Protocol for a statewide randomized controlled trial to compare three training models for implementing an evidence-based treatment

Background: Evidence-based treatments (EBTs) are available for treating childhood behavioral health challenges. Despite EBTs' potential to help children and families, they have primarily remained in university settings. Little empirical evidence exists regarding how specific, commonly used training and quality control models are effective in changing practice, achieving full implementation, and supporting positive client outcomes. Methods/design: This study (NIMH RO1 MH095750; ClinicalTrials.gov Identifier: NCT02543359), which is currently in progress, will evaluate the effectiveness of three training models (Learning Collaborative (LC), Cascading Model (CM), and Distance Education (DE)) to implement a well-established EBT , Parent-Child Interaction Therapy, in real-world, community settings. The three models differ in their costs, skill training, quality control methods, and capacity to address broader implementation challenges. The project is guided by three specific aims: (1) to build knowledge about training outcomes, (2) to build knowledge about implementation outcomes, and (3) to test the differential impact of training clinicians using LC, CM, and DE models on key client outcomes. Fifty (50) licensed psychiatric clinics across Pennsylvania were randomized to one of the three training conditions: (1) LC, (2) CM, or (3) DE. The impact of training on practice skills (clinician level) and implementation/sustainment outcomes (clinic level) are being evaluated at four timepoints coinciding with the training schedule: baseline, 6 (mid), 12 (post), and 24 months (1 year follow-up). Immediately after training begins, parent-child dyads (client level) are recruited from the caseloads of participating clinicians. Client outcomes are being assessed at four timepoints (pre-treatment, 1, 6, and 12 months after the pre-treatment). Discussion: This proposal builds on an ongoing initiative to implement an EBT statewide. A team of diverse stakeholders including state policy makers, payers, consumers, service providers, and academics from different, but complementary areas (e.g., public health, social work, psychiatry), has been assembled to guide the research plan by incorporating input from multidimensional perspective. Trial registration: ClinicalTrials.gov: NCT0254335

Clinician and Parent Perspectives on Parent and Family Contextual Factors that Impact Community Mental Health Services for Children with Behavior Problems

The present study employed qualitative methods to examine multiple stakeholder perspectives regarding the role of parent and family contextual factors on community child mental health treatment for children with behavior problems. Findings suggest agreement between clinicians and parents on the number, types and importance of parent and family factors in children’s mental health services; however, stakeholders differed in reports of which factors were most salient. Specifically, clinicians endorsed most factors as being equally salient, while parents described a few salient factors, with parental stress and inadequate social support being the most frequently discussed. These qualitative data further elucidate the context of community services and have implications for evidence-based practice implementation and improving community care

Development and evaluation of a measure of treatment knowledge in guided self-help for eating disorders in a sample of healthcare students and professionals

Purpose: The current study describes the development of a measure designed to assess treatment-specific competence in guided self-help (GSH) for eating disorders. The aim is to assess healthcare professionals’ understanding of a popular treatment manual and associated material. Methods: After initial item development from a review of relevant literature, a range of healthcare staff and students (N = 127) completed a knowledge questionnaire. From these data, estimates of psychometric properties were made and a subset of the original sample completed the measure again after six weeks. Results: The final questionnaire consists of 40 items, demonstrating acceptable content validity, internal consistency, and reliability. Significant differences in the number of questions answered correctly were observed between experts in GSH and those with less experience. Conclusions: This questionnaire offers a means of assessing therapist knowledge of GSH which demonstrates good psychometric properties. Further testing of this instrument is required in order to establish its full applicability

Therapist–Parent Interactions in PCIT: The Importance of Coach Coding

Therapist coaching (i.e., in vivo feedback) of parent behaviors is a core component of parent–child interaction therapy (PCIT). Coaching allows therapists to teach and reinforce parenting behaviors in the moment that they occur. Until recently, limited research had investigated the types of coaching skills that were associated with improved parent skill development and engagement in treatment. This chapter will review efforts to date to measure and evaluate the role of therapist–parent interactions on PCIT using the Therapist–Parent Interaction Coding System (TPICS). The TPICS measures the types of coaching techniques therapists use (e.g., modeling a skill, praising the parent’s skill use) and the parent behaviors targeted (e.g., behavior descriptions, questions). Coaching techniques are categorized as being directive (i.e., telling a parent what to do) or responsive (i.e., reinforcing a parent’s behavior). Based on the research on therapist–parent interactions, recommendations will be made on how the assessment of therapist behaviors can be used to improve training and supervision in PCIT

Assessing the Key to Effective Coaching in Parent–Child Interaction Therapy: The Therapist-Parent Interaction Coding System

This paper describes the initial evaluation of the Therapist-Parent Interaction Coding System (TPICS), a measure of in vivo therapist coaching for the evidence-based behavioral parent training intervention, parent-child interaction therapy (PCIT). Sixty-one video-recorded treatment sessions were coded with the TPICS to investigate (1) the variety of coaching techniques PCIT therapists use in the early stage of treatment, (2) whether parent skill-level guides a therapist’s coaching style and frequency, and (3) whether coaching mediates changes in parents’ skill levels from one session to the next. Results found that the TPICS captured a range of coaching techniques, and that parent skill-level prior to coaching did relate to therapists’ use of in vivo feedback. Therapists’ responsive coaching (e.g., praise to parents) was a partial mediator of change in parenting behavior from one session to the next for specific child-centered parenting skills; whereas directive coaching (e.g., modeling) did not relate to change. The TPICS demonstrates promise as a measure of coaching during PCIT with good reliability scores and initial evidence of construct validity