Clinical trial NCT01800266: Randomized Controlled Trial of Supervision Strategies to Improve Clinician Fidelity to Trauma-focused CBT
Official title: Improving Practice in Community-based Settings: A Randomized Trial of Supervision Strategies
Study type: INTERVENTIONAL
Overall status: UNKNOWN
Phase: NA
Conditions: Post Traumatic Stress
Overall Functioning
Clinician Fidelity
Supervision
Keywords: Supervision
Implementation
Community Based Mental Health Services
Trauma Focused Cognitive Behavioral Therapy
Skill Building and Behavioral Rehearsal
Symptom and Fidelity Monitoring
Children
Adolescents
Lead sponsor: University of Washington
Sponsor class: OTHER
Collaborators: name: National Institute of Mental Health (NIMH)
name: University of Medicine and Dentistry of New Jersey
First posted: 2013-02-27
Enrollment: 1280
Sex: ALL
Minimum age (years): 6
Maximum age (years): 17
Standard ages: CHILD
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: The primary goal of this study is to examine the impact of varying supervision strategies on clinician fidelity and client outcomes in a community-based setting. Prior research has established that training approaches that do not include a period of intervention-specific supervision or consultation are ineffective and that implementation efforts that include only an initial period of supervision show an eventual attenuation of gains in knowledge and fidelity in practice. Ongoing supervision may be required for effective and sustained implementation of evidence-based practices (EBPs) in community-based settings. However, supervision is one of the least investigated aspects of training. "Gold standard" elements of supervision from efficacy trials include review of sessions, standardized procedures for monitoring client outcomes and model fidelity, and ongoing skill-building (e.g., behavioral rehearsal). The degree (e.g., frequency, intensity) to which these strategies are used in community-based settings is unknown.

There are a growing number of national and statewide efforts to increase the reach of EBPs through dissemination and implementation initiatives. There are 18 statewide initiatives to implement Trauma-focused Cognitive Behavioral Therapy (TF-CBT), an EBP for child trauma exposure and sequelae. Many of the community based TF-CBT implementation efforts, and those for other EBPs, include a specific focus on supervisors. However, the limited scientific literature provides very little guidance for these efforts. Aims of the current trial include 1) studying supervision with existing implementation supports; particularly presence of gold standard elements; 2) evaluating the effects of varying supervision strategies on fidelity and client outcomes; and 3) testing the mediating effect of treatment fidelity on the relationship between supervision type and client outcomes. We propose a two-phased, within-subjects and between subjects design. In Phase I (9 months), we examined supervision with implementation support. In Phase II (30 months), we will examine two specific supervision conditions, each including varying EBP supervision elements.


Eligibility criteria: Inclusion Criteria:

* Children between the ages of 6-17 who are starting Trauma-focused Cognitive Behavioral Therapy (TF-CBT) with one of our enrolled clinicians.They must also have significant Post Traumatic Stress symptoms as measured by a score of 21 or higher on the UCLA PTSD-RI, and live with a parent or guardian who is willing to participate in the study.
* Community-based mental health clinicians who are employed in Regional Support Network agencies (state Medicaid clinics) who have participated in the Washington State Initiative for TF-CBT and are supervised by a participating supervisor, or have completed the TF-CBT web training and been supervised on a case.
* Community-based mental health supervisors trained in the WA State Initiative in TF-CBT and employed at participating clinics in WA.

Exclusion Criteria:

* Non-English speaking child.

Primary outcomes:
measure: Coding Therapy Sessions to Assess Clinician Fidelity to TF-CBT Strategy.
timeFrame: 2 years
Secondary outcomes:
measure: Client outcomes for Post-Traumatic Stress and overall functioning
timeFrame: 6 months
Other outcomes:
Locations:
city: Seattle
country: United States
facility: University of Washington Department of Psychology
state: Washington
Study officials:
affiliation: University of Washington
name: Shannon Dorsey, PhD
role: PRINCIPAL_INVESTIGATOR
affiliation: University of Washington
name: Kelly Thompson, MSW
role: STUDY_DIRECTOR
References:
citation: Dorsey S, Kerns SEU, Lucid L, Pullmann MD, Harrison JP, Berliner L, Thompson K, Deblinger E. Objective coding of content and techniques in workplace-based supervision of an EBT in public mental health. Implement Sci. 2018 Jan 24;13(1):19. doi: 10.1186/s13012-017-0708-3.
citation: Dorsey S, Pullmann MD, Deblinger E, Berliner L, Kerns SE, Thompson K, Unutzer J, Weisz JR, Garland AF. Improving practice in community-based settings: a randomized trial of supervision - study protocol. Implement Sci. 2013 Aug 10;8:89. doi: 10.1186/1748-5908-8-89.