Nancy Puttkammer, Jane M. Simoni, Tracy Sandifer, Jean Marcxime Chéry, Witson Dervis, Jean Gabriel Balan, Jean Geto Dubé, Guirlaine Calixte, Ermane Robin, Kesner François, Cameron Casey, Ira Wilson & Jean Guy Honoré
University of Washington affiliated authors are displayed in bold.
Published: July 2020
Lisa Amaya-Jackson, Dana Hagele, John Sideris, Donna Potter, Ernestine C. Briggs, Leila Keen, Robert A. Murphy, Shannon Dorsey, Vanessa Patchett, George S. Ake and Rebecca Socolar
University of Washington affiliated authors are displayed in bold.
Published: July 2018
A model for statewide dissemination of evidence-based treatment (EBT) for traumatized youth was piloted and taken to scale across North Carolina (NC). This article describes the implementation platform developed, piloted, and evaluated by the NC Child Treatment Program to train agency providers in Trauma-Focused Cognitive Behavioral Therapy using the National Center for Child Traumatic Stress Learning Collaborative (LC) Model on Adoption & Implementation of EBTs. This type of LC incorporates adult learning principles to enhance clinical skills development as part of training and many key implementation science strategies while working with agencies and clinicians to implement and sustain the new practice.
Clinicians (n = 124) from northeastern NC were enrolled in one of two TF-CBT LCs that lasted 12 months each. During the LC clinicians were expected to take at least two clients through TF-CBT treatment with fidelity and outcomes monitoring by trainers who offered consultation by phone and during trainings. Participating clinicians initiated treatment with 281 clients. The relationship of clinician and client characteristics to treatment fidelity and outcomes was examined using hierarchical linear regression.
One hundred eleven clinicians completed general training on trauma assessment batteries and TF-CBT. Sixty-five clinicians met all mastery and fidelity requirements to meet roster criteria. One hundred fifty-six (55%) clients had fidelity-monitored assessment and TF-CBT. Child externalizing, internalizing, and post-traumatic stress symptoms, as well as parent distress levels, decreased significantly with treatment fidelity moderating child PTSD outcomes. Since this pilot, 11 additional cohorts of TF-CBT providers have been trained to these roster criteria.
Scaling up or outcomes-oriented implementation appears best accomplished when training incorporates: 1) practice-based learning, 2) fidelity coaching, 3) clinical assessment and outcomes-oriented treatment, 4) organizational skill-building to address barriers for agencies, and 5) linking clients to trained clinicians via an online provider roster. Demonstrating clinician performance and client outcomes in this pilot and subsequent cohorts led to legislative support for dissemination of a service array of EBTs by the NC Child Treatment Program.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
Jonathan D. Fuchs, Kristefer Stojanovski, Eric Vittinghoff, Vanessa M. McMahan, Sybill G. Hosek, K. Rivet Amico, Aminta Kouyate, Hailey J. Gilmore, Susan P. Buchbinder, Richard T. Lester, Robert M. Grant, and Albert Y. Liu
University of Washington affiliated authors are displayed in bold.
Published: March 2018
Christopher G. Kemp, Julia de Kadt, Erushka Pillay, Jennifer M. Gilvydis, Evasen Naidoo, Jessica Grignon and Marcia R. Weaver
University of Washington affiliated authors are displayed in bold.
Published: May 2017
Prevention interventions for people living with HIV/AIDS are an important component of HIV programs. We report the results of a pilot evaluation of a four-hour, clinic-based training for healthcare providers in South Africa on HIV prevention assessments and messages. This pre/post pilot evaluation examined whether the training was associated with providers delivering more prevention messages.
Seventy providers were trained at four public primary care clinics with a high volume of HIV patients. Pre- and post-training patient exit surveys were conducted using Audio-Computer Assisted Structured Interviews. Seven provider appropriate messaging outcomes and one summary provider outcome were compared pre- and post-training using Poisson regression.
Four hundred fifty-nine patients pre-training and 405 post-training with known HIV status were interviewed, including 175 and 176 HIV positive patients respectively. Among HIV positive patients, delivery of all appropriate messages by providers declined post-training. The summary outcome decreased from 56 to 50%; adjusted rate ratio 0.92 (95% CI = 0.87–0.97). Sensitivity analyses adjusting for training coverage and time since training detected fewer declines. Among HIV negative patients the summary score was stable at 32% pre- and post-training; adjusted rate ratio 1.05 (95% CI = 0.98–1.12).
Surprisingly, this training was associated with a decrease in prevention messages delivered to HIV positive patients by providers. Limited training coverage and delays between training and post-training survey may partially account for this apparent decrease. A more targeted approach to prevention messages may be more effective.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**