Striving to Keep Up with the Field of Evidence-Based Interventions: Redesign of a Child Psychotherapy Seminar

Jennifer West PhD, Wendi Cross PhD, and Pamela Schippell PhDUniversity of Rochester Medical Center

Psychological practice should rest on the foundation of scientific knowledge (APA Presidential Task Force, 2006)

Empirically based treatments (EBTs) are more effective than usual care (Weisz et al, 2006); developing competence in evidence- based interventions should be a primary objective of training programs (Kaslow et al., 2004)

Guidelines for accreditation require that training programs provide instruction in evidence-based practices (APA, 1996)

Within the child and adolescent psychology doctoral internship at URMC, interventions with a solid evidence base were emphasized across different clinical settings, but a well- integrated approach for focused training in EBTs was lacking

Seminar aims to increase not only knowledge but also application of core skills and competencies

Strong emphasis on active learning Supervision a major component

• Trainees expected to show tapes Dissemination of seminar DVDs to individual supervisors so that developing competence in EBTs is a major focus of supervision

Participants: child psychology interns, fellows; child psychiatry fellows Faculty: Core child psychology and psychiatry faculty, community faculty Meets weekly for 2 hrs. from Sept-June Each section includes a syllabus with learning objectives, required readings Multicultural factors discussed in each section 1st hour of the seminar: didactic (lecture, demonstrations, role plays, tape of supervisor’s clinical work) 2nd hour: group supervision

2nd hour of the meeting: group supervision Participants required to bring session DVDs Coordination with Outpatient Intake Team so trainees have appropriate caseloads for EBTs taught in the seminar Techniques for giving and receiving feedback are modeled and reinforced Didactic portion of each seminar meeting is taped; DVDs made available to all supervisors so that they can reinforce application of EBTs in trainees’ individual supervision

EBTs compatible with common presenting problems of patients seen in practica settings were selected First five meetings focus on fundamental techniques

• Empathic listening, limit-setting, active learning, treatment planning Final meeting focused on termination Topics

• Parenting: Collaborative Problem Solving • Autism Spectrum Disorders: Diagnosis and Treatment • Fundamentals of Family Therapy • Parenting: Behavioral Techniques • PCIT (Eyberg), Incredible Years (Webster-Stratton), Defiant Child (Barkley)• CBT for Depression • CBT for Anxiety

Seminar participants complete pre- and post-efficacy measures for each section Faculty provide written feedback to each trainee

Copies of the evaluation are distributed to the trainees, the Training Director, and to their outpatient supervisors

Trainees complete evaluations of each instructor

Efficacy item examples I feel confident in my ability to implement this treatment I feel confident in my ability to explain the rationale for this treatment approach to parents I am comfortable using my supervision to enhance my practice with this treatment

Trainee performance evaluation items Willingness to learn & practice treatment-specific skills Understanding of the theoretical model Skill in implementing treatment approach

Strong emphasis on active learning Instructor & peer supervision support skill development Evaluation component (trainee and instructor)

Feedback to trainees can be integrated into individual supervision Quality improvement

Dissemination of seminar DVDs to supervisors Increases likelihood EBT skills will be applied, reinforced

Seminar receives high ratings from trainees Value opportunities to practice skills Value instructor feedback/supervision Perceived efficacy increased for all sections

• Average change ranged from 2.7-6.3 points

Determining EBTs to highlight in the seminar Trainees have a range of prior exposure to EBTs

Challenging to meet learning needs of all participants Efficacy and evaluation measures require oversight

Can use web-based surveys, on-line learning systems Recruitment of faculty instructors

Faculty appointments and hospital privileges required, since they provide supervision in the seminar

Difficult to determine the degree to which EBTs are being delivered in practica settings, and quality of delivery

Plan to revise current evaluation tool to include observation component

Difficult to measure extent that supervisors make use of seminar DVDs, reinforce content

Development of the Seminar

Structure of the Seminar

Supervision Evaluation of the Seminar

Seminar Topics

Challenges

Strengths