Bev Haarhoff, Transfer of training fade away or show and tell


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Bev Haarhoff, Transfer of training fade away or show and tell

  1. 1. Evaluating postgraduate CBT training in New zealand<br /> dr Beverly Haarhoff <br /> Massey University, Auckland.<br />Transfer of training: “Fade away or show and tell!” <br />
  2. 2. Agenda<br />Why is the evaluation of maintenance and transfer of training in psychotherapy important? <br />Obstacles and difficulties in assessing transfer<br />Brief look at current state of play in terms of research in the CBT field<br />Our study (descriptive data)<br />Problems<br />A way forward<br />
  3. 3. Defining transfer of training<br />“Transfer of training is defined as the generalisation and maintenance of new information, knowledge, attitudes and skills into the everyday practice of trainees”<br />Baldwin & Ford, 1988.<br />
  4. 4. Transfer of training why measure?<br />Management and allocation of resources<br />Increasing access to evidenced based therapies (IAPT program)<br />What works? <br />For whom?<br />To improve patient/client outcome<br />
  5. 5. Transfer of training in Psychotherapy?<br />*Difficult area to research<br />Comparatively few studies (increasing in CBT)<br />Lack of funding (the field falls between psychotherapy & education)<br />Competing psychotherapy training programs and paradigms<br />(profession specific, short-term, comprehensive, scholar-practitioner, scientist-practitioner, ‘apprenticeship model’, emphasis on personal therapy etc.) <br />
  6. 6. Evaluating CBT transfer of training<br /> More complications!<br />What represents competence? (which competecies? General or specific?)<br />Trainee Self-report ?<br />Supervisor ‘indirect’ report?<br />Objective scoring of competence? <br />Evaluation of patient outcome?<br />The willingness of graduates to participate? <br />Small participant samples (limited access programs) <br />
  7. 7. Transfer of training in CBT<br />Empirical studies have increased since 1999<br />Still heavily reliant on the self report of trainees <br />The few studies using ‘objective’ observation methods such as the Cognitive Therapy Scale (Young & Beck, 1980) measure overall competence have have generally been positive.<br />Very few linked to outcome or praticing CBT therapists<br />
  8. 8. Recent studies<br />McManus, Westbrook, Vazquez-Montes, Fennell & Kennerley, 2010.<br />Oxford Diploma CBT Course<br />278 trainees between 1998-2009<br />Increased competence <br />Clinical Psychologists achieved consistently better results<br />Age negatively correlated with improved competency <br />
  9. 9. Brosan, Reynolds & Moore, 2006<br />Naturalistic study<br />Practitioners recruited from a range of professions<br />mid t/m recorded CBT session rated using the CTS<br />5380 practitioners approached<br />47 responded & only 24 submitted tapes<br />Psychologists found to be the most competent<br />However a number of accredited therapist scored below the expected level of competence<br />
  10. 10. The Massey University Postgraduate CBT diploma<br />Minimum of two years Part-time<br />Phase one: theoretical: four papers taught in block mode namely Theory and Practice of CBT, CBT for Depression, CBT for the Anxiety Disorders and CBT for chronic and complex problems.<br />Phase two: Supervised clinical practicum over two semesters. x Two clients, two case studies and two verbal case presentations. (all supervision in-house)<br />Final oral exam with the focus on case conceptualisation <br />
  11. 11. The study<br />Questions:<br />★Is CBT competence maintained and transferred beyond training?<br /> Is therapist self-reported competence in using CBT related to observed use of CBT?<br /> Is professional development as therapist related to self-reported competence and observed competence?<br /> Is work involvement positively related to self-reported and observed competence as a CBT therapist?<br />
  12. 12. Measures<br />*Cognitive Therapy Scale (Young & Beck, 1980, 1988) (the most widely used & validated instrument for assessing CBT competence McManus et al., 2010)<br />Adapted Survey of PGDipCBT (Kennedy-Merrick et al., 2006)<br />Therapist Professional Development questionnaire (Orlinsky & Rønnestad, 2005)<br />Psychotherapist work involvement questionnaire (Orlinsky & Rønnestad, 2005) <br />
  13. 13. The Cognitive Therapy Scale (Young & Beck, 1980, 1988)<br />General therapeutic procedures & interpersonal effectiveness<br />Agenda<br />Feedback<br />Understanding<br />Interpersonal effectiveness<br />Collaboration<br />Pacing & efficient use of time<br />‘Red-line’ = 39-44 (RCT)<br />Specific CBT skills <br />Guided discovery<br />Focusing on key cognitions and behaviours<br />Strategy for change<br />Application of CBT Techniques<br />Homework<br />Each item rated on a (0-6) Likert scale yielding a total score of 66<br />
  14. 14. Participants<br />The participants were drawn from two groups of CBT trainees<br />Group one: trainees enrolled in the PGDipCBT during 2009<br />*Group two: Graduates from the PGDipCBT (2000-2009)<br />Mental health practitioners across multiple professions: psychologists, social workers, nurses, psychiatric registrars and consultants, GP’s, Occupational therapists, psychotherapists & counsellors<br />
  15. 15. Participants : Group Two<br />Of the 88 graduates between 2000-2009, 42% (n=37) were not contactable<br />Of the remaining 58% (n=51), 20 were currently not practicing CBT and 9 declined to participate. <br />A total of 29 agreed to participate in the study but of this group only 12 provided recorded examples of their clinical work. <br />Of this sample one tape was unusable and only 11 clinicians eventually took part (12.5% of the total sample)<br />
  16. 16. Results: Cognitive Therapy Scale (Young & Beck,1980,1988)<br />
  17. 17. Competent?<br />Out of 11 participants n=7 (64%) achieved competence scoring above the 39 ‘red-line’ competence for RCT criteria<br />3 of 7 were clinical psychologists, 43%<br />
  18. 18. Participants below the ‘red-line’<br />Poor performance in specific CBT competencies and skills <br />
  19. 19. Difficulties: Participant recruitment<br />
  20. 20. Difficulties<br />Fear of negative evaluation<br />Obtaining recorded clinical material (patient consent, graduate resistance, technological difficulties)<br />Expensive (scoring of competence measures)<br />
  21. 21. A way forward<br />Providing a strong rationale for participation in competency evaluation<br />Building in positive reinforcement for participation<br />Building a culture of accountability<br />Improving access to supervision<br />Technological support & know how<br />Deseminating feedback from research<br />
  22. 22. Acknowledgements<br />Robyn Gedye (PhD candidate)<br />Dr Mei Williams Senior Lecturer Massey University<br />Lynley Stenhouse (Clinical Psychologist)<br />Sarah Kennedy-Merrick PhD<br />Study participants Graduates of the Massey University Post Graduate Diploma in CBT 2000-2009.<br />
  23. 23. questions<br />