Training transfer: a systematic review of the impact of inner setting factors.

Consistent with Baldwin and Ford's model (Pers Psychol 41(1):63-105, 1988), training transfer is defined as the generalization of learning from a training to everyday practice in the workplace. The purpose of this review was to examine the influence of work-environment factors, one component of the model hypothesized to influence training transfer within behavioral health. An electronic literature search guided by the Consolidated Framework for Implementation Research's inner setting domain was conducted was conducted on Medline OVID, Medline EMBASE, and PsycINFO databases. Of 9184 unique articles, 169 full-text versions of articles were screened for eligibility, yielding 26 articles meeting inclusion criteria. Results from the 26 studies revealed that overall, having more positive networks and communication, culture, implementation climate, and readiness for implementation can facilitate training transfer. Although few studies have examined the impact of inner setting factors on training transfer, these results suggest organizational context is important to consider with training efforts. These findings have important implications for individuals in the broader health professions educational field.

Developing pictorial asthma action plans to promote self-management and health in rural youth with asthma: A qualitative study.

OBJECTIVE: Asthma action plans (AAPs) provide asthma management instructions to families; however, AAPs typically are written at a 7th-9th grade reading level, making them less useful in lower literacy families. There is a need to develop simpler AAP formats and content to optimize their utility across all families, including those who are rural and may be at a risk for literacy concerns. Because using pictures can simplify and enhance health education, our study's aim was to develop a pictorial AAP through a series of focus groups with key stakeholders - youth with asthma, caregivers, and physicians. METHODS: Fourteen caregiver/youth dyads and four physicians participated in separate focus groups where their preferences for pictorial AAP structure and content were obtained. Focus groups were audio recorded, transcribed, coded with ATLAS.ti, and analyzed for themes. RESULTS: Youth and their caregivers prefer that the AAPs include simple, cartoon-like pictures customized to the patient. Physicians emphasized AAP's capability to display pictures of controller medication given its importance in preventing asthma exacerbations. A stoplight format, currently used in most written AAPs, received positive reviews. Specific suggestions for pictures showing symptoms, medications, and how to take medication were suggested. Words and short phrases accompanying the pictures were thought to add clarity. CONCLUSIONS: Key stakeholders viewed pictorial AAPs as positive and potentially effective alternatives to standard written AAPs. It is expected that low literacy youth and caregivers would more easily understand a pictorial AAP presentation, which should facilitate better medication adherence and asthma outcomes in these children.

Web-Based Training Methods for Behavioral Health Providers: A Systematic Review.

There has been an increase in the use of web-based training methods to train behavioral health providers in evidence-based practices. This systematic review focuses solely on the efficacy of web-based training methods for training behavioral health providers. A literature search yielded 45 articles meeting inclusion criteria. Results indicated that the serial instruction training method was the most commonly studied web-based training method. While the current review has several notable limitations, findings indicate that participating in a web-based training may result in greater post-training knowledge and skill, in comparison to baseline scores. Implications and recommendations for future research on web-based training methods are discussed.

Efficacy of parent-delivered behavioral therapy for primary complex motor stereotypies.

AIM: Primary complex motor stereotypies (CMS) are persistent, patterned, repetitive, rhythmic movements in young people with typical development. This study evaluated the efficacy of an instructional DVD as a home-based, parent-administered, behavioral therapy for primary CMS. METHOD: Eighty-one children with primary CMS were enrolled. Primary outcome measures included the Stereotypy Severity Scale (SSS) - Motor and Impairment scores, and Stereotypy Linear Analog Scale (SLAS). Mean CMS onset was 13.4 months (SD 13.1). Eligibility required observed CMS. Psychiatric disorders were not exclusionary and a stable medication regimen was required. Intellectual disability, neurological disorder, autism spectrum disorder, and tics were exclusionary. Initial assessments were completed via REDCap before receipt of the DVD. Fifty-four of the 81 children (34 male, 20 female; mean age 8y 2mo, SD 1.42, range 7-14y) completed assessments at 1, 2, or 3 months after receiving the DVD. RESULTS: Reductions (baseline to last assessment) in SSS Motor, SSS Impairment, and SLAS scores (all p<0.001) represented change ratios of -15%, -24%, and a -20% respectively. Greatest relative treatment benefit was observed by younger children (ages 7-8y), and by 1 month after receipt of DVD, while a parent global assessment scale showed progressive improvement throughout the study. INTERPRETATION: An instructional DVD for parent-delivered behavioral therapy was a safe, effective intervention for primary CMS.

Usability testing of an electronic health application for patient activation on weight management.

BACKGROUND: Obesity is a leading public health concern in the United States. One promising method for enhancing patient activation to engage in health promoting behaviors is with technology in the primary care setting. The primary purpose of this study was to test the usability of a patient activation tool, called mWRAPPED, for weight management during primary care wait times. METHODS: A two-cycle approach to usability testing was followed by a pragmatic usability study in the primary care setting. The application was subsequently revised based on patient feedback. A convenience sample of patients completed usability testing in the clinical setting. Patients completed the System Usability Scale throughout all testing phases. RESULTS: First cycle patients provided an average score of 76.5 on the System Usability Scale. After revising mWRAPPED, the average patient System Usability Scale score increased to 80.5. mWRAPPED received an average System Usability Scale score of 77.9 when tested in the clinical setting. mWRAPPED demonstrated initial usability for primary care patients in an academic outpatient family medicine clinical setting. CONCLUSIONS: Results of the current study will help to support the use of this application in future studies as a novel approach to delivering guideline-based weight management information to patients.

Understanding the Effectiveness of the Cascading Model to Implement Parent-Child Interaction Therapy.

Few community-based behavioral health clinicians are trained in evidence-based practices (EBPs). The Cascading Model (CM), a training model in which expert-trained clinicians train others at their agency, may help increase the number of EBP-trained clinicians. This study is one of the first to describe CM training methods and to examine differences between clinicians trained by an expert, and those trained through a within-agency training (WAT) by a fellow clinician. Results indicate that 56% of the 38 eligible clinicians chose to become trainers and 50% of the 56% conducted WATs to train others. This represents a 50% increase in EBP-trained clinicians within the study timeframe. Clinicians trained by an expert reported higher knowledge and training satisfaction than those trained through a WAT. Of note, clinicians trained through a WAT reported increases in EBP knowledge and were more diverse (race/ethnicity, employment status), suggesting that the CM may improve access to EBPs.

Workforce Turnover in Community Behavioral Health Agencies in the USA: A Systematic Review with Recommendations.

Rates of behavioral health workforce turnover are chronically high, with detrimental effects on the agency and remaining staff, as well as hypothesized negative impacts on client care and outcomes. Turnover also creates challenges for studies investigating the effectiveness and/or implementation of behavioral health interventions. Research examining factors that precede and predict behavioral health staff turnover has become increasingly important, as have studies that include recommendations for preventing and reducing turnover. The current paper systematically reviews the body of research on factors associated with behavioral health staff turnover, synthesizes recommendations made for combating turnover, and identifies gaps in this important area of research.

Mixed method study of workforce turnover and evidence-based treatment implementation in community behavioral health care settings.

BACKGROUND: Practitioner turnover in behavioral health settings is high and hinders the implementation of new interventions. OBJECTIVE: This study examined practitioner and organizational characteristics that contribute to high staff turnover in community behavioral health settings. PARTICIPANTS AND SETTING: Clinicians in nine community-based agencies participated. Included agencies treated a high volume of families referred from child welfare. METHODS: This study was part of a larger trial testing the effectiveness of a Cognitive Behavior Therapy for family conflict. Authors assessed predictors of turnover quantitatively and qualitatively. Quantitative data was collected prospectively (n = 169) on practitioner and organizational-level variables (e.g., demographics, professional practice, job satisfaction, emotional exhaustion, organizational commitment). Semi-structured interviews with practitioners who left their agencies (n = 40) provided qualitative data retrospectively. RESULTS: Forth-five percent of practitioners left their agencies over three years. Two predictors of final survival status (lower age and lower job satisfaction) were associated with leaving the agency at the p < .05 level; however, they accounted for very little variance. Qualitative themes highlighted the importance of job characteristics, compensation, productivity requirements, advancement opportunities, and co-worker relationships as influential in the decision to leave. CONCLUSIONS: This study highlights the value of a mixed-method approach given that themes emerged from the qualitative interviews that were not accounted for in the quantitative results. Additional research is needed to better understand workforce turnover so that strategies can be developed to stabilize the behavioral health workforce.

Associations Among Job Role, Training Type, and Staff Turnover in a Large-Scale Implementation Initiative.

Staff turnover is problematic for behavioral health agencies implementing evidence-based practices (EBPs), which are costly and time-consuming. The current study examined the association between EBP training methods and turnover and explored predictors of turnover for different types of staff. Participants (100 clinicians, 50 supervisors, 50 administrators) were randomized to one of three training conditions for an EBP. Results indicated low annual rates of turnover for clinicians, supervisors, and administrators. However, contrary to hypothesis, no statistically significant differences were found in rates of turnover across training conditions. Partially consistent with prior research, organizational climate was a significant predictor of supervisor and administrator turnover at 24 months, but was not a significant predictor of clinician turnover. Implications and future directions for research are discussed.

Parent-Child Interaction Therapy: current perspectives.

Parent-Child Interaction Therapy (PCIT) is an empirically supported intervention originally developed to treat disruptive behavior problems in children between the ages of 2 and 7 years. Since its creation over 40 years ago, PCIT has been studied internationally with various populations and has been found to be an effective intervention for numerous behavioral and emotional issues. This article summarizes progress in the PCIT literature over the past decade (2006-2017) and outlines future directions for this important work. Recent PCIT research related to treatment effectiveness, treatment components, adaptations for specific populations (age groups, cultural groups, military families, individuals diagnosed with specific disorders, trauma survivors, and the hearing-impaired), format changes (group and home-based), teacher-child interaction training (TCIT), intensive PCIT (I-PCIT), treatment as prevention (for externalizing problems, child maltreatment, and developmental delays), and implementation are discussed.

Patterned changes in urge ratings with tic suppression in youth with chronic tic disorders.

BACKGROUND: Premonitory urges are central to emerging behavioral models of chronic tic disorders (CTD). Urge reduction has been proposed as a behavioral explanation for tic maintenance and exacerbation as well as the efficacy of behavioral treatments. Prior investigations have produced inconsistent findings despite common methodologies. The current study evaluated the possibility that data aggregation obscures distinct and meaningful patterns of change in urge ratings when tics are freely expressed versus suppressed. METHOD: Participants (n = 12) included children with moderate-to-marked tic severity and noticeable premonitory urges. Tic frequencies and urge ratings were obtained at 15 s and 10-s intervals, respectively, across an alternating sequence of 10-min tic freely and 40-min tic suppression conditions. Patterns were established using a two step approach. RESULTS: Five distinct patterns of urge rating change emerged, suggesting data aggregation may obscure meaningful patterns in the urge-tic relationship when tics are completed versus suppressed. LIMITATIONS: Eligibility criteria may have unintentionally excluded younger affected children and included older participants with more severe tic disorders than commonly seen. Additional research with less stringent eligibility criteria and a larger sample size will help validate the results. CONCLUSIONS: The relationship between urges and tics is much more complex than previously theorized. Investigations that rely on global assessments of urge and tic severity and/or assume uniformity when aggregating participant data may obscure meaningful differences in the urge-tic relationship. Future investigations should examine the possibility that individual differences and/or developmental considerations modulate the functional urge-tic relationship.