title: A Non-randomized Comparison of Strategies for Consultation in a Community-Academic Training Program to Implement an Evidence-Based Psychotherapy.
abstract: Despite the central role of training and consultation in the implementation of evidence-based psychological interventions (EBPIs), comprehensive reviews of research on training have highlighted serious gaps in knowledge regarding best practices. Consultation after initial didactic training appears to be of critical importance, but there has been very little research to determine optimal consultation format or interventions. This observational study compared two consultation formats that included review of session audio and feedback in the context of a program to train clinicians (n = 85) in community mental health clinics to deliver cognitive therapy (CT). A "gold standard" condition in which clinicians received individual feedback after expert consultants reviewed full sessions was compared to a group consultation format in which short segments of session audio were reviewed by a group of clinicians and an expert consultant. After adjusting for potential baseline differences between individuals in the two consultation conditions, few differences were found in terms of successful completion of the consultation phase or in terms of competence in CT at the end of consultation or after a 2 year follow-up. However, analyses did not support hypotheses regarding non-inferiority of the group consultation condition. While both groups largely maintained competence, clinicians in the group consultation condition demonstrated increases in competence over the follow-up period, while a sub-group of those in the individual condition experienced decreases. These findings, if replicated, have important implications for EBP implementation programs, as they suggest that observation and feedback is feasible in community mental health setting, and that employing this method in a group format is an effective and efficient consultation strategy that may enhance the implementation and sustainability of evidence-based psychotherapies.
authors.affiliation: Dissemination and Training Division, National Center for PTSD and Department of Psychiatry and Behavioral Sciences, VA Palo Alto Healthcare System and Stanford University, 795 Willow Road (NC-PTSD), Menlo Park, CA, 94025, USA. sws1@stanford.edu.
authors.forename: Shannon Wiltsey
authors.initials: SW
authors.lastname: Stirman
authors.affiliation: Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market St., Philadelphia, PA, 19104, USA.
authors.forename: Kristin
authors.initials: K
authors.lastname: Pontoski
authors.affiliation: Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market St., Philadelphia, PA, 19104, USA.
authors.forename: Torrey
authors.initials: T
authors.lastname: Creed
authors.affiliation: Department of Behavioral Health and Intellectual DisAbility Services, 801 Market Street, 7th Floor, Philadelphia, PA, 19107, USA.
authors.forename: Regina
authors.initials: R
authors.lastname: Xhezo
authors.affiliation: Department of Behavioral Health and Intellectual DisAbility Services, 801 Market Street, 7th Floor, Philadelphia, PA, 19107, USA.
authors.forename: Arthur C
authors.initials: AC
authors.lastname: Evans
authors.affiliation: Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market St., Philadelphia, PA, 19104, USA.
authors.forename: Aaron T
authors.initials: AT
authors.lastname: Beck
authors.affiliation: Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market St., Philadelphia, PA, 19104, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Crits-Christoph
mesh_terms: D000328:Adult; D055317:Evidence-Based Practice; D005260:Female; D006801:Humans; D008297:Male; D011613:Psychotherapy / Q000193:education*; D012017:Referral and Consultation; D055815:Young Adult
keywords: Consultation; Evidence-based psychological treatments; Implementation; Training