title: A randomized controlled dismantling trial of post-workshop consultation strategies to increase effectiveness and fidelity to an evidence-based psychotherapy for Posttraumatic Stress Disorder.
abstract: BACKGROUND
  Posttraumatic Stress Disorder (PTSD) is a serious mental health condition with substantial costs to individuals and society. Among military veterans, the lifetime prevalence of PTSD has been estimated to be as high as 20%. Numerous research studies have demonstrated that short-term cognitive-behavioral psychotherapies, such as Cognitive Processing Therapy (CPT), lead to substantial and sustained improvements in PTSD symptoms. Despite known benefits, only a minority of clinicians provide these therapies. Transferring this research knowledge into clinical settings remains one of the largest hurdles to improving the health of veterans with PTSD. Attending a workshop alone is insufficient to promote adequate knowledge transfer and sustained skill; however, relatively little research has been conducted to identify effective post-training support strategies.
  
  
  METHODS
  The current study investigates whether clinicians receiving post-workshop support (six-month duration) will deliver CPT with greater fidelity (i.e., psychotherapy adherence and competence) and have improved patient outcomes compared with clinicians receiving no formal post-workshop support. The study conditions are: technology-enhanced group tele-consultation; standard group tele-consultation; and fidelity assessment with no consultation. The primary outcome is independent assessment (via audio-recordings) of the clinicians' adherence and competence in delivering CPT. The secondary outcome is observed changes in patient symptoms during and following treatment as a function of clinician fidelity. Post-consultation interviews with clinicians will help identify facilitators and barriers to psychotherapy skill acquisition. The study results will inform how best to implement and transfer evidence-based psychotherapy (e.g., CPT) to clinical settings to attain comparable outcomes to those observed in research settings.
  
  
  CONCLUSIONS
  Findings will deepen our understanding of how much and what type of support is needed following a workshop to help clinicians become proficient in delivering a new protocol. Several influences on clinician learning and patient outcomes will be discussed. An evidence-based model of clinical consultation will be developed, with the ultimate goal of informing policy and influencing best practice in clinical consultation.
  
  
  BACKGROUND
  ClinicalTrials.gov: NCT01861769.
authors.affiliation: Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston University, 150 South Huntington Ave (116B3), Boston, MA 02130, USA.
authors.forename: Shannon
authors.initials: S
authors.lastname: Wiltsey Stirman
authors.forename: Norman
authors.initials: N
authors.lastname: Shields
authors.forename: Josh
authors.initials: J
authors.lastname: Deloriea
authors.forename: Meredith S H
authors.initials: MS
authors.lastname: Landy
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Belus
authors.forename: Marta M
authors.initials: MM
authors.lastname: Maslej
authors.forename: Candice M
authors.initials: CM
authors.lastname: Monson
mesh_terms: D002983:Clinical Competence / Q000592:standards; D015928:Cognitive Behavioral Therapy / Q000193:education / Q000379:methods*; D003695:Delivery of Health Care / Q000592:standards; D004493:Education; D004502:Education, Medical, Continuing; D019317:Evidence-Based Medicine; D006801:Humans; D013313:Stress Disorders, Post-Traumatic / Q000628:therapy*; D016896:Treatment Outcome
references.citation: Behav Res Ther. 2010 Jul;48(7):599-606
references.pmid: 20362978
references.citation: J Trauma Stress. 2009 Jun;22(3):197-204
references.pmid: 19466746
references.citation: Drug Alcohol Depend. 2004 Jan 7;73(1):99-106
references.pmid: 14687964
references.citation: Clin Psychol Rev. 2010 Jul;30(5):496-516
references.pmid: 20488599
references.citation: Depress Anxiety. 2005;21(4):193-202
references.pmid: 16075453
references.citation: Adm Policy Ment Health. 2009 Jan;36(1):24-34
references.pmid: 19104929
references.citation: J Nerv Ment Dis. 2000 Aug;188(8):496-504
references.pmid: 10972568
references.citation: J Consult Clin Psychol. 1994 Dec;62(6):1235-40
references.pmid: 7860822
references.citation: Am J Epidemiol. 1991 Nov 1;134(9):973-80
references.pmid: 1951295
references.citation: Adm Policy Ment Health. 2011 Jul;38(4):254-86
references.pmid: 21656256
references.citation: J Rehabil Res Dev. 2012;49(5):667-78
references.pmid: 23015578
references.citation: Psychosom Med. 2007 Apr;69(3):242-8
references.pmid: 17401056
references.citation: Adv Mind Body Med. 2004 Spring;20(1):18-29
references.pmid: 15068106
references.citation: J Consult Clin Psychol. 2010 Oct;78(5):751-6
references.pmid: 20873911
references.citation: JAMA. 2006 Mar 1;295(9):1023-32
references.pmid: 16507803
references.citation: J Consult Clin Psychol. 2004 Dec;72(6):1050-62
references.pmid: 15612851
references.citation: Adm Policy Ment Health. 2012 Sep;39(5):331-40
references.pmid: 20607597
references.citation: Med Care. 1996 Mar;34(3):220-33
references.pmid: 8628042
references.citation: J Consult Clin Psychol. 2008 Apr;76(2):243-258
references.pmid: 18377121
references.citation: Behav Res Ther. 2009 Nov;47(11):980-9
references.pmid: 19632668
references.citation: J Consult Clin Psychol. 1992 Oct;60(5):748-56
references.pmid: 1401390
references.citation: Am J Epidemiol. 2001 Jul 15;154(2):128-37
references.pmid: 11447045
references.citation: Arch Gen Psychiatry. 2005 Jun;62(6):617-27
references.pmid: 15939839
references.citation: J Consult Clin Psychol. 2002 Aug;70(4):867-79
references.pmid: 12182270
references.citation: BMJ. 2000 Jan 8;320(7227):114-6
references.pmid: 10625273
references.citation: Am J Psychiatry. 1999 Jul;156(7):1007-13
references.pmid: 10401443
references.citation: Implement Sci. 2009 Aug 07;4:50
references.pmid: 19664226
references.citation: Behav Res Ther. 1996 Aug;34(8):669-73
references.pmid: 8870294
references.citation: J Consult Clin Psychol. 1986 Jun;54(3):381-5
references.pmid: 3722567
references.citation: BMJ. 2004 Nov 13;329(7475):1177-9
references.pmid: 15539680
references.citation: Clin Psychol (New York). 2010 Mar;17(1):1-30
references.pmid: 20877441
references.citation: J Clin Psychiatry. 2000;61 Suppl 5:4-12; discussion 13-4
references.pmid: 10761674
references.citation: J Consult Clin Psychol. 2000 Apr;68(2):258-68
references.pmid: 10780126
references.citation: Implement Sci. 2013 Jun 10;8:65
references.pmid: 23758995
references.citation: J Consult Clin Psychol. 2012 Apr;80(2):201-10
references.pmid: 22182261
references.citation: Psychiatr Serv. 2007 Mar;58(3):395
references.pmid: 17325114
references.citation: Clin Psychol Rev. 2010 Jun;30(4):448-66
references.pmid: 20304542
references.citation: Arch Intern Med. 2004 Feb 23;164(4):394-400
references.pmid: 14980990
references.citation: Adm Policy Ment Health. 2008 Sep;35(5):379-94
references.pmid: 18561019
references.citation: J Consult Clin Psychol. 1999 Dec;67(6):837-46
references.pmid: 10596506
references.citation: J Subst Abuse Treat. 2002 Jun;22(4):197-209
references.pmid: 12072164
references.citation: J Consult Clin Psychol. 2005 Oct;73(5):965-71
references.pmid: 16287396
references.citation: CNS Neurosci Ther. 2008 Fall;14(3):171-81
references.pmid: 18801110
references.citation: J Consult Clin Psychol. 2008 Aug;76(4):544-55
references.pmid: 18665684
references.citation: J Consult Clin Psychol. 2011 Oct;79(5):590-9
references.pmid: 21744946
references.citation: J Trauma Stress. 2010 Feb;23(1):25-32
references.pmid: 20146255
references.citation: J Trauma Stress. 2010 Dec;23(6):663-73
references.pmid: 21171126
references.citation: Ann Intern Med. 2010 Jun 1;152(11):726-32
references.pmid: 20335313
references.citation: J Consult Clin Psychol. 2006 Oct;74(5):898-907
references.pmid: 17032094
references.citation: Adm Policy Ment Health. 2011 Jan;38(1):44-53
references.pmid: 20967495
references.citation: J Consult Clin Psychol. 2010 Jun;78(3):429-37
references.pmid: 20515218
references.citation: Arch Gen Psychiatry. 2006 Aug;63(8):925-34
references.pmid: 16894069
references.citation: Am Psychol. 2010 Feb-Mar;65(2):73-84
references.pmid: 20141263