Sustaining clinician penetration, attitudes and knowledge in cognitive-behavioral therapy for youth anxiety

Implementation Science

Rinad S Beidas²  Philip C Kendall⁴  Douglas M Brodman⁴  Vanesa A Ringle³  Kendra L Read⁴  Julie M Edmunds¹ 

[1] Center for Effective Child Therapy, Judge Baker Children’s Center, 53 Parker Hill Avenue, Boston 02120, MA, USA;Department of Psychiatry, University of Pennsylvania, 3535 Market Street, 3rd Floor, Philadelphia 19104, PA, USA;New York University Child Study Center, 1 Park Avenue, 7th floor, New York 10016, NY, USA;Department of Psychology, Temple University, 1701 North 13th Street, Philadelphia 19122, PA, USA

关键词: Penetration;    Implementation;    Attitudes;    Knowledge;    Consultation;    Training;    Evidence-based practice;    Sustainment;   

Others  :  1146871
DOI  :  10.1186/s13012-014-0089-9

 received in 2013-12-31, accepted in 2014-06-27,  发布年份 2014

【 摘 要 】

Background

Questions remain regarding the sustainment of evidence-based practices following implementation. The present study examined the sustainment of community clinicians’ implementation (i.e., penetration) of cognitive-behavioral therapy, attitudes toward evidence-based practices, and knowledge of cognitive-behavioral therapy for youth anxiety two years following training and consultation in cognitive-behavioral therapy for youth anxiety.

Methods

Of the original 115 participants, 50 individuals (43%) participated in the two-year follow-up. A t- test examined sustainment in penetration over time. Hierarchical linear modeling examined sustainment in knowledge and attitudes over time. Time spent in consultation sessions was examined as a potential moderator of the change in knowledge and attitudes.

Results

Findings indicated sustained self-reported penetration of cognitive-behavioral therapy for anxious youth, with low fidelity to some key CBT components (i.e., exposure tasks). Follow-up knowledge was higher than at baseline but lower than it had been immediately following the consultation phase of the study. Belief in the utility of evidence-based practices was sustained. Willingness to implement an evidence-based practice if required to do so, appeal of evidence-based practices, and openness toward evidence-based practices were not sustained. Participation in consultation positively moderated changes in knowledge and some attitudes.

Conclusions

Sustainment varied depending on the outcome examined. Generally, greater participation in consultation predicted greater sustainment. Implications for future training include higher dosages of consultation.

【 授权许可】

   
2014 Edmunds et al.; licensee BioMed Central

【 图 表 】

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【 参考文献 】

• [1]Scheirer MA, Dearing JW: An agenda for research on the sustainability of public health programs. Am J Public Health 2011, 101:2059-2067.
• [2]Stirman SW, Kimberly J, Cook N, Calloway A, Castro F, Charns M: The sustainability of new programs and innovations: a review of the empirical literature and recommendations for future research. Implement Sci 2012, 7:1-19.
• [3]Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O: Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q 2004, 82:581-629.
• [4]Aarons GA, Hurlburt M, Horwitz SM: Advancing a conceptual model of evidence-based practice implementation in public service sectors. Adm Policy Ment Health Ment Health Serv Res 2010, 38:4-23.
• [5]Proctor E, Silmere H, Raghavan R, Hovmand P, Aarons G, Bunger A, Griffey R, Hensley M: Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Adm Policy Ment Health Ment Health Serv Res 2010, 38:65-76.
• [6]Beidas RS, Edmunds JM, Marcus SC, Kendall PC: Training and consultation to promote implementation of an empirically supported treatment: a randomized trial. Psychiatr Serv 2012, 63:660-665.
• [7]Hollon SD, Beck AT: Cognitive And Cognitive-Behavioral Therapies. In Bergin Garfields Handb. Psychother. Behav. Change. 6th edition. Wiley, New York, NY; 2013:393-442.
• [8]Fixsen DL, Blase KA, Naoom SF, Wallace F: Core implementation components. Res Soc Work Pract 2009, 19:531-540.
• [9]Palinkas LA, Weisz JR, Chorpita BF, Levine B, Garland AF, Hoagwood KE, Landsverk J: Continued use of evidence-based treatments after a randomized controlled effectiveness trial: a qualitative study. Psychiatr Serv 2013, 64:1110-1118.
• [10]Beidas RS, Barmish A, Kendall PC: Training as usual: can clinician behavior change following reading a manual and attending a brief workshop on cognitive behavioral therapy for youth anxiety? Behav Clin 2009, 32:97-101.
• [11]Aarons GA: Measuring provider attitudes toward evidence-based practice: consideration of organizational context and individual differences. Child Adolesc Psychiatr Clin N Am 2005, 14:255.
• [12]Aarons GA: Mental health provider attitudes toward adoption of evidence-based practice: the Evidence-Based Practice Attitude Scale (EBPAS). Ment Health Serv Res 2004, 6:61-74.
• [13]Walkup JT, Albano AM, Piacentini J, Birmaher B, Compton SN, Sherrill JT, Ginsburg GS, Rynn MA, McCracken J, Waslick B, Iyengar S, March JS, Kendall PC: Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. N Engl J Med 2008, 359:2753-2766.
• [14]Perepletchikova F, Kazdin AE: Treatment integrity and therapeutic change: issues and research recommendations. Clin Psychol Sci Pract 2006, 12:365-383.
• [15]Beidas RS, Cross W, Dorsey S: Show me, don’t tell me: Behavioral rehearsal as a training and analogue fidelity tool. Cogn Behav Pract 2014, 21:1-11.
• [16]Kendall PC, Hedtke K: Cognitive-Behavioral Therapy For Anxious Children: Therapist Manual. Workbook Publishing, Ardmore, PA; 2006.
• [17]Stirman SW, Gutiérrez-Colina A, Toder K, Esposito G, Barg F, Castro F, Beck AT, Crits-Christoph P: Clinicians’ perspectives on cognitive therapy in community mental health settings: Implications for training and implementation. Adm Policy Ment Health Ment Health Serv Res 2012, 40:274-285.
• [18]Beidas RS, Edmunds JM, Cannuscio CC, Gallagher M, Downey MM, Kendall PC: Therapists perspectives on the effective elements of consultation following training. Adm Policy Ment Health Ment Health Serv Res 2013, 40:507-517.
• [19]Silverman WK, Pina AA, Viswesvaran C: Evidence-based psychosocial treatments for phobic and anxiety disorders in children and adolescents. J Clin Child Adolesc Psychol 2008, 37:105-130.
• [20]Kendall PC, Hedtke K: Coping Cat Workbook. Workbook Publishing, Ardmore, PA; 2006.
• [21]Edmunds JM, Kendall PC, Ringle VA, Read KL, Brodman DM, Pimentel SS, Beidas RS: An examination of behavioral rehearsal during consultation as a predictor of training outcomes. Adm Policy Ment Health Ment Health Serv Res 2013, 40:456-466.
• [22]Raudenbush SW, Bryk AS: Hierarchical Linear Models: Applications And Data Analysis Methods. Sage Publications, Thousand Oaks, CA; 2002.
• [23]Raudenbush SW, Bryk AS, Cheong YF, Congdon R: HLM 6: Hierarchical linear and nonlinear modeling. Scientific Software International Inc., Lincolnwood, IL; 2004.
• [24]Kendall PC, Flannery-Schroeder E, Panichelli-Mindel SM, Southam-Gerow M, Henin A, Warman M: Therapy for youths with anxiety disorders: a second randomized clinical trial. J Consult Clin Psychol 1997, 65:366-380.
• [25]Kendall PC, Beidas RS: Smoothing the trail for dissemination of evidence-based practices for youth: flexibility within fidelity. Prof Psychol Res Pract 2007, 38:13-20.
• [26]Kendall PC, Gosch E, Furr JM, Sood E: Flexibility within fidelity. J Am Acad Child Adolesc Psychiatry 2008, 47:987-993.
• [27]Lim A, Nakamura BJ, Higa-McMillan CK, Shimabukuro S, Slavin L: Effects of workshop trainings on evidence-based practice knowledge and attitudes among youth community mental health providers. Behav Res Ther 2012, 50:397-406.
• [28]Beidas RS, Kendall PC: Training therapists in evidence-based practice: a critical review of studies from a systems-contextual perspective. Clin Psychol Sci Pract 2010, 17:1-30.
• [29]Cooper BR, Bumbarger BK, Moore JE: Sustaining evidence-based prevention programs: Correlates in a large-scale dissemination initiative.Prev Sci 2013, ᅟ:ᅟ [serial online] August 24.
• [30]Herschell AD, Kolko DJ, Baumann BL, Davis AC: The role of therapist training in the implementation of psychosocial treatments: a review and critique with recommendations. Clin Psychol Rev 2010, 30:448-466.