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

Implementation Science

Ann F Garland⁶  John R Weisz³  Jürgen Unützer¹  Kelly Thompson⁴  Suzanne E Kerns²  Lucy Berliner⁵  Esther Deblinger⁷  Michael D Pullmann²  Shannon Dorsey⁴ 

[1] Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 Northeast Pacific Street, Room BB-1661A, Seattle, WA 98195, USA;Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 2815 Eastlake Avenue East, Suite 200, Seattle, WA 98102, USA;Department of Psychology, Harvard University Medical School, 1030 William James Hall, 33 Kirkland Street, Cambridge, MA 02138, USA;Department of Psychology, University of Washington, 335 Guthrie Hall, Seattle, WA 98195, USA;Harborview Center for Sexual Assault and Traumatic Stress, 401 Broadway, Suite 2027, Seattle, WA 98122, USA;Department of School, Family, and Mental Health Professions, School of Leadership & Education Sciences, University of San Diego, 5998 Alcalá Park, San Diego, CA 92110, USA;School of Osteopathic Medicine, Rowan University, 42 E. Laurel Road, Suite 1100, Stratford, NJ 08084, USA

关键词: Trauma-focused cognitive behavioral therapy;    Role-play;    Symptom monitoring;    Behavioral rehearsal;    Fidelity;    Implementation;    Training;    Supervision;    EBT;    Evidence-based treatment;   

Others  :  813434
DOI  :  10.1186/1748-5908-8-89

 received in 2013-05-25, accepted in 2013-07-31,  发布年份 2013

【 摘 要 】

Background

Evidence-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/Design

The 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.

Discussion

This 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 registration

ClinicalTrials.gov NCT01800266

【 授权许可】

   
2013 Dorsey et al.; licensee BioMed Central Ltd.

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