Clinician Training, Then What? Randomized Clinical Trial of Child STEPs Psychotherapy Using Lower-Cost Implementation Supports With Versus Without Expert Consultation

• Published in: Journal of consulting and clinical psychology 2020-12, Vol.88 (12), p.1065-1078
• Main Authors: Weisz, John R., Thomassin, Kristel, Hersh, Jacqueline, Santucci, Lauren C., MacPherson, Heather A., Rodriguez, Gabriela M., Bearman, Sarah Kate, Lang, Jason M., Vanderploeg, Jeffrey J., Marshall, Timothy M., Lu, Jack J., Jensen-Doss, Amanda, Evans, Spencer C.
• Format: Article
• Language: English
• Subjects: Adherence; Adolescent; Adolescent Psychotherapy; Adult; Black white differences; Child; Child Behavior Checklist; Child Psychotherapy; Children; Clinical medicine; Clinical outcomes; Clinical Practice; Clinical research; Clinical training; Clinical trials; Clinicians; Clinics; Community health services; Community Mental Health Services; Competence; Costs; Evidence Based Practice; Evidence-based medicine; Evidence-Based Practice - economics; Female; Fidelity; Health Care Costs; Health Personnel - education; Human; Humans; Implementation; Male; Middle Aged; Outcome and Process Assessment, Health Care; Professional Consultation; Psychotherapy; Psychotherapy - methods; Referral and Consultation - economics; Self report; Test Construction; Training; Treatment Compliance; Treatment methods; Treatment Outcomes
• ISSN: 0022-006X; 1939-2117
• DOI: 10.1037/ccp0000536

Objective: Implementation of evidence-based treatments in funded trials is often supported by expert case consultation for clinicians; this may be financially and logistically difficult in clinical practice. Might less costly implementation support produce acceptable treatment fidelity and clinical outcomes? Method: To find out, we trained 42 community clinicians from four community clinics in Modular Approach to Therapy for Children (MATCH), then randomly assigned them to receive multiple lower-cost implementation supports (LC) or expert MATCH consultation plus lower-cost supports (CLC). Clinically referred youths (N = 200; ages 7-15 years, M = 10.73; 53.5% male; 32.5% White, 27.5% Black, 24.0% Latinx, 1.0% Asian, 13.5% multiracial, 1.5% other) were randomly assigned to LC (n = 101) or CLC (n = 99) clinicians, and groups were compared on MATCH adherence and competence, as well as on multiple clinical outcomes using standardized measures (e.g., Child Behavior Checklist, Youth Self-Report) and idiographic problem ratings (Top Problems Assessment). Results: Coding of therapy sessions revealed substantial therapist adherence to MATCH in both conditions, with significantly stronger adherence in CLC; however, LC and CLC did not differ significantly in MATCH competence. Trajectories of change on all outcome measures were steep, positive, and highly similar for LC and CLC youths, with no significant differences; a supplemental analysis of posttreatment outcomes also showed similar LC and CLC posttreatment scores, with most LC-CLC differences nonsignificant. Conclusions: The findings suggest that effective implementation of a complex intervention in clinical practice may be supported by procedures that are less costly and logistically challenging than expert consultation. What is the public health significance of this article? Expert consultation, sometimes used to support implementation of evidence-based therapies, may be difficult to arrange and fund in some practice settings. Our findings suggest that effective implementation in clinical practice may be supported by a combination of lower-cost procedures in the absence of expert consultation.