The impact of implementation climate on community mental health clinicians' attitudes toward exposure: An evaluation of the effects of training and consultation.
The impact of implementation climate on community mental health clinicians' attitudes toward exposure: An evaluation of the effects of training and consultation.
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DOI：
10.1177/26334895211057883
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发表时间：
2021-01
影响因子：
--
通讯作者：
Dorsey, Shannon
中科院分区：
文献类型：
--
作者：
Woodard, Grace S.;Triplett, Noah S.;Frank, Hannah E.;Harrison, Julie P.;Robinson, Sophia;Dorsey, Shannon
关键词：
大多数创伤后应激障碍(PTSD)和焦虑症的循证治疗(EBTS)包括暴露；然而，在社区环境中，暴露的实施滞后于EBT的其他组成部分。临床医生水平的决定因素一直被认为是实施暴露的障碍，但很少有组织决定因素被研究。目前的研究考察了组织层面的决定因素、实施环境和临床医生层面的决定因素、临床医生人口统计和背景因素，作为对暴露的态度和培训后态度变化的预测因子。临床医生(n = 197人)完成了为期3天的培训，6个月一次，每月两次。临床医生接受了认知行为疗法(CBT)的培训，以治疗焦虑、抑郁、行为问题和以创伤为重点的CBT(TF-CBT)。在培训前的调查中评估了人口统计和背景信息、实施环境和对暴露的态度；在会诊后重新评估了态度。实施环境是在聚合/组级别和临床医生级别进行衡量的。从培训前到咨询后，对暴露的态度显著改善(t(193) = 9.9，p <； .001；d = 0.71)。临床医生层面的实施气氛评分并不能预测培训前更积极的态度(p >； .05)，但可以预测会诊后更积极的态度(？ = −2.46；p <； .05)和这些态度的更大变化(？ = 2.28；p <； .05)。小组级别的实施环境评分不能预测培训前、会诊后的态度或态度的变化(所有PS >； .05)。自我报告使用CBT的频率较高与培训前更积极的态度相关(？ = −0.81；p <； .05)，但没有其他临床医生人口统计学或背景决定因素与会诊后的态度(所有p >； .05)或态度的改变(所有p &> .05)相关。临床医生对实施气氛的看法预测，在EBT培训和咨询之后，对暴露的态度会有更大的改善。研究结果表明，培训之外的组织决定因素会影响临床医生态度的改变。四个EBT的培训，其中只有两个包括暴露作为一个组成部分，导致临床医生对暴露的态度发生了积极的变化，这表明非专业培训可以有效地改变态度，这可能使规模扩大。
Most evidence-based treatments (EBTs) for posttraumatic stress disorder (PTSD) and anxiety disorders include exposure; however, in community settings, the implementation of exposure lags behind other EBT components. Clinician-level determinants have been consistently implicated as barriers to exposure implementation, but few organizational determinants have been studied. The current study examines an organization-level determinant, implementation climate, and clinician-level determinants, clinician demographic and background factors, as predictors of attitudes toward exposure and changes in attitudes following training. Clinicians (n = 197) completed a 3-day training with 6 months of twice-monthly consultation. Clinicians were trained in cognitive behavioral therapy (CBT) for anxiety, depression, behavior problems, and trauma-focused CBT (TF-CBT). Demographic and background information, implementation climate, and attitudes toward exposure were assessed in a pre-training survey; attitudes were reassessed at post-consultation. Implementation climate was measured at the aggregated/group-level and clinician-level. Attitudes toward exposure significantly improved from pre-training to post-consultation (t(193) = 9.9, p < .001; d = 0.71). Clinician-level implementation climate scores did not predict more positive attitudes at pre-training (p > .05) but did predict more positive attitudes at post-consultation (ß = −2.46; p < .05) and greater changes in those attitudes (ß = 2.28; p < .05). Group-level implementation climate scores did not predict attitudes at pre-training, post-consultation, or changes in attitudes (all ps > .05). Higher frequency of self-reported CBT use was associated with more positive attitudes at pre-training (ß = −0.81; p < .05), but no other clinician demographic or background determinants were associated with attitudes at post-consultation (all p > .05) or with changes in attitudes (all p > .05). Clinician perceptions of implementation climate predicted greater improvement of attitudes toward exposure following EBT training and consultation. Findings suggest that organizational determinants outside of training impact changes in clinicians’ attitudes. Training in four EBTs, only two of which include exposure as a component, resulted in positive changes in clinicians’ attitudes toward exposure, which suggests non-specialty trainings can be effective at changing attitudes, which may enable scale-up.
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DOI：
10.1186/1748-5908-4-50
发表时间：
2009-08-07
期刊：
Implementation science : IS
影响因子：
--
作者：
Damschroder LJ;Aron DC;Keith RE;Kirsh SR;Alexander JA;Lowery JC
通讯作者：
Lowery JC
DOI：
10.1023/b:mhsr.0000024351.12294.65
发表时间：
2004-06-01
期刊：
Mental health services research
影响因子：
--
作者：
Aarons, Gregory A
通讯作者：
Aarons, Gregory A
影响因子：
10.3
作者：
Deacon, Brett J.;Lickel, James J.;Hipol, Leilani J.
通讯作者：
Hipol, Leilani J.
影响因子：
2.8
作者：
Amaya-Jackson, Lisa;Hagele, Dana;Socolar, Rebecca
通讯作者：
Socolar, Rebecca
影响因子：
7.2
作者：
Aarons, Gregory A.;Sklar, Marisa;Brown, C. Hendricks
通讯作者：
Brown, C. Hendricks