1. Clinician knowledge of evidence-based practice
elements for youth: A national study
Rosa M. Poggesi, Robert D. Friedberg, Ricardo F. Muñoz, & Robert Wickham
INTRODUCTION
RESULTS, CONT.
DISCUSSION
Findings
Length of EBP education was not related to EBP knowledge. This was consistent with previous literature (Nakamura et al., 2011). Outdated clinician knowledge may explain this finding. Education efforts to focus on changes in recent literature, rather than re-teaching long-standing interventions. Another possibility includes that self-report of training may be inaccurate (Creed, Wolk, Feinberg, Evans, & Beck, 2014). Other methods of corroborating length of EBP training may resolve this discrepancy. Regardless, use of the KEBSQ to assess provider knowledge in training efforts may facilitate identification of target growth areas.
The relationship between greater years of experience working and higher EBP knowledge scores approached significance. This was somewhat inconsistent with previous literature finding no relationship (Nakamura et al., 2011).
Possibility 1: years of clinical experience serves as evidence, similar to research literature on effective interventions
Possibility 2: the quality of clinical training is decreasing
EBP knowledge did not vary by geographic area, but approached significance. It is possible that there truly are no differences between clinicians of varying geographic areas. Perhaps population density combined with state/geographic region may clarify true differences regarding geographic area.
Providers in hospital settings were more knowledgeable than those in community MH settings and those in “other” treatment settings. This was consistent with previous literature (Nakamura et al., 2011). Quality improvement efforts stand to benefit from targeted education efforts for community clinicians.
Doctoral-level clinicians scored higher on practice element knowledge than masters-level participants. This was consistent with previous literature (Nakamura et al., 2011). Specifically, respondents with a doctorate in clinical psychology achieved higher knowledge scores than did those with masters in professional counseling degrees. This finding may be Possibly due to rigorous coursework or focus on scientific method. Integrating these into masters-level training may improve knowledge
Clinicians with cognitive behavioral theoretical orientation scored higher in practice element knowledge than providers identifying with integrative/eclectic, systems, and humanistic orientations. Previous literature found no relationship (Nakamura et al., 2011). This finding may possibly be due to the prevalence of evidence-based CBT protocols. CBT is the most prevalent modality taught in training programs (Creed et al., 2014). Additionally, CBT is the only EBP required for the psychiatry accreditation board (Creed et al., 2014). Clinicians who identify with a cognitive behavioral orientation may be most familiar with CBT due to greater training with this modality.
Implications
Training
EBP knowledge was related to education level but not length of training. This finding implies that the quality of EBP education is more important than length of EBP training. Determining which components of doctoral-level EBP training are most successful may provide a roadmap for improvement efforts for masters- and bachelors-level education. Based off the results of this study, targeted education efforts are recommended for clinicians in the following groups:
Early in their careers
With masters-level degrees
Professional field of mental health
Recent legislation calls for improved treatment outcomes in mental health care (Nordal, 2012). The use of EBPs demonstrates improvement in treatment outcomes as well as reduction in costs (Daleiden et al., 2006). Targeting specific groups of clinicians who could benefit most from EBP education stands to increase EBP use as well as adherence to APA and ACA guidelines. With increased use of EBPs in mental health care, treatment costs will decrease. Improving clinician knowledge of practice elements is a necessary step in implementing those interventions and achieving favorable treatment outcomes for youth.
Numerous evidence-based services exist to treat mental health concerns among youth. Despite the prevalence of such effective treatments, they are rarely implemented in community care settings.
Discrete clinical interventions called practice elements exist within evidence-based practices (EBPs; Chorpita et al., 2005). Clinician awareness of these practice elements is essential for the successful implementation of EBPs in mental health care. Limited provider knowledge of practice elements is arguably the greatest barrier to the dissemination of EBPs (Higa & Chorpita, 2008). Despite the importance of this area, limited research focuses on therapist demographic factors associated with knowledge of such practice elements (Stumpf et al., 2009). Identifying the provider demographic variables associated with practice element knowledge would allow for more efficient and targeted dissemination efforts, increasing the likelihood of EBP dissemination and success.
This study gathered information regarding clinician demographic factors associated with awareness knowledge of evidence-based practice elements for youth. The Knowledge of Evidence Based Services Questionnaire (KEBSQ; Stumpf, Higa-McMillan, & Chorpita, 2009) was used to measure awareness of practice elements.
RQ 4: Is treatment setting related to knowledge of practice elements?
The setting type explained a statistically significant amount of the variance in total knowledge scores (F (5, 94) = 3.444, p < .01). Knowledge scores for providers in hospital setting were greater than:
providers in community mental health settings (Tukey HSD=15.56; p < .01)
providers in “other” locations (Tukey HSD=16.96; p < .05)
RQ 5: Is a clinician’s highest obtained degree related to knowledge of practice elements?
Highest obtained degree category explained a statistically significant amount of the variance in total knowledge scores (F (1, 96) = , p < .01). Clinicians with doctoral degrees scored higher on the knowledge measure than did those with masters degrees (Tukey HSD=14.15; p < .001).
Highest obtained degree explained a statistically significant amount of the variance in total knowledge scores (F (7, 77) = 4.220, p < .01). Participants with a doctorate in clinical psychology achieved higher knowledge scores than did respondents with masters degree in professional counseling (Tukey HSD=20.22; p < .01).
METHODS
Participants
Respondents were recruited through s to training programs, agencies, and individual providers. Data from 101 clinicians from across the nation were included in the analyses.
Procedure
Participants provided consent online, and completed measures online through Qualtrics. Upon completion, clinicians received a list of relevant EBP resources.
Measures
A demographics questionnaire was created for this project, collecting information regarding training, education, location, etc. The 40-item Knowledge of Evidence-based Services Questionnaire (KEBSQ; Stumpf et al., 2009) was used to assess clinician awareness of practice elements for youth.
Analyses
Correlational analyses were computed for to assess the relationship between knowledge of practice elements and continuous demographic variables (years of EBP training, and years experience working with youth). Analysis of variance was used to determine whether categorical demographic variables (location, service setting, highest obtained degree, theoretical orientation) explained a significant amount of the variance in knowledge scores.
RQ 6: Is a clinician’s theoretical orientation related to knowledge of practice elements?
Theoretical orientation explained a statistically significant amount of the variance in total knowledge scores (F (4, 92) = 4.470, p < .01). Providers identifying with a cognitive behavioral theoretical orientation achieved higher knowledge scores than those identifying as integrative/eclectic (Tukey HSD=12.689; p<.01), systems (Tukey HSD=16.655; p<.05), and humanistic (Tukey HSD=13.455; p<.05).
Provide services in community-based settings
Integrative/eclectic theoretical orientations
RESULTS
RQ 1: Is knowledge of practice elements related to years of education in EBPs?
Length of EBP training was not significantly correlated with practice element knowledge scores (r=.089, p>.05).
REFERENCES
RQ 2: Is knowledge of practice elements related to years of experience working with youth?
Practice element knowledge scores were significantly correlated with greater years of experience treating youth (r=.172, p<.05 ). Clinicians who spent more time working with youth in treatment were significantly more knowledgeable regarding EBP elements.
Chorpita, B. F., Daleiden, E. L., & Weisz, J. R. (2005). Identifying and selecting the common elements of evidence based interventions: a distillation and matching model. Mental Health Services Research, 7(1), 5–20.
Creed, T. A., Wolk, C. B., Feinberg, B., Evans, A. C., & Beck, A. T. (2014). Beyond the Label: Relationship Between Community Therapists’ Self-Report of a Cognitive Behavioral Therapy Orientation and Observed Skills. Administration and Policy in Mental Health and Mental Health Services Research, 43(1), 36–43.
Daleiden, E. L., Chorpita, B. F., Donkervoet, C., Arensdorf, A. M., & Brogan, M. (2006). Getting better at getting them better: health outcomes and evidence-based practice within a system of care. Journal Of The American Academy Of Child And Adolescent Psychiatry, 45(6), 749–756.
Higa, C. K., & Chorpita, B. F. (2008). Evidence-based therapies: Translating research into practice. In R. G. Steele, T. D. Elkin, & M. C. Roberts (Eds.), Handbook of evidence-based therapies for children and adolescents: Bridging science and practice. (pp. 45– 61). New York, NY, US: Springer Science + Business Media.
Nakamura, B. J., Higa-McMillan, C. K., Okamura, K. H., & Shimabukuro, S. (2011). Knowledge of and attitudes towards evidence- based practices in community child mental health practitioners. Administration And Policy In Mental Health, 38(4), 287–
Nordal, K. C. (2012). Healthcare reform: Implications for independent practice. Professional Psychology: Research and Practice, 43(6), 535–544.
Stumpf, R. E., Higa-McMillan, C. K., & Chorpita, B. F. (2009). Implementation of evidence-based services for youth: assessing provider knowledge. Behavior Modification, 33(1), 48–65.
Limitations
Future Research
Generalizability
Unequal sampling of demographic variables
Limited sample size
RQ 3: Is clinician location related to knowledge of practice elements?
Geographic area did not explain a statistically significant amount of the variance in total knowledge scores (F (2, 97) = 2.792, p > .05), approaching significance. Knowledge scores were independent of clinician location
Diversify recruitment methods
Non-internet
Focus on masters disciplines
Larger sample size
Address correspondence to Rosa M. Poggesi, at