Category: Dissemination / Implementation

Symposium

Multiple Baseline Trial of a Training Intervention 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 | OCD (Obsessive Compulsive Disorder)
Presentation Type: Symposium

This talk will describe the development and initial test of a training intervention targeting provider behaviors (target engagement). Using behavioral coding results from the previous study and an iterative process with community partners, a principle-based and user-friendly training tool (the Exposure Guide; EG) was developed to aid providers in understanding the function of their own behavior during exposures. Using RCT data described in the first talk (N = 356 exposures), results provide preliminary support for convergent and discriminant validity of the EG with the full coding system (EPCS) and excellent inter-rater reliability (K or ICC range .85 to 1.0). We then used a multiple baseline design to assess whether the EG impacts provider behaviors as part of a principle-based training approach. Providers (N = 6) first received training and supervision in exposure therapy for children with OCD without the EG (baseline phase), followed by training and supervision with the EG (active phase). Results showed that provider beliefs about exposure (t= 2.75, p<.05) and knowledge about anxiety decreasing behaviors during exposure (t=4.81, p<.05) changed from pre-baseline to post-baseline but there was no additional change from post-baseline to post-EG. However, provider anxiety increasing and anxiety decreasing behaviors during exposure did not consistently meet established benchmarks from the POTS trials for the majority of providers until after EG introduction (active phase), signaling preliminary support that the EG specifically impacts provider behavior above standard training. We will additionally describe our iterative feedback process with clinicians during the EG phase to enhance the feasibility and accessibility of the EG in community practice. Patient outcomes (N=5) showed significant improvement in symptoms with a large effect size as measured by the CY-BOCS (t=2.49, p<.05, d=1.14) and CGI-Severity (t=2.39, p<.05, d=1.19). Overall, these results provide preliminary support that the EG is acceptable and feasible for community providers and specifically impacts their behaviors during exposure above standard training.

Jennifer Herren

Warren Alpert medical School of Brown University

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