Training Models for Implementing Evidence-Based Psychological Treatment A Cluster-Randomized Trial in College Counseling Centers
Training Models for Implementing Evidence-Based Psychological Treatment A Cluster-Randomized Trial in College Counseling Centers
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DOI：
10.1001/jamapsychiatry.2019.3483
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发表时间：
2020-02-01
期刊：
影响因子：
25.8
通讯作者：
Wilson, G. Terence
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文献类型：
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作者：
Wilfley, Denise E.;Agras, W. Stewart;Wilson, G. Terence
问题：在循证治疗（人际心理治疗）中，使用培训培训者方法与专家培训方法对学院（大学）咨询中心治疗师进行培训是否会提高忠诚度（依从性和能力）？结果在这个集群随机试验，包括184治疗师从24所大学的咨询中心，结果表明在组内改善的坚持和能力，只有能力不同组之间，有利于培训的教练条件。成果支持培训员培训办法的有效性;此外，考虑到随着时间的推移，它有可能培养更多的治疗师，它有可能促进循证治疗的广泛传播。（大学）咨询中心治疗师比较了两种使用人际心理治疗精神疾病的培训方法，重要性在为精神疾病建立循证治疗方面取得了进展，但这些治疗并不经常在常规环境中提供。需要一种可扩展的解决方案来培训临床医生进行循证治疗。目的比较两种不同的培训方法对高校心理咨询中心治疗师进行人际心理治疗的效果。该假设是，与专家条件相比，培训培训师条件将显示出上级的实施结果。还探讨了调节因素。设计、环境和参与者这项整群随机试验于2012年10月至2017年12月在美国24个大学咨询中心进行。治疗师参与者从注册中心招募，有抑郁症和饮食失调症状的学生患者由治疗师招募。分析了184名登记的治疗师的数据。干预咨询中心被随机分配到专家条件，其中包括一个研讨会和12个月的后续咨询，或培训教练的条件，其中一名工作人员从咨询中心的教练培训其他工作人员。主要结果和措施的主要结果是治疗师的忠诚度（坚持和能力），以人际心理治疗，通过治疗会话的录音进行评估。治疗师的人际心理治疗知识是次要结果。结果共纳入184名治疗师（平均[SD]年龄，41.9 [10.6]岁; 140名女性[76.1%]; 142名白色[77.2%]）。在人际关系心理治疗的依从性方面，训练者条件组和专家条件组都表现出显著的组内改善（变化：0.233 [95% CI，0.192-0.274]和0.190 [0.145-0.235];均P <0.001），具有较大的效应量（分别为1.64 [95% CI，1.35-1.93]和1.34 [95% CI，1.02-1.66]），并且条件之间无显著差异。两组在人际关系治疗能力方面也有显著的组内改善（变化：分别为0.179 [95%CI，0.132-0.226]和0.106 [0.059-0.153];均P <0.001），教练培训条件的效应量较大（1.16 [95%CI，0.85-1.46]; P < .001），组间差异显著，有利于教练培训条件（效应量，0.47 [95%CI，0.05-0.89]; P = .03）。两组的人际心理治疗知识都有显著提高（效应量：培训者，0.64 [95%CI，0.28-0.99]; P = 0.005;专家，0.69 [95%CI，0.38-1.01]; P <0.001），两组之间没有显著差异。工作满意度对依从性有显著的调节作用（B，0.120 [95% CI，0.001-0.24]; P = 0.048）和能力（B，0.133 [95% CI，0.001-0.27]; P = 0.048）和临床能力监督频率（B，0.05 [95% CI，0.004-0.09]; P = 0.03）。结论和相关性结果表明，培训师模型产生的培训结果与专家模型的依从性和上级的能力。鉴于其随着时间的推移培训更多治疗师的潜在能力，它有可能促进循证治疗的广泛传播。
Question Does training college (university) counseling center therapists in an evidence-based treatment (interpersonal psychotherapy) using the train-the-trainer method vs an expert training method result in improved fidelity (adherence and competence)? Findings In this cluster-randomized trial that included 184 therapists from 24 college counseling centers, results indicated within group improvements in both adherence and competence; only competence differed between groups, favoring the train-the-trainer condition. Meaning Results support the effectiveness of the train-the-trainer approach; further, given its potential capability to train more therapists over time, it has the potential to facilitate widespread dissemination of evidence-based treatments.This cluster-randomized trial of 184 therapists at 24 college (university) counseling center therapists compares 2 methods of training to treat psychiatric disorders using interpersonal psychotherapy, a train-the-trainer model and a condition emphasizing expert advice.Importance Progress has been made in establishing evidence-based treatments for psychiatric disorders, but these are not often delivered in routine settings. A scalable solution for training clinicians in evidence-based treatments is needed. Objective To compare 2 methods of training college (university) counseling center therapists to treat psychiatric disorders using interpersonal psychotherapy. The hypothesis was that the train-the-trainer condition would demonstrate superior implementation outcomes vs the expert condition. Moderating factors were also explored. Design, Setting, and Participants This cluster-randomized trial was conducted from October 2012 to December 2017 in 24 college counseling centers across the United States. Therapist participants were recruited from enrolled centers, and student patients with symptoms of depression and eating disorders were recruited by therapists. Data were analyzed from 184 enrolled therapists. Interventions Counseling centers were randomized to the expert condition, which involved a workshop and 12 months of follow-up consultation, or the train-the-trainer condition, in which a staff member from the counseling center was coached to train other staff members. Main Outcomes and Measures The main outcome was therapist fidelity (adherence and competence) to interpersonal psychotherapy, as assessed via audio recordings of therapy sessions. Therapist knowledge of interpersonal psychotherapy was a secondary outcome. Result A total of 184 therapists (mean [SD] age, 41.9 [10.6] years; 140 female [76.1%]; 142 white [77.2%]) were included. Both the train-the-trainer-condition and expert-condition groups showed significant within-group improvement for adherence to interpersonal psychotherapy (change: 0.233 [95% CI, 0.192-0.274] and 0.190 [0.145-0.235], respectively; both P < .001), with large effect sizes (1.64 [95% CI, 1.35-1.93] and 1.34 [95% CI, 1.02-1.66], respectively) and no significant difference between conditions. Both groups also showed significant within-group improvement in interpersonal therapy competence (change: 0.179 [95% CI, 0.132-0.226] and 0.106 [0.059-0.153], respectively; both P < .001), with a large effect size for the train-the-trainer condition (1.16 [95% CI, 0.85-1.46]; P < .001) and a significant difference between groups favoring the train-the-trainer condition (effect size, 0.47 [95% CI, 0.05-0.89]; P = .03). Knowledge of interpersonal psychotherapy improved significantly within both groups (effect sizes: train-the-trainer, 0.64 [95% CI, 0.28-0.99]; P = .005; expert, 0.69 [95% CI, 0.38-1.01]; P < .001), with no significant difference between groups. The significant moderating factors were job satisfaction for adherence (b, 0.120 [95% CI, 0.001-0.24]; P = .048) and competence (b, 0.133 [95% CI, 0.001-0.27]; P = .048), and frequency of clinical supervision for competence (b, 0.05 [95% CI, 0.004-0.09]; P = .03). Conclusions and Relevance Results demonstrate that the train-the-trainer model produced training outcomes comparable with the expert model for adherence and was superior on competence. Given its potential capability to train more therapists over time, it has the potential to facilitate widespread dissemination of evidence-based treatments.