Training Community Therapists in Core Elements of CBT and Family Therapy for Adolescent Externalizing Problems

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.

Acknowledgments

The authors gratefully acknowledge the contributions of our talented clinician colleagues who participated in producing video vignettes for coder training: Nestor Borrero, Megan Braconnier, Elizabeth Casline, Julia Chan, Cheryl Ching, Mickey Correa, Guy Diamond, Genoveva Garcia, Suzanne Levy, Elisabeth Liu, Marissa Moore, Nicole Porter, Niza Tonarely, and Jennifer Wolff. We also thank our dedicated team of observational coders: Marcus Daugherty, Cori Hammond, Jill Plevan, Chris Tapia, Kenia Valentin, Kelly Roberts, and Erica Zakotyansky.

Disclosure Statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

Preparation of this article was supported by the National Institute of Mental Health [R34MH117212; PI: Hogue]; the content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The trial registration number (ClinicalTrials.gov) is NCT03722654.