Search

Many training initiatives are underway to increase implementation of evidence-based practice (EBPs) in mental healthcare. However, little is known about what types of trainings and supports yield the highest reach and engagement. Supported by a tax-funded, countywide initiative to improve access to quality care for youths, the current mixed methods study evaluates mental health (MH) provider reach, or registering for the training initiative, and engagement, or participation in training activities, for several EBP training and implementation supports. MH providers were offered free 1) formal EBP workshops, 2) a biweekly learning community, 3) individual case consultation, and 4) confidential online clinical feedback system. To register, interested providers (N = 698) completed a web-based assessment measuring clinical practice information, organizational implementation climate, and EBP knowledge, attitudes, and practices. Thirteen providers, selected via purposeful sampling stratified by level of participation, completed semi-structured qualitative interviews. While the training initiative achieved high reach (66% of county agencies had a provider register), far fewer providers engaged substantially in training. Quantitative results indicated that providers whose professional discipline was not psychology, had higher baseline EBP knowledge, more extensive use of common evidence-based strategies, and less extensive use of other therapy strategies, engaged in more training. Rapid qualitative analysis of interviews expanded upon these findings and illuminated provider, organizational, system, practical, and training activity-specific barriers and facilitators to engagement. Findings suggest the importance of identifying strategies for improving provider engagement in training activities beyond workshops. Implications for future research and training initiatives are discussed. [ABSTRACT FROM AUTHOR]

At present, the mental healthcare system cannot meet the demand for services, and the need‐to‐access gap is widest among children and adolescents. Single session interventions (SSIs) are brief, intentional, and mechanism‐targeted programs that have shown promise in increasing the reach of effective, evidence‐based services; yet, a wide gap still remains due to structural barriers (e.g., lack of awareness, workforce shortages). The present paper posits the integration of SSIs and mentor‐delivered programs as a promising future step to further overcome the inaccessibility of youth mental health services. Capitalizing on the advantages of mentoring relationships (e.g., the associated interpersonal benefits and mentors' pre‐existence in most community settings) has the potential to complement and enhance the value of SSIs, and to expand the acceptability and reach of evidence‐based mental health services. In this paper, we discuss the anticipated benefits of mentor‐delivered SSIs, as well as cautionary considerations related to the proposed model. To conclude, we highlight the necessary implementation and research implications. [ABSTRACT FROM AUTHOR]

Purpose: Treatment engagement poses challenges for youth mental health providers. With the expansion of evidence-based treatments (EBTs), providers face complex decisions regarding how to engage youth and families using available information sources. This study investigated how EBT protocols are associated with the selection and delivery of engagement practices. Method: Twenty engagement practices were coded in a sample of digital recordings of early treatment sessions (N = 193) from the Child STEPs in California study, a randomized trial testing modular treatment and community-implemented treatment for youth mental health problems. Data were collected on which protocols mental health providers reportedly used to guide their sessions and the protocols in which they had received training. We examined which information sources (i.e., the guiding protocol, other protocols in training history, unspecified source) were associated with observed engagement practices. Results: In sessions guided by a protocol, most observed engagement practices were accounted for by the guiding protocol (p <.001), rather than protocols in training history or unspecified sources (p <.001). In sessions not guided by a protocol, most observed practices were accounted for by training history (p <.001). Practice frequency and extensiveness was generally greater when a protocol guided the session. Conclusions: Inclusion in protocols is associated with the selection and delivery of engagement practices, but this strategy might be insufficient for supporting the use of the full range of engagement practices supported by evidence. Supports are needed that leverage the engagement evidence base to ensure that selected practices empirically fit the engagement needs of youth and families. [ABSTRACT FROM AUTHOR]

Objective: To test for equivalence between providers with and without advanced degrees in multiple domains related to delivery of evidence-based treatment.Data Source: Provider and client data from an effectiveness trial of Alternatives for Families: A Cognitive Behavioral Therapy (AF-CBT) in a major metropolitan area in the United States.Study Design: We tested for equivalence between providers (N = 182) with and without advanced degrees in treatment-related knowledge, practices, and attitudes; job demands and stress; and training engagement and trainer-rated competence in AF-CBT. We also conducted exploratory analyses to test for equivalence in family clinical outcomes.Data Collection: Providers completed measures prior to randomization and at 6-month follow-up, after completion of training and consultation in AF-CBT. Children and caregivers completed assessments at 0, 6, 12, and 18 months.Principal Findings: Providers without advanced degrees were largely non-inferior to those with advanced degrees in treatment-related knowledge, practices, and attitudes, while findings for job demands and stress were mixed. Providers without advanced degrees were non-inferior to providers with advanced degrees in consultation attendance (B = -1.42; confidence interval (CI) = -3.01-0.16; margin of equivalence (Δ) = 2), number of case presentations (B = 0.64; CI = -0.49-1.76; Δ = 2), total training hours (B = -4.57; CI = -10.52-1.37; Δ = 3), and trainer-rated competence in AF-CBT (B = -0.04; CI = -3.04-2.96; Δ = 4), and they were significantly more likely to complete training (odds ratio = 0.66; CI = 0.10-0.96; Δ = 30%). Results for clinical outcomes were largely inconclusive.Conclusions: Provider-level outcomes for those with and without advanced degrees were generally comparable. Additional research is needed to examine equivalence in clinical outcomes. Expanding evidence-based treatment training to individuals without advanced degrees may help to reduce workforce shortages and improve reach of evidence-based treatments. [ABSTRACT FROM AUTHOR]

Better integration of evidence-based practices (EBPs) in schools can improve access to effective youth mental health care. However, EBPs typically developed and tested within clinics may not be feasible for school-based implementation. We conducted a small randomized trial comparing Show Me FIRST, a brief intervention designed for efficient uptake in diverse clinical settings, against usual care (UC) in a school-based sample of 34 youth (70.59% female, 79.41% White; 11.76% Latinx; M = 12.21 years old; 41.18% received free or reduced lunch) with significantly elevated depression and anxiety. Using a mixed methods approach to gauge feasibility and efficacy, we found that school-based providers were able to deliver most content with fidelity and within six sessions. Youth and providers reported significant symptom improvements, but comparisons against UC were nonsignificant. Providers reported several challenges to implementing Show Me FIRST with the high-risk sample that may help explain these findings and suggest future adaptations. [ABSTRACT FROM AUTHOR]

Advancements in evidence-based psychosocial interventions, digital technologies, and implementation strategies (i.e., health services research products) for youth mental health services have yet to yield significant improvement in public health outcomes. Achieving such impact will require that these research products are easy to use, useful, and contextually appropriate. This paper describes how human-centered design (HCD), an approach that aligns product development with the needs of the people and settings that use those products, can be leveraged to improve youth mental health services. We articulate how HCD can advance accessibility, effectiveness, and equity, with specific consideration of unique aspects of youth mental health services. [ABSTRACT FROM AUTHOR]