title: Continuing education to go: capacity building in psychotherapies for front-line mental health workers in underserviced communities.
abstract: OBJECTIVE
  To address the gaps between need and access, and between treatment guidelines and their implementation for mental illness, through capacity building of front-line health workers.
  
  
  METHODS
  Following a learning needs assessment, work-based continuing education courses in evidence-supported psychotherapies were developed for front-line workers in underserviced community settings. The 5-hour courses on the fundamentals of cognitive-behavioural therapy, interpersonal psychotherapy, motivational interviewing, and dialectical behaviour therapy each included videotaped captioned simulations, interactive lesson plans, and clinical practice behaviour reminders. Two courses, sequentially offered in 7 underserviced settings, were subjected to a mixed methods evaluation. Ninety-three nonmedical front-line workers enrolled in the program. Repeated measures analysis of variance was used to assess pre- and postintervention changes in knowledge and self-efficacy. Qualitative data from 5 semistructured focus groups with 25 participants were also analyzed.
  
  
  RESULTS
  Significant pre- and postintervention changes in knowledge (P < 0.001) were found in course completers. Counselling self-efficacy improved in participants who took the first course offered (P = 0.001). Dropouts were much less frequent in peer-led, small-group learning than in a self-directed format. Qualitative analysis revealed improved confidence, morale, self-reported practice behaviour changes, and increased comfort in working with difficult clients.
  
  
  CONCLUSIONS
  This work-based, multimodal, interactive, interprofessional curriculum for knowledge translation of psychotherapeutic techniques is feasible and helpful. A peer-led group format is preferred over self-directed learning. Its application can build capacity of front-line health workers in helping patients who suffer from common mental disorders.
authors.affiliation: Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada. pravitz@mtsinai.on.ca
authors.forename: Paula
authors.initials: P
authors.lastname: Ravitz
authors.forename: Robert G
authors.initials: RG
authors.lastname: Cooke
authors.forename: Scott
authors.initials: S
authors.lastname: Mitchell
authors.forename: Scott
authors.initials: S
authors.lastname: Reeves
authors.forename: John
authors.initials: J
authors.lastname: Teshima
authors.forename: Bhadra
authors.initials: B
authors.lastname: Lokuge
authors.forename: Andrea
authors.initials: A
authors.lastname: Lawson
authors.forename: Nancy
authors.initials: N
authors.lastname: McNaughton
authors.forename: Wayne
authors.initials: W
authors.lastname: Skinner
authors.forename: Carolynne
authors.initials: C
authors.lastname: Cooper
authors.forename: Mark
authors.initials: M
authors.lastname: Fefergrad
authors.forename: Ari
authors.initials: A
authors.lastname: Zaretsky
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D057191:Capacity Building / Q000379:methods* / Q000458:organization & administration*; D015928:Cognitive Behavioral Therapy / Q000193:education / Q000458:organization & administration; D003156:Community Mental Health Services / Q000458:organization & administration*; D003159:Community-Institutional Relations; D015897:Comorbidity; D003479:Curriculum; D003866:Depressive Disorder / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D004496:Education, Continuing; D055317:Evidence-Based Practice; D005260:Female; D006282:Health Personnel / Q000193:education* / Q000458:organization & administration* / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand / Q000458:organization & administration / Q000706:statistics & numerical data; D006801:Humans; D007318:Inservice Training; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D008875:Middle Aged; D009864:Ontario; D011613:Psychotherapy / Q000193:education* / Q000458:organization & administration*; D035862:Vulnerable Populations / Q000523:psychology*; D000078329:Workforce
keywords: capacity building; community mental health services; continuing education; health education; knowledge translation; psychotherapy