Training preservice general education teachers in response to intervention: A survey of teacher educators throughout the United States

Response to intervention (RTI) is an evidence-based approach to educational service delivery that is being increasingly adopted by schools across the country. To effectively implement RTI models, teachers require specialized training. Little is currently known, however, about the extent to which this training is being provided at the preservice level. The purpose of this survey study was to learn more about RTI-related training provided to preservice general educators in undergraduate elementary education programs. Respondents included 95 program directors of accredited college/university teacher education programs across the United States. Participants reported providing varying levels of didactic and applied training related to each of the six core components of RTI (i.e., multitiered service delivery, universal screening, progress monitoring, data-based decision making, evidence-based interventions, and fidelity of implementation). Although most teacher educators were familiar with the overall concept of RTI, over a third of respondents were not familiar with the core component of fidelity of implementation, and reported providing limited training opportunities in this area. Respondents also indicated whether preservice teachers in their programs receive training related to specific progress monitoring tools and evidence-based interventions. Implications for school psychologists, who frequently collaborate with teachers to implement RTI models, are discussed.     

Meeting the Needs of Evidence-based Practice in Family Therapy: Developing the Scientist-practitioner Model

Effective models of clinical training have been and continue to be a primary topic of discussion in the field of family therapy, particularly given the needs of evidence-based practice. This article outlines the major historical and contemporary struggles of one such model of clinical training and practice: the scientist-practitioner model. Throughout the article, the principles of the scientist-practitioner model and evidence-based practices are compared and contrasted. Suggestions for overcoming the contemporary challenges faced by the scientist-practitioner in a family therapy practice or in an educational environment are discussed.     

Development of Clinical Psychology and Mental Health Resources in Vietnam

In this paper, we discuss development of the Vietnam National University graduate Clinical Psychology Program, which has the goal of training both Vietnamese researchers who will develop and evaluate culturally appropriate mental health treatments, as well as Vietnamese clinicians who will implement and help disseminate these evidence-based treatments. We first review the background situation in Vietnam regarding mental health, and its infrastructure and training needs, and discuss the process through which the decision was made to develop a graduate program in clinical psychology as the best approach to address these needs. We then review the development process for the program and its current status, and our focus on the schools as a site for service provision and mental health task shifting. Finally, we outline future goals and plans for the program, and discuss the various challenges that the program has faced and our attempts to resolve them.     

Implementation and Evaluation of Evidence-Based Psychotherapeutic Practices for Youth in a Mental Health Organization

The current initiative and program evaluation study is a demonstration of the research to practice process in youth-focused psychotherapy. We collaborated within a community-university partnership to create practice and research infrastructure in order to develop, implement, and evaluate two new models of service founded on evidence-based psychotherapeutic practice parameters. The two new service models incorporated validated interventions to address behavior problems in elementary age children, and depression in adolescents, which were delivered in separate but similarly run intensive outpatient programs within a mental health setting. We utilized a rigorous training, technical assistance, fidelity monitoring, and outcome measurement strategy to promote the integrity and quality of services provided. The resultant programs were delivered with acceptable to high fidelity and effects on youth and parenting measures collected during program and from pre to post showed a decrease in targeted problems in youth and positive benefits for families. This initiative and program evaluation adds to the accumulating research-to-practice literature in children’s mental health.     

Multimedia Field Test: Evaluating the Creative Ambitions of SuperBetter and Its Quest to Gamify Mental Health

SuperBetter is a family of interfaces including a browser-based game, an online forum, and a companion mobile application that collectively seek to “gamify” resilience, wellness, motivation, and mental health. Players register and use “gamified” components and content to address mental and physical health challenges and to pursue identified goals. The primary strength of the SuperBetter ecosystem is its innovative approach, drawing on gaming metaphors and the use of evidence-based strategies in both its design and provided content. Efforts in creating an engaging, playable system incentivizing users’ incremental steps towards larger goals are constrained by SuperBetter’s relative lack of structure and direction, limits to meaningful progress monitoring, its largely static content regardless of varied user goals, and broad concerns regarding the utility of the overall system. The program presents a potential model for the application of gaming techniques and design to the dissemination of clinically effective concepts to a larger consumer market, but presently lacks sufficient empirical support for claims of evidence-based effectiveness.     

Development of Stepped Care Trauma-Focused Cognitive-Behavioral Therapy for Young Children

Young children who are exposed to traumatic events are at risk for developing posttraumatic stress disorder (PTSD). While effective psychosocial treatments for childhood PTSD exist, novel interventions that are more accessible, efficient, and cost-effective are needed to improve access to evidence-based treatment. Stepped care models currently being developed for mental health conditions are based on a service delivery model designed to address barriers to treatment. This treatment development article describes how trauma-focused cognitive-behavioral therapy (TF-CBT), a well-established evidence-based practice, was developed into a stepped care model for young children exposed to trauma. Considerations for developing the stepped care model for young children exposed to trauma, such as the type and number of steps, training of providers, entry point, inclusion of parents, treatment components, noncompliance, and a self-correcting monitoring system, are discussed. This model of stepped care for young children exposed to trauma, called Stepped Care TF-CBT, may serve as a model for developing and testing stepped care approaches to treating other types of childhood psychiatric disorders. Future research needed on Stepped Care TF-CBT is discussed.     

Impact Challenges in Community Science-with-Practice: Lessons from PROSPER on Transformative Practitioner-Scientist Partnerships and Prevention Infrastructure Development

At present, evidence-based programs (EBPs) to reduce youth violence are failing to translate into widespread community practice, despite their potential for impact on this pervasive public health problem. In this paper we address two types of challenges in the achievement of such impact, drawing upon lessons from the implementation of a partnership model called PROSPER. First, we address five key challenges in the achievement of community-level impact through effective community planning and action: readiness and mobilization of community teams; maintaining EBP implementation quality; sustaining community teams and EBPs; demonstrating community-level impact; and continuous, proactive technical assistance. Second, we consider grand challenges in the large-scale translation of EBPs: (1) building, linking and expanding existing infrastructures to support effective EBP delivery systems, and (2) organizing networks of practitioner-scientist partnerships-networks designed to integrate diffusion of EBPs with research that examines effective strategies to do so. The PROSPER partnership model is an evidence-based delivery system for community-based prevention and has evolved through two decades of NIH-funded research, assisted by land grant universities' Cooperative Extension Systems. Findings and lessons of relevance to each of the challenges are summarized. In this context, we outline how practitioner-scientist partnerships can serve to transform EBP delivery systems, particularly in conjunction with supportive federal policy.     

Evaluation of Interactive Computerized Training to Teach Paraprofessionals to Implement Errorless Discrete Trial Instruction

Efficient and effective training strategies for paraprofessionals in special education settings face many challenges. Interactive computerized training (ICT)—a self-paced program that incorporates audio narration, video models, interactive activities, and competency checks—is one potential solution. ICT has been successful in training college students and special education teachers to implement discrete trial instruction (DTI), but its effectiveness to train paraprofessionals is unknown. Using a multiple-baseline design, we evaluated the feasibility of ICT, to train six paraprofessionals to implement DTI with an errorless learning procedure. Following ICT, the fidelity of implementation of DTI increased for all participants when implemented with a student in their classroom; however, competency varied. We added additional training components that progressed from low to more intensive feedback delivered remotely in attempt to increase fidelity to 90% or higher implementation. We also evaluated generalization to novel instructional programs and maintenance of instruction in the absence of feedback.     

Challenges in implementing evidence-based treatment practices for co-occurring disorders in the criminal justice system

The presence of adults with mental health and substance abuse disorders within the criminal justice system has become increasingly evident over the past decade. Interventions and treatment services have been designed and research conducted in an effort to establish evidence-based practices that effectively address the complex needs of this population. However, adopting and implementing these evidence-based interventions and practices within the real-world setting of criminal justice environments is challenging. This article reviews the research literature related to evidence-based treatment practices for offenders with co-occurring mental health and substance abuse disorders and explores the inherent challenges of fitting these interventions and services within criminal justice settings.     

Implementation of a Trauma-Specific,Evidence-Informed Treatment for Adolescents: Two Cases Highlighting How to and How Not to Integrate

The clinical team at an urban trauma clinic sought to evaluate a protocol representing an integration of empirically validated treatment components to address trauma sequelae among female adolescents with a history of physical and/or sexual abuse. PARTNERS with teens is an exposure-based, trauma-specific cognitive-behavioral therapy protocol. Specifically, PARTNERS integrates engagement strategies, cultural sensitivity, and elements of motivational interviewing, dialectical behavior therapy, and family-based parent and communication training in order to reduce symptoms of posttraumatic stress disorder (PTSD) and depression and improve affect regulation among economically disadvantaged, multiracial/ethnic adolescents. This paper describes two cases that represent both treatment success and failure in treatment integration, specifically in negotiation of caregiver resistance, adolescent safety concerns, and ongoing interpersonal crises. Results illustrate how treatment components were emphasized and incorporated differentially throughout treatment as a function of case conceptualization. Successful implementation of treatment resulted in reductions in PTSD, depression, externalizing behaviors, and emotion dysregulation. In contrast, failure to effectively reconcile different philosophies and techniques within the treatment model to address challenges in engagement and motivation, inconsistent caregiver involvement, and trauma-related conflicts in the dyad, contributed to disengagement from treatment and persistence of trauma sequelae. Treatment outcome across these two cases is discussed as a function of how well the philosophies and techniques of different adolescent specific treatment components are integrated; directions for future research and training are discussed.     

Brief Behavioral Activation Treatment for Depressed Adolescents Delivered by Nonspecialist Clinicians: A Case Illustration

Behavioral activation (BA) can be as effective as cognitive-behavioral therapy for the treatment of depression in adults, but to date there is little research with adolescents. This is problematic given the recognized need to increase access to evidence-based interventions for depression in young people. We have developed a new adaptation of brief Behavioral Activation (Lejuez, Hopko, Acierno, Daughters, & Pagoto, 2011) specifically for young people: Brief BA for depressed adolescents. In this paper, we use a case example with session-by-session measurement to show how a nonspecialist clinician can deliver this intervention successfully. We discuss the key themes arising from this training case, challenges the clinician faced, and how these were managed through training and supervision.     

Addressing the Global Burden of Mental Illness: Why Transdiagnostic and Common Elements Approaches to Evidence-Based Practice Might Be Our Best Bet

This paper provides a commentary of Murray et al. (2014--this issue), who discuss the need for greater treatment quality and availability globally, particularly in low- and middle-income countries, and present outcome data for a common elements treatment approach that was developed to address the staggering burden of mental illness. This commentary discusses barriers to the dissemination and implementation of evidence-based psychological treatments, with a particular emphasis on training initiatives. The utility of a transdiagnostic approach to evidence-based practice is also explored within the context of training initiatives and ease of dissemination.     

Nurturing Environments for Boys and Men of Color with Trauma Exposure

Boys and men of color are exposed to traumatic experiences at significantly higher rates than are other demographic groups. To understand and address the mental and behavioral health effects of trauma, including violent incidents, on this population, we review the literature showing the context for, outcomes of, and potential responses to trauma exposure. We present the existing research about the unique challenges and associated negative outcomes for boys and men of color, as well as identify the gaps in the literature. We present the potential nurturing responses by systems such as schools, law enforcement, and communities to trauma-exposed boys and men of color, and we describe evidence-based programs and practices that directly address trauma. Finally, we argue that, rather than using a deficit model, a model of optimal development can be used to understand how to support and protect boys and men of color through nurturing environments.     

Evidence-Based Practice in Psychology: An Ethical Framework for Graduate Education,Clinical Training,and Maintaining Professional Competence

Evidence-based practice is often acknowledged as the future state of psychology, yet those graduate students who will soon be applying such practices tend to hold several misconceptions about the major components within this framework. This review highlights implications for graduate education, clinical training, and professional competence in light of the movement toward evidence-based practice in psychology. These implications are discussed in relation to the close parallel between the major components of the evidence-based framework and the current Ethical Principles of Psychologists and Code of Conduct. The evidence-based framework is discussed as an ideology that promotes lifelong learning and best prepares graduate students for ethical clinical practice throughout their careers as psychologists.     

Using Technology to Train and Sustain Delivery of Evidence-Based Practices

Practitioners face three challenges in delivering evidence-based practice: limitations in the evidence available to guide routine clinical decisions; limitations in clinical judgment that are hard to remedy with typical work routines; and the practical difficulties of training and sustaining the breadth of skills relevant to meet diverse patient needs in a generalist practice. We recommend designing practice environments that support development of excellent clinical judgment with use of standardized work routines that help detect relationships between clinical decisions, interventions, and patient outcomes. We describe examples illustrating how technology can support training and supervision within this framework.