Amy D. Herschell

The Role of Therapist Training in the Implementation of Psychosocial Treatments: A Review and Critique with Recommendations

Evidence-based treatments (EBT) are underutilized in community settings, where consumers are often seen for treatment. Underutilization of EBTs may be related to a lack of empirically informed and supported training strategies. The goals of this review are to understand the state of the literature for training therapists in psychotherapy skills and to offer recommendations to improve research in this area. Results of this review of 55 studies evaluating six training methods indicate that multi-component trainings have been studied most often and have most consistently demonstrated positive training outcomes relative to other training methods. Studies evaluating utility of reading, self-directed trainings, and workshops have documented that these methods do not routinely produce positive outcomes. Workshop follow-ups help to sustain outcomes. Little is known about the impact of train-the-trainer methods. Methodological flaws and factors that may influence training outcome and future directions are also reviewed.

Parent-child interaction therapy: New directions in research

Parent-Child Interaction Therapy (PCIT) is a short-term, evidence-based parent training program for families with 2- to 6-year-old children experiencing behavioral, emotional, or family problems. Based on both attachment theory and social learning theory, PCIT research has provided evidence of efficacy, generalization, and maintenance. The new directions in PCIT research are highlighted in this article.

Evaluation of a treatment manual and workshops for disseminating, parent-child interaction therapy.

This study’s main purposes were to: (a) evaluate a treatment manual as a dissemination strategy, (b) compare two workshop formats for evidence-based treatment (EBT) training, and (c) provide preliminary data on therapist characteristics potentially associated with successful EBT adoption. Forty-two community-based clinicians were assigned to one of two training groups (didactic or experiential). Behavior observation and self-report data were collected at four time points. Results suggest that reading a treatment manual is useful, but not sufficient. Experiential and didactic training were equally effective in increasing knowledge, skill, and satisfaction; however, after a 2-day training, few participants demonstrated mastery of skills.

Clinical issues in parent-child interaction therapy

The scientist-practitioner model depends on the interplay of research and clinical work. Just as research informs and improves clinical practice, clinical practice leads to the generation of important and practical research questions. The purpose of this article is to describe the clinical application of Parent-Child Interaction Therapy (PCIT), detailing its essential clinical components and presenting a case example that illustrates the application of PCIT to the treatment of child physical abuse. Recommendations for common implementation difficulties are presented through the case example.

Implementation of AF-CBT by Community Practitioners Serving Child Welfare and Mental Health: A Randomized Trial

The Partnerships for Families project is a randomized clinical trial designed to evaluate the implementation of Alternatives for Families: A Cognitive–Behavioral Therapy (AF-CBT), an evidence-based treatment for family conflict, coercion, and aggression, including child physical abuse. To evaluate the effectiveness of a training program in this model, 182 community practitioners from 10 agencies were randomized to receive AF-CBT training (n = 90) using a learning community model (workshops, consultation visits) or Training as Usual (TAU; n = 92) which provided trainings per agency routine. Practitioners completed self-report measures at four time points (0, 6, 12, and 18 months following baseline). Of those assigned to AF-CBT, 89% participated in at least one training activity and 68% met a “training completion” definition. A total of 80 (44%) practitioners were still active clinicians in the study by 18-month assessment in that they had not met our staff turnover or study withdrawal criteria. Using an intent-to-train design, hierarchical linear modeling analyses revealed significantly greater initial improvements for those in the AF-CBT training condition (vs. TAU condition) in CBT-related knowledge and use of AF-CBT teaching processes, abuse-specific skills, and general psychological skills. In addition, practitioners in both groups reported significantly more negative perceptions of organizational climate through the intervention phase. These significant, albeit modest, findings are discussed in the context of treatment training, research, and work force issues as they relate to the diverse backgrounds, settings, and populations served by community practitioners.

Education and Treatment for Boys Who Set Fires: Specificity, Moderators, and Predictors of Recidivism

Given the relative absence of treatment outcome studies, information about the specificity and utility of interventions for children who set fires has not been reported. In a treatment outcome study with young boys referred for firesetting that compared brief home visitation from a firefighter, fire safety education (FSE), and cognitive—behavioral treatment (CBT), we examined the specificity, potential moderators, and predictors of recidivism. FSE exerted specific effects on some fire knowledge and safety measures, as expected; CBT tended to show specific effects only on positive problem solutions. Potential moderators of FSE and CBT were suggested in an exploratory analysis (e.g.,exposure to fire models/materials,childs general fire knowledge, and family functioning). Fire history,fire attraction, and externalizing behaviors were among the predictors of firesetting recidivism. Implications of these findings for assessment and intervention are discussed in the context of future research directions.

Evaluation of an Implementation Initiative for Embedding Dialectical Behavior Therapy in Community Settings

We examined the effectiveness of Dialectical Behavior Therapy (DBT) training in community-based agencies. Data were gathered at four time points over a 2-year period from front-line mental health therapists (N=64) from 10 community-based agencies that participated in a DBT implementation initiative. We examined change on therapist attitudes toward consumers with Borderline Personality Disorder (BPD), confidence in the effectiveness of DBT, and use of DBT model components. All measures were self-report. Participating in DBT training was associated with positive changes over time, including improved therapist attitudes toward consumers with BPD, improved confidence in the effectiveness of DBT, and increased use of DBT components. Therapists who had the lowest baseline scores on the study outcomes had the greatest self-reported positive change in outcomes over time. Moreover, there were notable positive correlations in therapist characteristics; therapists who had the lowest baseline attitudes toward individuals with BPD, confidence in the effectiveness of DBT, or who were least likely to use DBT modes and components were the therapists who had the greatest reported increase over time in each respective area. DBT training with ongoing support resulted in changes not commonly observed in standard training approaches typically used in community settings. It is encouraging to observe positive outcomes in therapist self-reported skill, perceived self-efficacy and DBT component use, all of which are important to evidence-based treatment (EBT) implementation. Our results underscore the importance to recognize and target therapist diversity of learning levels, experience, and expertise in EBT implementation.

Who Is Testing Whom? Ten Suggestions for Managing the Disruptive Behavior of Young Children During Testing

Children exhibiting extremely disruptive behavior constitute a large percentage of those referred for testing. These children often are challenging to test, even for the experienced examiner, because their behavior is overly active, noncompliant, and disrespectful. They typically do not enjoy the quiet, calm environment considered most conducive to testing. Yet, critically important decisions regarding educational placement and psychological treatment often are based on the results of such testing. The purpose of this article is to offer 10 suggestions that examiners can use to manage disruptive behavior so that optimal test performance is elicited from children, and testing is more enjoyable for both children and examiners.

Characterizing the Use of Research-Community Partnerships in Studies of Evidence-Based Interventions in Children’s Community Services

This study characterized the use of research community partnerships (RCPs) to tailor evidence-based intervention, training, and implementation models for delivery across different childhood problems and service contexts using a survey completed by project principal investigators and community partners. To build on previous RCP research and to explicate the tacit knowledge gained through collaborative efforts, the following were examined: (1) characteristics of studies using RCP models; (2) RCP functioning, processes, and products; (3) processes of tailoring evidence-based practices for community implementation; and (4) perceptions of the benefits and challenges of collaborating with community providers and consumers. Results indicated that researchers were solely or jointly involved in the formation of almost all of the RCPs; interpersonal and operational processes were perceived as primary challenges; community partners’ roles included greater involvement in implementation and participant recruitment than more traditional research activities; and the partnership process was perceived to increase the relevance and “fit” of interventions and research.

The Role of Therapist Communication Style in Parent-Child Interaction Therapy

ABSTRACT The impact of therapist characteristics on maternal compliance and satisfaction was examined with a parent-training program, Parent-Child Interaction Therapy (PCIT). Participants were 45 mothers with children between the ages of 24 and 83 months. Each mother was taught components of PCIT using one of three therapist communication styles: (1) positive, (2) neutral, and (3) constructive criticism. Although all groups demonstrated an increase in skill level from pre- to post-treatment, mothers in the constructive criticism therapist group used the target skills at a significantly higher rate at post-treatment than the two other groups. No difference was found on maternal satisfaction. The importance of considering therapist variables when providing parent training is discussed.