Bev Haarhoff, Transfer of training fade away or show and tell
-
Upload
nz-psychological-society -
Category
Health & Medicine
-
view
1.008 -
download
0
description
Transcript of Bev Haarhoff, Transfer of training fade away or show and tell
EVALUATING POSTGRADUATE CBT TRAINING IN NEW ZEALAND
DR BEVERLY HAARHOFF MASSEY UNIVERSITY, AUCKLAND.
Transfer of training: “Fade away or show and tell!”
Agenda
Why is the evaluation of maintenance and transfer of training in psychotherapy important?
Obstacles and difficulties in assessing transferBrief look at current state of play in terms of
research in the CBT fieldOur study (descriptive data)Problems
A way forward
Defining transfer of training
“Transfer of training is defined as the generalisation and maintenance of new information, knowledge, attitudes and skills into the everyday practice of trainees”
Baldwin & Ford, 1988.
Transfer of training why measure?
Management and allocation of resources
Increasing access to evidenced based therapies (IAPT program)
What works? For whom?To improve
patient/client outcome
Transfer of training in Psychotherapy?
*Difficult area to researchComparatively few studies (increasing in CBT)Lack of funding (the field falls between
psychotherapy & education)Competing psychotherapy training programs
and paradigms(profession specific, short-term,
comprehensive, scholar-practitioner, scientist-practitioner, ‘apprenticeship model’, emphasis on personal therapy etc.)
Evaluating CBT transfer of training
More complications!What represents competence? (which
competecies? General or specific?)Trainee Self-report ?Supervisor ‘indirect’ report?Objective scoring of competence? Evaluation of patient outcome?The willingness of graduates to participate? Small participant samples (limited access
programs)
Transfer of training in CBT
Empirical studies have increased since 1999Still heavily reliant on the self report of
trainees The few studies using ‘objective’ observation
methods such as the Cognitive Therapy Scale (Young & Beck, 1980) measure overall competence have have generally been positive.
Very few linked to outcome or praticing CBT therapists
Recent studies
McManus, Westbrook, Vazquez-Montes, Fennell & Kennerley, 2010.Oxford Diploma CBT Course278 trainees between 1998-2009Increased competence Clinical Psychologists achieved consistently better resultsAge negatively correlated with improved competency
Brosan, Reynolds & Moore, 2006Naturalistic studyPractitioners recruited from a range of professionsmid t/m recorded CBT session rated using the CTS5380 practitioners approached47 responded & only 24 submitted tapes
Psychologists found to be the most competentHowever a number of accredited therapist scored below the expected level of competence
The Massey University Postgraduate CBT diploma
Minimum of two years Part-timePhase one: theoretical: four papers taught in
block mode namely Theory and Practice of CBT, CBT for Depression, CBT for the Anxiety Disorders and CBT for chronic and complex problems.
Phase two: Supervised clinical practicum over two semesters. x Two clients, two case studies and two verbal case presentations. (all supervision in-house)
Final oral exam with the focus on case conceptualisation
The study
Questions:★Is CBT competence maintained and transferred
beyond training? Is therapist self-reported competence in using CBT related
to observed use of CBT?
Is professional development as therapist related to self-reported competence and observed competence?
Is work involvement positively related to self-reported and observed competence as a CBT therapist?
Measures
*Cognitive Therapy Scale (Young & Beck, 1980, 1988) (the most widely used & validated instrument for assessing CBT competence McManus et al., 2010)
Adapted Survey of PGDipCBT (Kennedy-Merrick et al., 2006)
Therapist Professional Development questionnaire (Orlinsky & Rønnestad, 2005)
Psychotherapist work involvement questionnaire (Orlinsky & Rønnestad, 2005)
The Cognitive Therapy Scale (Young & Beck, 1980, 1988)
General therapeutic procedures & interpersonal
effectiveness
1. Agenda2. Feedback3. Understanding4. Interpersonal
effectiveness5. Collaboration6. Pacing & efficient use of
time
‘Red-line’ = 39-44 (RCT)
Specific CBT skills
1. Guided discovery2. Focusing on key
cognitions and behaviours
3. Strategy for change4. Application of CBT
Techniques5. Homework
Each item rated on a (0-6) Likert scale yielding a total score of 66
Participants
The participants were drawn from two groups of CBT trainees
Group one: trainees enrolled in the PGDipCBT during 2009
*Group two: Graduates from the PGDipCBT (2000-2009)
Mental health practitioners across multiple professions: psychologists, social workers, nurses, psychiatric registrars and consultants, GP’s, Occupational therapists, psychotherapists & counsellors
Participants : Group Two
Of the 88 graduates between 2000-2009, 42% (n=37) were not contactable
Of the remaining 58% (n=51), 20 were currently not practicing CBT and 9 declined to participate.
A total of 29 agreed to participate in the study but of this group only 12 provided recorded examples of their clinical work.
Of this sample one tape was unusable and only 11 clinicians eventually took part (12.5% of the total sample)
Results: Cognitive Therapy Scale (Young & Beck,1980,1988)
Participant professional background
General therapeutic competency (6)
Specific CBT competency (5)
Total Cognitive Therapy scale Score (66)
1. Nurse 25.5 18.5 44
2. CBT therapist 33 26.5 59.5
3. Psychologist/CS
32 26 58
4. Nurse 34 26.5 60.5
5. OT 32.5 28 60.5
6. Psychologist/CS
32 24.5 56.5
7. Psychologist/CS
31.5 20.5 52
8. Psychotherapist
18.5 8 26.5
9. Psychologist/GS
16 5 21
10. OT 18.5 8 26.5
11.Nurse 20.5 11 31.5
Competent?
Out of 11 participants n=7 (64%) achieved competence scoring above the 39 ‘red-line’ competence for RCT criteria
3 of 7 were clinical psychologists, 43%
agen
da F/B u/st
Inte
r/per
colla
bora
tion
stra
tegy
/chan
ge GD
key c
og. &
Beh
avio
ur
stra
tegy
for c
hang
e
appl
icat
ion
of C
BTHW
0
1
2
3
4
5
6
PsychotherapistPchol GSOTNurse
Poor performance in specific CBT competencies and skills
Participants below the ‘red-line’
Difficulties: Participant recruitment
Difficulties
Fear of negative evaluation
Obtaining recorded clinical material (patient consent, graduate resistance, technological difficulties)
Expensive (scoring of competence measures)
A way forward
Providing a strong rationale for participation in competency evaluation
Building in positive reinforcement for participation
Building a culture of accountability
Improving access to supervision
Technological support & know how
Deseminating feedback from research
Acknowledgements
Robyn Gedye (PhD candidate)
Dr Mei Williams Senior Lecturer Massey University
Lynley Stenhouse (Clinical Psychologist)Sarah Kennedy-Merrick PhD
Study participants Graduates of the Massey University Post Graduate Diploma in CBT 2000-2009.
questions