Effects of Workshop Training on Practice Element Utilization among Therapists in a Youth Public Mental Health System.
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2017-05
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Abstract
Despite significant advancements for properly defining and establishing evidence-based
practices (EBPs) for specific disorders and populations, there continues to be a science-practice
gap in community mental health settings. One strategy that has been examined to increase the
rate of EBP utilization is adapting evidence-based training processes (and related factors
influential to those processes) to better fit large community mental health systems. Of particular
interest, recent research has suggested that a modular approach to treatment and training may be
a useful method for striking a balance between the prescriptive nature of EBPs and the need for
flexible implementation within community mental health. Thus, the present investigation had
two overarching foci within the context of a large scale modular therapy training initiative on
various practice elements: to examine the extent to which community therapists appropriately
applied treatment techniques focused on at these trainings, and the extent to which community
therapists failed to appropriately apply treatment techniques focused on at trainings.
Longitudinal, archival data from community mental health providers (n = 47) who
participated in a series of state-sponsored anxiety and/or disruptive behavior workshops in
modular approaches to EBPs for youth in Hawaii was examined. Utilizing two different methods
of three-level mixed model approaches (i.e., cross-classified multilevel modeling and generalized
linear mixed modeling [level-1: effects of time, level-2: client factors, and level-3: therapist
factors]), average rates of change in therapists’ EBP utilization were examined following their
attendance at the specific types of workshops (e.g., therapists’ use of trained anxiety techniques
was examined following attendance at an anxiety workshop). Client and therapist characteristics,
within which these treatment episodes are embedded, were also investigated within these
analyses for their potential effects on utilization patterns. Results indicated that time, client age,
training attendance, and therapist specific technique knowledge were significant predictors of
therapists’ technique utilization rates. However, therapists’ attitudes towards evidence-based
practices was not a significant predictor. Youth community therapists within this sample selfreported
increases for their appropriate utilization of the anxiety trained techniques following the
anxiety training, yet decreased in their self-reported appropriate use of disruptive behavior
techniques after the disruptive behavior training. These results potentially suggest that the effects
of training on specific technique implementation are moderated by a variety of factors, including
not only traditionally studied therapist and youth factors, but also the type of problem area
addressed at the training. Study limitation and implications for EBP dissemination and
implementation are further discussed.
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children’s mental health, evidence-based training, dissemination, implementation, practice element
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