Dorsey Shannon, AlRasheed Rashed, Kerns Suzanne Eu, Meza Rosemary D, Triplett Noah, Deblinger Esther, Jungbluth Nathaniel, Berliner Lucy, Naithani Lavangi, Pullmann Michael D
Department of Psychology, University of Washington, Seattle, WA, USA.
The Kempe Center, University of Colorado-Anschutz, Aurora, CO, USA.
Implement Res Pract. 2025 May 23;6:26334895251330523. doi: 10.1177/26334895251330523. eCollection 2025 Jan-Dec.
Clinicians need supports beyond training to deliver evidence-based treatments with fidelity. Workplace-based clinical supervision often is a commonly provided support in community mental health, yet too few studies have empirically examined supervision and its impact on clinician fidelity and treatment delivery.
Building on a Washington State-funded evidence-based treatment initiative (CBT+), we conducted a randomized controlled trial (RCT), testing two supervision conditions delivered by workplace-based supervisors (supervisors employed by community mental health organizations). The RCT followed a supervision-as-usual (SAU) phase for comparison. The treatment of focus was trauma-focused cognitive behavioral therapy (TF-CBT). Clinicians ( = 238) from 25 organizations participated in the study across the SAU baseline and RCT phases. In the RCT phase, clinicians were randomized to either symptom and fidelity monitoring (SFM) or SFM and behavioral rehearsal (SFM + BR). For BR, clinicians engaged in a short role play of an upcoming treatment element. Supervisors delivered both conditions, with regular study monitoring for drift. Clinicians audiorecorded therapy sessions with enrolled clients, and masked coders coded a subset of recordings for adherence to TF-CBT. One hundred and thirty-three clinicians had recorded TF-CBT session data for 258 youth. We examined six adherence outcomes, including potential moderators.
Results of generalized estimating equations indicated that there were no real differences on adherence outcomes for experimental conditions (SFM, SFM + BR) compared to SAU. Adherence scores in the baseline SAU phase and the RCT conditions were high. Only one interaction was significant.
Contrary to our hypotheses, we did not see improvements in adherence with the RCT conditions. However, nonsignificant findings seem best explained by clinicians' acceptable/high adherence in SAU. This study was conducted within the context of a long-standing, state-funded EBT initiative, in which clinicians and their supervisors receive training and support, and in which participating community mental health organizations have adopted and supported TF-CBT.
NCT01800266.
临床医生在提供基于证据的高质量治疗时，除了培训之外还需要其他支持。基于工作场所的临床督导通常是社区心理健康领域常见的一种支持方式，但实证研究督导及其对临床医生治疗保真度和治疗实施影响的研究却太少。
基于华盛顿州资助的一项基于证据的治疗计划（CBT+），我们开展了一项随机对照试验（RCT），测试由基于工作场所的督导（社区心理健康组织雇佣的督导）提供的两种督导条件。该RCT设有一个常规督导（SAU）阶段作为对照。重点治疗方法是创伤聚焦认知行为疗法（TF-CBT）。来自25个组织的238名临床医生参与了整个SAU基线期和RCT阶段的研究。在RCT阶段，临床医生被随机分配到症状与保真度监测（SFM）组或SFM与行为预演（SFM+BR）组。对于BR组，临床医生就即将进行的治疗环节进行简短的角色扮演。督导提供这两种条件，同时研究定期监测是否出现偏差。临床医生对与登记客户的治疗会话进行录音，且由盲法编码人员对一部分录音进行TF-CBT依从性编码。133名临床医生记录了针对258名青少年的TF-CBT会话数据。我们检查了六项依从性结果，包括潜在的调节因素。
广义估计方程的结果表明，与SAU相比，实验条件（SFM、SFM+BR）在依从性结果上没有实际差异。基线SAU阶段和RCT条件下的依从性得分都很高。只有一个交互作用具有显著性。
与我们的假设相反，我们没有看到RCT条件下依从性的改善。然而，非显著性结果似乎最好的解释是临床医生在SAU中的依从性可接受/较高。本研究是在一项长期的、由州政府资助的循证治疗计划背景下进行的，在该计划中，临床医生及其督导接受培训和支持，且参与的社区心理健康组织已采用并支持TF-CBT。
NCT01800266。
