ABSTRACT

Objective

This pilot study tested pragmatic methods for training therapists in core techniques of two evidence-based interventions (EBIs) for adolescent externalizing problems: cognitive-behavioral therapy (CBT) or family therapy (FT). Training methods were designed to help therapists accurately self-monitor their use of EBIs and increase delivery of EBIs with current clients. The study compared coder training only versus coder training plus fidelity-focused consultation.

Method

Therapists (N = 42) from seven behavioral health clinics reported on 65 youth clients; four clinics elected to train in CBT and three in FT. Therapists were randomized to either coder training only, consisting of a 25-week observational coder training course (didactic instruction and mock session coding exercises in core EBI techniques); or coder training plus fidelity-focused consultation, consisting of direct-to-therapist fidelity measurement feedback along with fidelity-focused expert consultation. During the 25 weeks of training, therapists submitted self-report data on EBI use along with companion session audiotapes subsequently coded by observational raters.

Results

Compared to coder training only, coder training plus fidelity-focused consultation produced superior effects in therapist ability to judge the extensiveness of EBI techniques in online coding sessions, as well as therapist ability to self-rate use of EBI techniques with their own cases. In both conditions, therapists who trained in CBT showed a significant, though modest, increase in real-world delivery of core CBT techniques; this did not occur for FT.

Conclusions

Pragmatic training and consultation methods show promise as viable and effective options for enhancing EBI fidelity monitoring and, for CBT, increasing EBI delivery.

中文翻译：

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对社区治疗师进行 CBT 核心要素和针对青少年外化问题的家庭治疗的培训

摘要

客观的

这项试点研究测试了培训治疗师使用两种针对青少年外化问题的循证干预措施 (EBI) 核心技术的实用方法：认知行为治疗 (CBT) 或家庭治疗 (FT)。培训方法旨在帮助治疗师准确地自我监控 EBI 的使用情况，并增加对现有客户的 EBI 交付。该研究比较了仅编码员培训与编码员培训加保真度咨询的情况。

方法

来自 7 个行为健康诊所的治疗师（N  = 42）对 65 名青少年客户进行了报告；四个诊所选择接受 CBT 培训，三个诊所选择接受 FT 培训。治疗师被随机分配接受仅编码员培训，包括为期 25 周的观察性编码员培训课程（核心 EBI 技术中的教学指导和模拟课程编码练习）；或编码员培训加上以保真度为中心的咨询，包括直接向治疗师提供的保真度测量反馈以及以保真度为中心的专家咨询。在 25 周的培训期间，治疗师提交了有关 EBI 使用的自我报告数据以及随后由观察评估者编码的同伴会议录音带。

结果

与仅进行编码员培训相比，编码员培训加上以保真度为中心的咨询对治疗师判断在线编码课程中 EBI 技术的广泛性的能力以及治疗师根据自己的案例自我评价 EBI 技术的使用的能力产生了卓越的效果。在这两种情况下，接受过 CBT 培训的治疗师在现实世界中核心 CBT 技术的运用方面表现出了显着的增长，尽管幅度不大。《金融时报》却没有出现这种情况。

结论

务实的培训和咨询方法有望成为增强 EBI 保真度监控以及 CBT 提高 EBI 交付的可行且有效的选择。