Training Models for Implementing Evidence-Based Psychological Treatment

Abstract

IMPORTANCE Progress has been made in establishing evidence-based treatments for psychiatric disorders, but these are not often delivered in routine settings. A scalable solution for training clinicians in evidence-based treatments is needed.OBJECTIVE To compare 2 methods of training college (university) counseling center therapists to treat psychiatric disorders using interpersonal psychotherapy. The hypothesis was that the train-the-trainer condition would demonstrate superior implementation outcomes vs the expert condition. Moderating factors were also explored. DESIGN, SETTING, AND PARTICIPANTS This cluster-randomized trial was conducted from October 2012 to December 2017 in 24 college counseling centers across the United States. Therapist participants were recruited from enrolled centers, and student patients with symptoms of depression and eating disorders were recruited by therapists. Data were analyzed from 184 enrolled therapists.INTERVENTIONS Counseling centers were randomized to the expert condition, which involved a workshop and 12 months of follow-up consultation, or the train-the-trainer condition, in which a staff member from the counseling center was coached to train other staff members. MAIN OUTCOMES AND MEASURESThe main outcome was therapist fidelity (adherence and competence) to interpersonal psychotherapy, as assessed via audio recordings of therapy sessions. Therapist knowledge of interpersonal psychotherapy was a secondary outcome.RESULT A total of 184 therapists (mean [SD] age, 41.9 [10.6] years; 140 female [76.1%]; 142 white [77.2%]) were included. Both the train-the-trainer-condition and expert-condition groups showed significant within-group improvement for adherence to interpersonal psychotherapy (change: 0.233 [95% CI, 0.192-0.274] and 0.190 [0.145-0.235], respectively; both P < .001), with large effect sizes (1.64 [95% CI, 1.35-1.93] and 1.34 [95% CI, 1.02-1.66], respectively) and no significant difference between conditions. Both groups also showed significant within-group improvement in interpersonal therapy competence (change: 0.179 [95% CI, 0.132-0.226] and 0.106 [0.059-0.153], respectively; both P < .001), with a large effect size for the train-the-trainer condition (1.16 [95% CI, 0.85-1.46]; P < .001) and a significant difference between groups favoring the train-the-trainer condition (effect size, 0.47 [95% CI, 0.05-0.89]; P = .03). Knowledge of interpersonal psychotherapy improved significantly within both groups (effect sizes: train-the-trainer, 0.64 [95% CI, 0.28-0.99];

Binge eating disorder

“…An important next step, given that there is a considerable progress in the development of psychological treatments for BED, is to tackle the research-practice-gap and to ensure that evidencebased treatments are translated into clinical practice. Scalable solutions for the training of clinicians to deliver evidence-based psychotherapy have recently been proposed and investigated 225 . Another avenue for making evidence-based care more accessible for patients, not only during the COVID-19 pandemic, is the implementation of digital intervention and delivery technologies and strategies, also in terms of stepped-care-approaches 226 .…”

Evaluating an implementation model of evidence-based therapy for eating disorders in non-specialist regional mental health settings

“…Models to address the research practice gap target improved and accessible practitioner training, for example scalable web-based methods [ 2 ] with outcomes including therapist competence and adherence. Models addressing the treatment gap include approaches of "best buy" therapies (selected based on cost-effectiveness, and feasibility for the setting; e.g., [ 3 ]) and higher-level support and policy such as training more but less specialised practitioners (e.g., [ 4 ]). In these models, the outcome of most interest is the reach of the treatment and its outcome.…”

Internalizing in adolescents and young adults.

“…Given rising rates of internalizing on college campuses, there is a clear need for intervention efforts. Counseling center staff can be trained to effectively deliver evidence-based treatments (e.g., Wilfley et al, 2020), indicating a promising way to increase dissemination and impact on YA internalizing.…”