According to the findings of a new study published in JAMA Psychiatry, researchers have developed a model that shows efficacy in training therapists on evidence-based treatments within a college counseling setting.
“Progress has been made in establishing evidence-based treatments for psychiatric disorders, but these are not often delivered in routine settings. A scalable solution for training clinicians in evidence-based treatments is needed,” the study authors wrote in their abstract.
In this cluster-randomized trial, which was conducted from October 2012 to December 2017 across 24 US college counseling centers, the researchers assessed 184 therapists (mean age, 42, 76% female, 77% white) who they recruited from enrolled centers, while student patients with symptoms of depression and eating disorders were recruited by therapists. Subsequently, the researchers randomized counseling centers to expert condition, which involved a workshop and 12 months of follow-up consultation, or the train-the-trainer condition, which involved a staff member from the counseling center was coached to train other staff members.
The primary endpoint of this study was defined as therapist fidelity adherence and competence to interpersonal psychotherapy, which the researchers assessed via audio recordings of therapy sessions. The secondary endpoint was stipulated as therapist knowledge of interpersonal psychotherapy.
Models Shows Efficacy
According to the results of the study, the train-the-trainer–condition and expert-condition groups exhibited notably group improvements with respect to adherence to interpersonal psychotherapy (change: 0.233 [95% CI, 0.192 to 0.274] and 0.190 [0.145 to 0.235], respectively; both P < .001), with large effect sizes (1.64 [95% CI, 1.35 to 1.93] and 1.34 [95% CI, 1.02 to 1.66], respectively) and no significant difference between conditions. Also, both groups showed significant within-group improvement in interpersonal therapy competence (change: 0.179 [95% CI, 0.132 to 0.226] and 0.106 [0.059-0.153], respectively; both P < .001), with a large effect size for the train-the-trainer condition (1.16 [95% CI, 0.85-1.46]; P < .001) and a significant difference between groups favoring the train-the-trainer condition (effect size, 0.47 [95% CI, 0.05-0.89]; P = .03).
Moreover, knowledge of interpersonal psychotherapy improved significantly within both groups (effect sizes: train-the-trainer, 0.64 [95% CI, 0.28-0.99]; P = .005; expert, 0.69 [95% CI, 0.38-1.01]; P < .001), with no significant difference between groups. The significant moderating factors were job satisfaction for adherence (b, 0.120 [95% CI, 0.001 to 0.24]; P = .048) and competence (b, 0.133 [95% CI, 0.001-0.27]; P = .048), and frequency of clinical supervision for competence (b, 0.05 [95% CI, 0.004-0.09]; P = .03).
“Results demonstrate that the train-the-trainer model produced training outcomes comparable with the expert model for adherence and was superior on competence,” the research authors wrote in their conclusion.
“Given its potential capability to train more therapists over time, it has the potential to facilitate widespread dissemination of evidence-based treatments.”
How can we increase access in college #mentalhealth services? The trainer model, which resulted in improved competence versus expert training, may be a viable approach https://t.co/2NRXdYABr1 https://t.co/2HGETrW0zE
— JAMA Psychiatry (@JAMAPsych) November 6, 2019