Use of Fidelity Assessments to Train Clinicians in the CBT for PTSD Program for Clients With Serious Mental Illness
Use of Fidelity Assessments to Train Clinicians in the CBT for PTSD Program for Clients With Serious Mental Illness
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DOI：
10.1176/appi.ps.201000458
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发表时间：
2012-08-01
影响因子：
3.8
通讯作者：
Mueser, Kim T.
中科院分区：
文献类型：
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作者：
Lu, Weili;Yanos, Philip T.;Mueser, Kim T.
目标：为严重精神疾病患者传播循证实践的一大障碍是一线临床医生的培训困难。本研究评估了当使用标准化保真度测量为临床医生提供实践案例反馈时，一线临床医生是否可以接受培训，以针对严重精神疾病患者的创伤后应激障碍（PTSD）实施经验支持的认知行为治疗（CBT）计划。方法：来自 5 个机构的 25 名临床医生（23 名硕士水平）接受了针对 PTSD 项目的 CBT 培训，并在六个月内向 35 名客户（实践案例）提供了该培训。主管或顾问使用保真度测量来对录音会话进行评分并提供反馈。建立了能力标准来指定项目认证。监测客户的创伤后应激障碍和抑郁症状。还评估了临床医生对培训的满意度。结果：两名临床医生退出，其余 23 名临床医生中有 21 名（91%）通过第一个病例获得了项目认证；其余两人 (9%) 在第二个案例中实现了这一目标。通过创伤后应激障碍检查表和贝克抑郁量表测量的客户症状在治疗期间显着减轻，表明该计划的临床益处。临床医生报告说，团体监督非常有帮助，书面反馈也有帮助或非常有帮助。大家都对此次培训评价为优秀。结论：结果支持通过使用基于保真度测量的定期反馈来培训 PTSD 项目的 CBT 一线临床医生的可行性，并表明大多数临床医生可以通过单个实践案例获得该模型的能力。 （精神病学服务 63：785-792，2012 年；doi：10.1176/appi.ps.201000458）
Objective: One barrier to disseminating evidence-based practices for persons with serious mental illness is the difficulty of training frontline clinicians. This study evaluated whether frontline clinicians could be trained to implement an empirically supported cognitive-behavioral therapy (CBT) program for posttraumatic stress disorder (PTSD) among persons with serious mental illness when a standardized fidelity measure was used to provide clinicians with feedback on practice cases. Methods: Twenty-five clinicians (23 master's level) at five agency sites were trained in the CBT for PTSD program and delivered it to 35 clients (practice cases) over six months. Supervisors or consultants used the fidelity measure to rate audio-recorded sessions and provide feedback. A criterion of competence was established to designate program certification. Clients' PTSD and depression symptoms were monitored. Clinicians' satisfaction with training was also assessed. Results: Two clinicians dropped out, and 21 of the remaining 23 clinicians (91%) achieved program certification with their first case; the remaining two (9%) achieved it with their second case. Clients' symptoms, measured by the PTSD Checklist and the Beck Depression Inventory, decreased significantly during treatment, suggesting clinical benefits of the program. Clinicians reported that group supervision was very helpful and written feedback was helpful or very helpful. All rated the training as excellent. Conclusions: Results support the feasibility of training frontline clinicians in the CBT for PTSD program by using regular feedback based on the fidelity measure and indicate that most clinicians can achieve competence in the model with a single practice case. (Psychiatric Services 63:785-792, 2012; doi: 10.1176/appi.ps.201000458)