%0 Journal Article %J Implement Sci %D 2013 %T Improving practice in community-based settings: a randomized trial of supervision - study protocol. %A Dorsey, Shannon %A Pullmann, Michael D %A Deblinger, Esther %A Berliner, Lucy %A Kerns, Suzanne E %A Thompson, Kelly %A Unützer, Jürgen %A Weisz, John R %A Garland, Ann F %K Adolescent %K Child %K Cognitive Therapy %K Community Mental Health Centers %K Community Mental Health Services %K Evidence-Based Medicine %K Humans %K Interprofessional Relations %K Mental Disorders %K Treatment Outcome %K Washington %X

BACKGROUND: Evidence-based treatments for child mental health problems are not consistently available in public mental health settings. Expanding availability requires workforce training. However, research has demonstrated that training alone is not sufficient for changing provider behavior, suggesting that ongoing intervention-specific supervision or consultation is required. Supervision is notably under-investigated, particularly as provided in public mental health. The degree to which supervision in this setting includes 'gold standard' supervision elements from efficacy trials (e.g., session review, model fidelity, outcome monitoring, skill-building) is unknown. The current federally-funded investigation leverages the Washington State Trauma-focused Cognitive Behavioral Therapy Initiative to describe usual supervision practices and test the impact of systematic implementation of gold standard supervision strategies on treatment fidelity and clinical outcomes.

METHODS/DESIGN: The study has two phases. We will conduct an initial descriptive study (Phase I) of supervision practices within public mental health in Washington State followed by a randomized controlled trial of gold standard supervision strategies (Phase II), with randomization at the clinician level (i.e., supervisors provide both conditions). Study participants will be 35 supervisors and 130 clinicians in community mental health centers. We will enroll one child per clinician in Phase I (N = 130) and three children per clinician in Phase II (N = 390). We use a multi-level mixed within- and between-subjects longitudinal design. Audio recordings of supervision and therapy sessions will be collected and coded throughout both phases. Child outcome data will be collected at the beginning of treatment and at three and six months into treatment.

DISCUSSION: This study will provide insight into how supervisors can optimally support clinicians delivering evidence-based treatments. Phase I will provide descriptive information, currently unavailable in the literature, about commonly used supervision strategies in community mental health. The Phase II randomized controlled trial of gold standard supervision strategies is, to our knowledge, the first experimental study of gold standard supervision strategies in community mental health and will yield needed information about how to leverage supervision to improve clinician fidelity and client outcomes.

TRIAL REGISTRATION: ClinicalTrials.gov NCT01800266.

%B Implement Sci %V 8 %P 89 %8 2013 %G eng %R 10.1186/1748-5908-8-89 %0 Journal Article %J Child Maltreat %D 2012 %T Child welfare caseworkers as service brokers for youth in foster care: findings from project focus. %A Dorsey, Shannon %A Kerns, Suzanne E U %A Trupin, Eric W %A Conover, Kate L %A Berliner, Lucy %K Case Management %K Child %K Child Welfare %K Evidence-Based Practice %K Female %K Foster Home Care %K Humans %K Male %K Mental Disorders %K Referral and Consultation %K Washington %X

Youth in the foster care system have substantially higher rates of mental health needs compared to the general population, yet they rarely receive targeted, evidence-based practices (EBPs). Increasingly emerging in the literature on mental health services is the importance of "brokers" or "gateway providers" of services. For youth in foster care, child welfare caseworkers often play this role. This study examines caseworker-level outcomes of Project Focus, a caseworker training and consultation model designed to improve emotional and behavioral outcomes for youth in foster care through increased linkages with EBPs. Project Focus was tested through a small, randomized trial involving four child welfare offices. Caseworkers in the Project Focus intervention group demonstrated an increased awareness of EBPs and a trend toward increased ability to identify appropriate EBP referrals for particular mental health problems but did not have significantly different rates of actual referral to EBPs. Dose of consultation was associated with general awareness of EBPs. Implications for practice and outcomes for youth are discussed.

%B Child Maltreat %V 17 %P 22-31 %8 2012 Feb %G eng %N 1 %R 10.1177/1077559511429593