Disseminating evidence-base treatment
Thomas Insel, MD, the past director of the National Institute of Mental Health has said, “We have powerful, evidence-based psychosocial interventions, but they are not widely available . . . A serious deficit exists in training for evidence-based psychosocial interventions.”10 The following models can be used to increase the dissemination of evidence-based treatments for EDs (Table).
Train-the-trainer. Current approaches to training therapists to conduct new treatments typically consist of a 1- or 2-day workshop delivered by an expert; attendees are provided with a therapy manual. While workshops increase therapists’ knowledge, without further consultation their effect may be short-lived. Alternatively, there is a strong theoretical case for the “train-the-trainer” approach, which centers around an individual (the trainer) from a given setting (eg, community mental health center, college counseling center) who will be trained and will then train his or her colleagues. In addition, the trainer provides consultation as needed to anyone implementing the new treatment. In this way, the trainer becomes an internal coach and champion for the treatment.
This approach has been recommended as the most effective means of changing therapist behavior.11 The train-the-trainer approach also has the benefit of being more sustainable and cost-effective over time, as the trainer can continue to train new cohorts of therapists at relatively low cost. There is preliminary support for the usefulness of this method for guided self-help CBT.12 This approach is currently being tested as a method for training college counselors in interpersonal psychotherapy for EDs and depression.13
Web-centered training. Another method is web-centered training, which is scalable and low cost.
It has several key advantages:
1) Training can be offered to geographically dispersed trainees using minimal person-based resources.
2) The website can be accessed anytime, anywhere to effectively accommodate busy schedules.
3) It enables trainees to repeatedly review material, reinforcing learning.
4) The process can be customized to the trainee with quizzes, feedback, and refresher courses.
5) The website can be updated regularly, facilitating incorporation of new information.
6) Data collection on website usage can provide valuable information on the most accessed program features, informing refinement.
Dr Fitzsimmons-Craft is Assistant Professor of Psychiatry, and Dr Wilfley is the Scott Rudolph University Professor of Psychiatry, Medicine, Pediatrics, and Psychological and Brain Sciences, Washington University School of Medicine, St. Louis, MO. The authors report no conflicts of interest concerning the subject matter of this article.
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