Category: Dissemination / Implementation

Symposium

Confirming Target Engagement: Randomized Pilot Training Trial for Community Providers Learning Exposure Therapy

Saturday, November 18
8:30 AM - 10:00 AM
Location: Aqua Salon C & D, Level 3, Aqua Level

Keywords: Change Process / Mechanisms | Community-Based Assessment / Intervention | Anxiety
Presentation Type: Symposium

The final presentation describes the process of confirming target engagement, using a pilot randomized trial comparing principle-based training with the EG vs. standard training methods for impacting provider behavior. We recruited providers (N = 16) across two practice settings (Community Mental Health Agency and Private Practice) to deliver exposure therapy with families (N = 48) of children with a primary diagnosis of anxiety (Social Anxiety, Separation Anxiety, Panic Disorder, or Specific Phobia) or OCD. All providers received initial workshop trainings (12 hours) focused on anxiety disorders, exposure therapy, and the principles of using exposure for anxiety. They were then randomized to receive principle-based supervision with the EG vs. standard supervision with a flexible treatment manual. Providers in both groups attended supervision once weekly until meeting criteria for stepping down to once-monthly maintenance supervision. Criteria for moving into maintenance supervision included conducting regular exposures with at least 2 cases, meeting criteria on self-ratings of the EG (principle group) or adherence form (standard group), and being reliable with study supervisors on session self-ratings. To date, this study has recruited all provider and patient participants, and will conduct final analysis when all patients have completed treatment. Results initially support the feasibility and acceptability of these training interventions and of the Exposure Guide for community providers in both settings and for their patients. The rate of EG completion is high among providers (>80%), providing support for the practicality of this tool for the setting. Of 12 providers who have treated at least two cases, 7 have met maintenance criteria within their training arm (3/6 in standard, 4/6 in principle). Although training is ongoing and we anticipate that these will increase further, this provides initial support that providers are meeting behavioral targets during exposure. Final results (expected by Aug 2017) will test whether principle-based training results in higher levels of provider anxiety increasing behavior and lower levels of provider anxiety decreasing behavior vs. standard training, and will explore patient-level treatment outcome for each group. Together, these studies illustrate the process of using a treatment mechanism-informed approach to intervening on specific provider behaviors to improve psychotherapy quality and outcome.

Joshua Kemp

Warren Alpert medical School of Brown University

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