A randomized controlled dismantling trial of post-workshop consultation strategies to increase effectiveness and fidelity to an evidence-based psychotherapy for Posttraumatic stress disorder Public Deposited

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Creator
  • Belus, Jennifer M.
    • Affiliation: College of Arts and Sciences, Department of Psychology and Neuroscience
  • Shields, Norman
    • Other Affiliation: Veterans Affairs Canada, Operational Stress Injuries National Network (OSINN), 305 Boul des Anciens-Combattants, Sainte-Anne-de-Bellevue, QC H9X 1Y9, Canada
  • Maslej, Marta M.
    • Other Affiliation: Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, ON M5B 2K3, Canada
  • Monson, Candice M.
    • Other Affiliation: Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, ON M5B 2K3, Canada
  • Landy, Meredith S.H.
    • Other Affiliation: Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, ON M5B 2K3, Canada
  • Wiltsey Stirman, Shannon
    • Other Affiliation: Women’s Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston University, 150 South Huntington Ave (116B3), Boston, MA 02130, USA
  • Deloriea, Josh
    • Other Affiliation: Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, ON M5B 2K3, Canada
Abstract
  • Abstract: Background: Posttraumatic Stress Disorder (PTSD) is a serious mental health condition with substantial costs to individuals and society. Among military veterans, the lifetime prevalence of PTSD has been estimated to be as high as 20%. Numerous research studies have demonstrated that short-term cognitive-behavioral psychotherapies, such as Cognitive Processing Therapy (CPT), lead to substantial and sustained improvements in PTSD symptoms. Despite known benefits, only a minority of clinicians provide these therapies. Transferring this research knowledge into clinical settings remains one of the largest hurdles to improving the health of veterans with PTSD. Attending a workshop alone is insufficient to promote adequate knowledge transfer and sustained skill; however, relatively little research has been conducted to identify effective post-training support strategies. Methods: The current study investigates whether clinicians receiving post-workshop support (six-month duration) will deliver CPT with greater fidelity (i.e., psychotherapy adherence and competence) and have improved patient outcomes compared with clinicians receiving no formal post-workshop support. The study conditions are: technology-enhanced group tele-consultation; standard group tele-consultation; and fidelity assessment with no consultation. The primary outcome is independent assessment (via audio-recordings) of the clinicians’ adherence and competence in delivering CPT. The secondary outcome is observed changes in patient symptoms during and following treatment as a function of clinician fidelity. Post-consultation interviews with clinicians will help identify facilitators and barriers to psychotherapy skill acquisition. The study results will inform how best to implement and transfer evidence-based psychotherapy (e.g., CPT) to clinical settings to attain comparable outcomes to those observed in research settings. Discussion: Findings will deepen our understanding of how much and what type of support is needed following a workshop to help clinicians become proficient in delivering a new protocol. Several influences on clinician learning and patient outcomes will be discussed. An evidence-based model of clinical consultation will be developed, with the ultimate goal of informing policy and influencing best practice in clinical consultation. Trial registration: ClinicalTrials.gov: NCT01861769
Date of publication
Identifier
  • 23902798
  • doi:10.1186/1748-5908-8-82
Resource type
  • Article
Rights statement
  • In Copyright
Rights holder
  • Shannon Wiltsey Stirman et al.; licensee BioMed Central Ltd.
License
Journal title
  • Implementation Science
Journal volume
  • 8
Journal issue
  • 1
Page start
  • 82
Language
  • English
Is the article or chapter peer-reviewed?
  • Yes
ISSN
  • 1748-5908
Bibliographic citation
  • Implementation Science. 2013 Aug 01;8(1):82
Access
  • Open Access
Publisher
  • BioMed Central Ltd
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