Striving to Keep Up with the Field of Evidence-Based Interventions:

1. 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 PhD University 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 Structure of the Seminar Seminar Topics Strengths • 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 • 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 • 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 Supervision Evaluation of the Seminar Challenges • 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 • 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 • 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 • 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