Randomized Controlled Trial of Supervision Strategies to Improve Clinician Fidelity to Trauma-focused CBT

NCT ID: NCT01800266

Last Updated: 2015-05-01

Basic Information

• Recruitment Status: UNKNOWN
• Clinical Phase: NA
• Total Enrollment: 1280 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2012-07-31
• Study Completion Date: 2017-03-31

Brief Summary

The primary goal of this study is to examine the impact of varying supervision strategies on clinician fidelity and client outcomes in a community-based setting. Prior research has established that training approaches that do not include a period of intervention-specific supervision or consultation are ineffective and that implementation efforts that include only an initial period of supervision show an eventual attenuation of gains in knowledge and fidelity in practice. Ongoing supervision may be required for effective and sustained implementation of evidence-based practices (EBPs) in community-based settings. However, supervision is one of the least investigated aspects of training. "Gold standard" elements of supervision from efficacy trials include review of sessions, standardized procedures for monitoring client outcomes and model fidelity, and ongoing skill-building (e.g., behavioral rehearsal). The degree (e.g., frequency, intensity) to which these strategies are used in community-based settings is unknown.

There are a growing number of national and statewide efforts to increase the reach of EBPs through dissemination and implementation initiatives. There are 18 statewide initiatives to implement Trauma-focused Cognitive Behavioral Therapy (TF-CBT), an EBP for child trauma exposure and sequelae. Many of the community based TF-CBT implementation efforts, and those for other EBPs, include a specific focus on supervisors. However, the limited scientific literature provides very little guidance for these efforts. Aims of the current trial include 1) studying supervision with existing implementation supports; particularly presence of gold standard elements; 2) evaluating the effects of varying supervision strategies on fidelity and client outcomes; and 3) testing the mediating effect of treatment fidelity on the relationship between supervision type and client outcomes. We propose a two-phased, within-subjects and between subjects design. In Phase I (9 months), we examined supervision with implementation support. In Phase II (30 months), we will examine two specific supervision conditions, each including varying EBP supervision elements.

Conditions

Post Traumatic Stress; Overall Functioning; Clinician Fidelity; Supervision

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: HEALTH_SERVICES_RESEARCH
• Blinding Strategy: SINGLE

Study Groups

Symptom and Fidelity Monitoring (SFM)

Half of the study clinicians will be randomized to this supervision condition of TF-CBT.

Group Type: EXPERIMENTAL

Supervision Practices of TF-CBT

Intervention Type: BEHAVIORAL

Supervisors will be trained in one of two supervision strategies: Symptom and Fidelity Monitoring (SFM) or Symptom and Fidelity Monitoring + Behavioral Rehearsal (SFM + BR)

SFM + Behavioral Rehearsal

Half of the study clinicians will be randomized to this supervision condition of TF-CBT.

Group Type: EXPERIMENTAL

Supervision Practices of TF-CBT

Intervention Type: BEHAVIORAL

Supervisors will be trained in one of two supervision strategies: Symptom and Fidelity Monitoring (SFM) or Symptom and Fidelity Monitoring + Behavioral Rehearsal (SFM + BR)

Interventions

Supervision Practices of TF-CBT

Supervisors will be trained in one of two supervision strategies: Symptom and Fidelity Monitoring (SFM) or Symptom and Fidelity Monitoring + Behavioral Rehearsal (SFM + BR)

Intervention Type: BEHAVIORAL

Eligibility Criteria

Inclusion Criteria

• Children between the ages of 6-17 who are starting Trauma-focused Cognitive Behavioral Therapy (TF-CBT) with one of our enrolled clinicians.They must also have significant Post Traumatic Stress symptoms as measured by a score of 21 or higher on the UCLA PTSD-RI, and live with a parent or guardian who is willing to participate in the study.
• Community-based mental health clinicians who are employed in Regional Support Network agencies (state Medicaid clinics) who have participated in the Washington State Initiative for TF-CBT and are supervised by a participating supervisor, or have completed the TF-CBT web training and been supervised on a case.
• Community-based mental health supervisors trained in the WA State Initiative in TF-CBT and employed at participating clinics in WA.

Exclusion Criteria

• Non-English speaking child.

• Minimum Eligible Age: 6 Years
• Maximum Eligible Age: 17 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

National Institute of Mental Health (NIMH)

NIH

Sponsor Role: collaborator

University of Medicine and Dentistry of New Jersey

OTHER

Sponsor Role: collaborator

University of Washington

OTHER

Sponsor Role: lead

Responsible Party

Shannon Dorsey

Associate Professor

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Shannon Dorsey, PhD

Role: PRINCIPAL_INVESTIGATOR

University of Washington

Kelly Thompson, MSW

Role: STUDY_DIRECTOR

University of Washington

Locations

University of Washington Department of Psychology

Seattle, Washington, United States

Site Status: RECRUITING

Countries

United States

Central Contacts

Shannon Dorsey, PhD

Role: CONTACT

dorsey2@u.washington.edu

206.543.4527

Kelly Thompson, MSW

Role: CONTACT

kelly3@u.washington.edu

206.616.5768

Facility Contacts

Shannon Dorsey, PhD

Role: primary

dorsey2@u.washington.edu

206-543-4527

Kelly Thompson, MSW

Role: backup

kelly3@u.washington.edu

206.616.5768

References

Dorsey S, AlRasheed R, Kerns SE, Meza RD, Triplett N, Deblinger E, Jungbluth N, Berliner L, Naithani L, Pullmann MD. A randomized controlled trial testing supervision strategies in community mental health. Implement Res Pract. 2025 May 23;6:26334895251330523. doi: 10.1177/26334895251330523. eCollection 2025 Jan-Dec.

Reference Type: DERIVED

PMID: 40416801 (View on PubMed)

Dorsey S, Kerns SEU, Lucid L, Pullmann MD, Harrison JP, Berliner L, Thompson K, Deblinger E. Objective coding of content and techniques in workplace-based supervision of an EBT in public mental health. Implement Sci. 2018 Jan 24;13(1):19. doi: 10.1186/s13012-017-0708-3.

Reference Type: DERIVED

PMID: 29368656 (View on PubMed)

Dorsey S, Pullmann MD, Deblinger E, Berliner L, Kerns SE, Thompson K, Unutzer J, Weisz JR, Garland AF. Improving practice in community-based settings: a randomized trial of supervision - study protocol. Implement Sci. 2013 Aug 10;8:89. doi: 10.1186/1748-5908-8-89.

Reference Type: DERIVED

PMID: 23937766 (View on PubMed)

Other Identifiers

R01MH095749

Identifier Type: NIH

Identifier Source: secondary_id

View Link

A64442

Identifier Type: -

Identifier Source: org_study_id