Category: Dissemination / Implementation
Due to its benefits, modular approaches to treatment and training have become important areas for dissemination and implementation research. Given its potential, Hawaii led a quality improvement initiative that investigated the effects of training community therapists on youth anxiety (ANX) practice elements (PE; i.e., discrete clinical techniques used as components of a larger intervention plan [Chorpita et al., 2005, 2007]). The current study examines the effects of therapists’ training attendance on their use of the trained ANX PEs. Specifically, the present study examines the extent to which therapists appropriately used or failed to use the package of ANX PEs with clients. The current study also included therapists’ post-training knowledge and attitudes within analyses for their potential effects on utilization patterns.
Data from 47 therapists who treated 778 youth, were collected during the trainings. Therapists were trained on five core ANX PEs (i.e., Psychoeducation-Child, Exposure, Relaxation, Self-Monitoring, and Cognitive). Therapists were 76.6% female (n=36), aged 24 to 66 (M=41.2, SD=11.2). Youth were 57.8% male (n=450), aged 3.1 to 18.6 (M=12.1, SD=3.8). Therapists’ practice data were extracted from the Monthly Treatment Progress Summary. Therapists’ knowledge of EBPs was assessed through the Knowledge of Evidence Based Services Questionnaire (Stumpf et al., 2009) and attitudes were assessed through the Modified Practice Attitude Scale (Borntrager et al., 2009).
Results of cross-classified multi-level modeling (CCMM) analyses indicated that therapists’ initial rate of appropriately using (i.e., using ANX techniques with youth presented with ANX concerns) the five ANX PEs was 2.08 (p < 0.001). This rate increased over time by .06 (p < 0.001). Further, after attending the ANX training, therapists’ appropriate use of the ANX PEs increased by 0.16 (p < 0.05). CCMM results indicated that therapists’ initial rate of failing to use the five ANX PEs was 1.48 (p < 0.001) and this rate decreased over time by -0.19 (p < 0.001). After attending the ANX training, therapists’ rate of failing to use the five ANX PEs decreased at rate of -0.22 (p < 0.05). Also, therapists with higher post-training ANX knowledge scores increased their appropriate use of the ANX PEs by 0.22 (p < 0.01). Interestingly, results indicated that therapists’ appropriate use decreased by -0.09 (p < 0.001) for those therapists with more favorable attitudes towards EBPs after the training.
Results support the potential for modular therapy training influencing therapists’ use of PEs in a positive way. Further study results, limitations and training implications will also be discussed.
Priya McLennan– Graduate Student, University of Hawaii at Manoa, Honolulu, Hawaii
Tommie Yamamoto– University of Hawaii at Manoa
Brad Nakamura– Associate Professor, University of Hawaii at Manoa, Honolulu, Hawaii
Charmaine Higa-McMillan– University of Hawaii at Hilo
Scott Shimabukuro– Child and Adolescent Mental Health Division