No train, no gain?

What kind of training is needed for what type of clinician to deliver what type of therapy? An article in Clinical Psychology: Science and Practice by Beidas and Kendall (“Training Therapists in Evidence-Based Practices: A Critical Review of Studies from a Systems-Contextual Perspective,” 2010;17:1-30) featured well-considered recommendations for further research into systematic strategies for training clinicians to utilize evidence-based treatments, highlighting the limitations of didactic training alone (without supervision, fidelity monitoring, and feedback) in conferring specific skills to clinicians.

To further amplify some of the points made, this article summarizes findings from a recent series of platform/ancillary studies in the National Drug Abuse Treatment Clinical Trials Network which evaluated the impact of training and supervision of clinicians using motivational interviewing (MI) in protocols CTN-0004, CTN-0005, and CTN-0021. In particular, review of tapes from the “treatment as usual” conditions in those studies suggests that (a) delivery of interventions associated with evidence-based treatment was infrequent; (b) clinicians overestimated the time spent on evidence-based interventions, and (c) ongoing supervision and performance-based feedback appear to suppress time spent in session on discourse unrelated to the patient’s problems and concerns. This article also discusses computer-assisted treatment and computer-assisted clinician training as important new tools for disseminating evidence-based therapies.

Related protocols: CTN-0004, CTN-0005, CTN-0021