; Miller, Yahne, Moyers, Martinez, & Pirritano, 2004; Sholomskas, Syracuse-Siewert, Rounsaville, Ball, & Nuro, 2005). Competency components typically entail application of disseminated EBPs or techniques in the trainees’ actual practices (Daleiden et al, 2006; Gleacher et al, 2011), and so training requires a steady flow of patients with the very problems targeted by the disseminated treatments. Didactic trainings are of limited utility if there are not subsequent opportunities to develop competency under applied supervision.…”

“…In the United States, the Veterans Health Administration (VHA) has committed hundreds of millions of dollars to the implementation of centralized dissemination efforts requiring all clinicians in VHA settings across the nation to complete training in EBPs for depression, anxiety, and traumatic stress disorders (Ruzek et al, 2012). State mental health programs also explicitly focus on clinical areas of greatest need in the communities to be served (e.g., Gleacher et al, 2011). Given the large funds required to disseminate EBPs for the most common conditions, it is unlikely that there will be much funding left over for adequate broad-based training in the treatment of less common mental health problems.…”

A Statewide Common Elements Initiative for Children’s Mental Health

“…15 In New York State, an EBT center was established that offers in-person training and case consultation in EBTs for depression, disruptive behavior disorders, and Posttraumatic Stress Disorder (PTSD). 16 …”

“…Furthermore, more detailed outcomes, when available, are typically written in reports to funders (e.g., state, foundations). Implementation and/or clinical outcomes have only been included in a limited number of reports in the scientific literature (for some exceptions, see 13,16–20 ).…”