Understanding the Effectiveness of the Cascading Model to Implement Parent-Child Interaction Therapy
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Journal of Behavioral Health Services & Research, 2020. 1–18. c 2020 National Council for Behavioral Health. DOI 10.1007/s11414-020-09732-2
Use of the Cascading Model to Implement PCIT
BRABSON ET AL.
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.
Introduction The field of implementation science, which focuses on studying methods to promote the uptake and integration of evidence-based practices (EBPs) into routine care, emerged amid calls to increase consumer access to effective behavioral health treatment [1–3]. Implementation barriers are complex and exist across individual, organizational, and system levels [4]. Clinician training is one such barrier that has been identified by stakeholder groups as both considerable and modifiable [5], marking it as an important point of intervention to facilitate implementation efforts. Though training alone is not sufficient to promote successful EBP implementation [6–8], it is a crucial factor in the early adoption [5] and long-term sustainability [9] of EBPs. As such, there have been efforts to better understand specific components of effective training methods to produce the most favorable training outcomes. Research on traditional didactic strategies that are common in EBP training (e.g., workshops, review of written materials) [6, 10] has shown that these strategies increase clinician knowledge and improve clinician attitudes toward EBPs; however, no consistent changes in clinician behavior or client outcomes have been noted [11, 12]. Subsequent research has indicated that the addition of ongoing support (i.e., expert consultation) following the initial training period fosters changes in clinician behavior [8, 10] and improved client outcomes [13]. This body of research has yielded recommendations that EBP trainings include components that encourage active participation as well as some form of ongoing support [10, 14, 15]. Identifying specific training components and strategies that produce the best outcomes is an important first step in developing a competent and effective behavioral health workforce. Unfortunately, barriers exist to conducting effective trainings that are interactive and include ongoing support. The primary barrier is that the provision of such trainings is both costly and timeconsuming [16, 17]. This is further compounded by the current shortage of behavioral health clinicians in general [18, 19], as well as a shortage of qualified trainers and consultants [20, 21]. Given these barriers, it is important to develop and test innovative strategies for effectively training clinicians in EBPs. Cascading model One training method with the potential to address some of the barriers noted above is the Cascading Model (CM) [22], which has also been referred to as the train-the-train
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