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Published in: Implementation Science 1/2014

Open Access 01-12-2014 | Research

Sustaining clinician penetration, attitudes and knowledge in cognitive-behavioral therapy for youth anxiety

Authors: Julie M Edmunds, Kendra L Read, Vanesa A Ringle, Douglas M Brodman, Philip C Kendall, Rinad S Beidas

Published in: Implementation Science | Issue 1/2014

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Abstract

Background

Questions remain regarding the sustainment of evidence-based practices following implementation. The present study examined the sustainment of community clinicians’ implementation (i.e., penetration) of cognitive-behavioral therapy, attitudes toward evidence-based practices, and knowledge of cognitive-behavioral therapy for youth anxiety two years following training and consultation in cognitive-behavioral therapy for youth anxiety.

Methods

Of the original 115 participants, 50 individuals (43%) participated in the two-year follow-up. A t- test examined sustainment in penetration over time. Hierarchical linear modeling examined sustainment in knowledge and attitudes over time. Time spent in consultation sessions was examined as a potential moderator of the change in knowledge and attitudes.

Results

Findings indicated sustained self-reported penetration of cognitive-behavioral therapy for anxious youth, with low fidelity to some key CBT components (i.e., exposure tasks). Follow-up knowledge was higher than at baseline but lower than it had been immediately following the consultation phase of the study. Belief in the utility of evidence-based practices was sustained. Willingness to implement an evidence-based practice if required to do so, appeal of evidence-based practices, and openness toward evidence-based practices were not sustained. Participation in consultation positively moderated changes in knowledge and some attitudes.

Conclusions

Sustainment varied depending on the outcome examined. Generally, greater participation in consultation predicted greater sustainment. Implications for future training include higher dosages of consultation.
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Literature
2.
go back to reference Stirman SW, Kimberly J, Cook N, Calloway A, Castro F, Charns M: The sustainability of new programs and innovations: a review of the empirical literature and recommendations for future research. Implement Sci. 2012, 7: 1-19.CrossRef Stirman SW, Kimberly J, Cook N, Calloway A, Castro F, Charns M: The sustainability of new programs and innovations: a review of the empirical literature and recommendations for future research. Implement Sci. 2012, 7: 1-19.CrossRef
3.
go back to reference Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O: Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q. 2004, 82: 581-629.CrossRefPubMedPubMedCentral Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O: Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q. 2004, 82: 581-629.CrossRefPubMedPubMedCentral
4.
go back to reference Aarons GA, Hurlburt M, Horwitz SM: Advancing a conceptual model of evidence-based practice implementation in public service sectors. Adm Policy Ment Health Ment Health Serv Res. 2010, 38: 4-23.CrossRef Aarons GA, Hurlburt M, Horwitz SM: Advancing a conceptual model of evidence-based practice implementation in public service sectors. Adm Policy Ment Health Ment Health Serv Res. 2010, 38: 4-23.CrossRef
5.
go back to reference Proctor E, Silmere H, Raghavan R, Hovmand P, Aarons G, Bunger A, Griffey R, Hensley M: Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Adm Policy Ment Health Ment Health Serv Res. 2010, 38: 65-76.CrossRef Proctor E, Silmere H, Raghavan R, Hovmand P, Aarons G, Bunger A, Griffey R, Hensley M: Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Adm Policy Ment Health Ment Health Serv Res. 2010, 38: 65-76.CrossRef
6.
go back to reference Beidas RS, Edmunds JM, Marcus SC, Kendall PC: Training and consultation to promote implementation of an empirically supported treatment: a randomized trial. Psychiatr Serv. 2012, 63: 660-665.CrossRefPubMedPubMedCentral Beidas RS, Edmunds JM, Marcus SC, Kendall PC: Training and consultation to promote implementation of an empirically supported treatment: a randomized trial. Psychiatr Serv. 2012, 63: 660-665.CrossRefPubMedPubMedCentral
7.
go back to reference Hollon SD, Beck AT: Cognitive And Cognitive-Behavioral Therapies. Bergin Garfields Handb. Psychother. Behav. Change. 2013, Wiley, New York, NY, 393-442. 6 Hollon SD, Beck AT: Cognitive And Cognitive-Behavioral Therapies. Bergin Garfields Handb. Psychother. Behav. Change. 2013, Wiley, New York, NY, 393-442. 6
8.
go back to reference Fixsen DL, Blase KA, Naoom SF, Wallace F: Core implementation components. Res Soc Work Pract. 2009, 19: 531-540.CrossRef Fixsen DL, Blase KA, Naoom SF, Wallace F: Core implementation components. Res Soc Work Pract. 2009, 19: 531-540.CrossRef
9.
go back to reference Palinkas LA, Weisz JR, Chorpita BF, Levine B, Garland AF, Hoagwood KE, Landsverk J: Continued use of evidence-based treatments after a randomized controlled effectiveness trial: a qualitative study. Psychiatr Serv. 2013, 64: 1110-1118.CrossRefPubMed Palinkas LA, Weisz JR, Chorpita BF, Levine B, Garland AF, Hoagwood KE, Landsverk J: Continued use of evidence-based treatments after a randomized controlled effectiveness trial: a qualitative study. Psychiatr Serv. 2013, 64: 1110-1118.CrossRefPubMed
10.
go back to reference Beidas RS, Barmish A, Kendall PC: Training as usual: can clinician behavior change following reading a manual and attending a brief workshop on cognitive behavioral therapy for youth anxiety?. Behav Clin. 2009, 32: 97-101. Beidas RS, Barmish A, Kendall PC: Training as usual: can clinician behavior change following reading a manual and attending a brief workshop on cognitive behavioral therapy for youth anxiety?. Behav Clin. 2009, 32: 97-101.
11.
go back to reference Aarons GA: Measuring provider attitudes toward evidence-based practice: consideration of organizational context and individual differences. Child Adolesc Psychiatr Clin N Am. 2005, 14: 255-CrossRefPubMedPubMedCentral Aarons GA: Measuring provider attitudes toward evidence-based practice: consideration of organizational context and individual differences. Child Adolesc Psychiatr Clin N Am. 2005, 14: 255-CrossRefPubMedPubMedCentral
12.
go back to reference Aarons GA: Mental health provider attitudes toward adoption of evidence-based practice: the Evidence-Based Practice Attitude Scale (EBPAS). Ment Health Serv Res. 2004, 6: 61-74.CrossRefPubMedPubMedCentral Aarons GA: Mental health provider attitudes toward adoption of evidence-based practice: the Evidence-Based Practice Attitude Scale (EBPAS). Ment Health Serv Res. 2004, 6: 61-74.CrossRefPubMedPubMedCentral
13.
go back to reference Walkup JT, Albano AM, Piacentini J, Birmaher B, Compton SN, Sherrill JT, Ginsburg GS, Rynn MA, McCracken J, Waslick B, Iyengar S, March JS, Kendall PC: Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. N Engl J Med. 2008, 359: 2753-2766.CrossRefPubMedPubMedCentral Walkup JT, Albano AM, Piacentini J, Birmaher B, Compton SN, Sherrill JT, Ginsburg GS, Rynn MA, McCracken J, Waslick B, Iyengar S, March JS, Kendall PC: Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. N Engl J Med. 2008, 359: 2753-2766.CrossRefPubMedPubMedCentral
14.
go back to reference Perepletchikova F, Kazdin AE: Treatment integrity and therapeutic change: issues and research recommendations. Clin Psychol Sci Pract. 2006, 12: 365-383.CrossRef Perepletchikova F, Kazdin AE: Treatment integrity and therapeutic change: issues and research recommendations. Clin Psychol Sci Pract. 2006, 12: 365-383.CrossRef
15.
go back to reference Beidas RS, Cross W, Dorsey S: Show me, don’t tell me: Behavioral rehearsal as a training and analogue fidelity tool. Cogn Behav Pract. 2014, 21: 1-11.CrossRefPubMed Beidas RS, Cross W, Dorsey S: Show me, don’t tell me: Behavioral rehearsal as a training and analogue fidelity tool. Cogn Behav Pract. 2014, 21: 1-11.CrossRefPubMed
16.
go back to reference Kendall PC, Hedtke K: Cognitive-Behavioral Therapy For Anxious Children: Therapist Manual. 2006, Workbook Publishing, Ardmore, PA Kendall PC, Hedtke K: Cognitive-Behavioral Therapy For Anxious Children: Therapist Manual. 2006, Workbook Publishing, Ardmore, PA
17.
go back to reference Stirman SW, Gutiérrez-Colina A, Toder K, Esposito G, Barg F, Castro F, Beck AT, Crits-Christoph P: Clinicians’ perspectives on cognitive therapy in community mental health settings: Implications for training and implementation. Adm Policy Ment Health Ment Health Serv Res. 2012, 40: 274-285.CrossRef Stirman SW, Gutiérrez-Colina A, Toder K, Esposito G, Barg F, Castro F, Beck AT, Crits-Christoph P: Clinicians’ perspectives on cognitive therapy in community mental health settings: Implications for training and implementation. Adm Policy Ment Health Ment Health Serv Res. 2012, 40: 274-285.CrossRef
18.
go back to reference Beidas RS, Edmunds JM, Cannuscio CC, Gallagher M, Downey MM, Kendall PC: Therapists perspectives on the effective elements of consultation following training. Adm Policy Ment Health Ment Health Serv Res. 2013, 40: 507-517.CrossRef Beidas RS, Edmunds JM, Cannuscio CC, Gallagher M, Downey MM, Kendall PC: Therapists perspectives on the effective elements of consultation following training. Adm Policy Ment Health Ment Health Serv Res. 2013, 40: 507-517.CrossRef
19.
go back to reference Silverman WK, Pina AA, Viswesvaran C: Evidence-based psychosocial treatments for phobic and anxiety disorders in children and adolescents. J Clin Child Adolesc Psychol. 2008, 37: 105-130.CrossRefPubMed Silverman WK, Pina AA, Viswesvaran C: Evidence-based psychosocial treatments for phobic and anxiety disorders in children and adolescents. J Clin Child Adolesc Psychol. 2008, 37: 105-130.CrossRefPubMed
20.
go back to reference Kendall PC, Hedtke K: Coping Cat Workbook. 2006, Workbook Publishing, Ardmore, PA Kendall PC, Hedtke K: Coping Cat Workbook. 2006, Workbook Publishing, Ardmore, PA
21.
go back to reference Edmunds JM, Kendall PC, Ringle VA, Read KL, Brodman DM, Pimentel SS, Beidas RS: An examination of behavioral rehearsal during consultation as a predictor of training outcomes. Adm Policy Ment Health Ment Health Serv Res. 2013, 40: 456-466.CrossRef Edmunds JM, Kendall PC, Ringle VA, Read KL, Brodman DM, Pimentel SS, Beidas RS: An examination of behavioral rehearsal during consultation as a predictor of training outcomes. Adm Policy Ment Health Ment Health Serv Res. 2013, 40: 456-466.CrossRef
22.
go back to reference Raudenbush SW, Bryk AS: Hierarchical Linear Models: Applications And Data Analysis Methods. 2002, Sage Publications, Thousand Oaks, CA Raudenbush SW, Bryk AS: Hierarchical Linear Models: Applications And Data Analysis Methods. 2002, Sage Publications, Thousand Oaks, CA
23.
go back to reference Raudenbush SW, Bryk AS, Cheong YF, Congdon R: HLM 6: Hierarchical linear and nonlinear modeling. 2004, Scientific Software International Inc., Lincolnwood, IL Raudenbush SW, Bryk AS, Cheong YF, Congdon R: HLM 6: Hierarchical linear and nonlinear modeling. 2004, Scientific Software International Inc., Lincolnwood, IL
24.
go back to reference Kendall PC, Flannery-Schroeder E, Panichelli-Mindel SM, Southam-Gerow M, Henin A, Warman M: Therapy for youths with anxiety disorders: a second randomized clinical trial. J Consult Clin Psychol. 1997, 65: 366-380.CrossRefPubMed Kendall PC, Flannery-Schroeder E, Panichelli-Mindel SM, Southam-Gerow M, Henin A, Warman M: Therapy for youths with anxiety disorders: a second randomized clinical trial. J Consult Clin Psychol. 1997, 65: 366-380.CrossRefPubMed
25.
go back to reference Kendall PC, Beidas RS: Smoothing the trail for dissemination of evidence-based practices for youth: flexibility within fidelity. Prof Psychol Res Pract. 2007, 38: 13-20.CrossRef Kendall PC, Beidas RS: Smoothing the trail for dissemination of evidence-based practices for youth: flexibility within fidelity. Prof Psychol Res Pract. 2007, 38: 13-20.CrossRef
26.
go back to reference Kendall PC, Gosch E, Furr JM, Sood E: Flexibility within fidelity. J Am Acad Child Adolesc Psychiatry. 2008, 47: 987-993.CrossRefPubMed Kendall PC, Gosch E, Furr JM, Sood E: Flexibility within fidelity. J Am Acad Child Adolesc Psychiatry. 2008, 47: 987-993.CrossRefPubMed
27.
go back to reference Lim A, Nakamura BJ, Higa-McMillan CK, Shimabukuro S, Slavin L: Effects of workshop trainings on evidence-based practice knowledge and attitudes among youth community mental health providers. Behav Res Ther. 2012, 50: 397-406.CrossRefPubMed Lim A, Nakamura BJ, Higa-McMillan CK, Shimabukuro S, Slavin L: Effects of workshop trainings on evidence-based practice knowledge and attitudes among youth community mental health providers. Behav Res Ther. 2012, 50: 397-406.CrossRefPubMed
28.
go back to reference Beidas RS, Kendall PC: Training therapists in evidence-based practice: a critical review of studies from a systems-contextual perspective. Clin Psychol Sci Pract. 2010, 17: 1-30.CrossRef Beidas RS, Kendall PC: Training therapists in evidence-based practice: a critical review of studies from a systems-contextual perspective. Clin Psychol Sci Pract. 2010, 17: 1-30.CrossRef
29.
go back to reference Cooper BR, Bumbarger BK, Moore JE: Sustaining evidence-based prevention programs: Correlates in a large-scale dissemination initiative.Prev Sci 2013, ᅟ:ᅟ [serial online] August 24., Cooper BR, Bumbarger BK, Moore JE: Sustaining evidence-based prevention programs: Correlates in a large-scale dissemination initiative.Prev Sci 2013, ᅟ:ᅟ [serial online] August 24.,
30.
go back to reference Herschell AD, Kolko DJ, Baumann BL, Davis AC: The role of therapist training in the implementation of psychosocial treatments: a review and critique with recommendations. Clin Psychol Rev. 2010, 30: 448-466.CrossRefPubMedPubMedCentral Herschell AD, Kolko DJ, Baumann BL, Davis AC: The role of therapist training in the implementation of psychosocial treatments: a review and critique with recommendations. Clin Psychol Rev. 2010, 30: 448-466.CrossRefPubMedPubMedCentral
Metadata
Title
Sustaining clinician penetration, attitudes and knowledge in cognitive-behavioral therapy for youth anxiety
Authors
Julie M Edmunds
Kendra L Read
Vanesa A Ringle
Douglas M Brodman
Philip C Kendall
Rinad S Beidas
Publication date
01-12-2014
Publisher
BioMed Central
Published in
Implementation Science / Issue 1/2014
Electronic ISSN: 1748-5908
DOI
https://doi.org/10.1186/s13012-014-0089-9

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