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Evaluating postgraduate CBT training in New zealand,[object Object], dr Beverly Haarhoff ,[object Object], Massey University, Auckland.,[object Object],Transfer of training: “Fade away or show and tell!” ,[object Object]
Agenda,[object Object],Why is the evaluation of maintenance and transfer of training in psychotherapy important? ,[object Object],Obstacles and difficulties in assessing transfer,[object Object],Brief look at current state of play in terms of research in the CBT field,[object Object],Our study (descriptive data),[object Object],Problems,[object Object],A way forward,[object Object]
Defining transfer of training,[object Object],“Transfer of training is defined as the generalisation and maintenance of new information, knowledge, attitudes and skills into the everyday practice of trainees”,[object Object],Baldwin & Ford, 1988.,[object Object]
Transfer of training why measure?,[object Object],Management and allocation of resources,[object Object],Increasing access to evidenced based therapies (IAPT program),[object Object],What works? ,[object Object],For whom?,[object Object],To improve patient/client outcome,[object Object]
Transfer of training in Psychotherapy?,[object Object],*Difficult area to research,[object Object],Comparatively few studies (increasing in CBT),[object Object],Lack of funding (the field falls between psychotherapy & education),[object Object],Competing psychotherapy training programs and paradigms,[object Object],(profession specific, short-term, comprehensive, scholar-practitioner, scientist-practitioner, ‘apprenticeship model’, emphasis on personal therapy etc.) ,[object Object]
Evaluating CBT transfer of training,[object Object], More complications!,[object Object],What represents competence? (which competecies? General or specific?),[object Object],Trainee Self-report ?,[object Object],Supervisor ‘indirect’ report?,[object Object],Objective scoring of competence? ,[object Object],Evaluation of patient outcome?,[object Object],The willingness of graduates to participate? ,[object Object],Small participant samples (limited access programs) ,[object Object]
Transfer of training in CBT,[object Object],Empirical studies have increased since 1999,[object Object],Still heavily reliant on the self report of trainees ,[object Object],The few studies using ‘objective’ observation methods such as the Cognitive Therapy Scale (Young & Beck, 1980) measure overall competence have have generally been positive.,[object Object],Very few linked to outcome or praticing CBT therapists,[object Object]
Recent studies,[object Object],McManus, Westbrook, Vazquez-Montes, Fennell & Kennerley, 2010.,[object Object],Oxford Diploma CBT Course,[object Object],278 trainees between 1998-2009,[object Object],Increased competence ,[object Object],Clinical Psychologists achieved consistently better results,[object Object],Age negatively correlated with improved competency ,[object Object]
Brosan, Reynolds & Moore, 2006,[object Object],Naturalistic study,[object Object],Practitioners recruited from a range of professions,[object Object],mid t/m recorded CBT session rated using the CTS,[object Object],5380 practitioners approached,[object Object],47 responded & only 24  submitted tapes,[object Object],Psychologists found to be the most competent,[object Object],However a number of accredited therapist scored below the expected level of competence,[object Object]
The Massey University Postgraduate CBT diploma,[object Object],Minimum of two years Part-time,[object Object],Phase one: theoretical: four papers taught in block mode namely Theory and Practice of CBT, CBT for Depression, CBT for the Anxiety Disorders and CBT for chronic and complex problems.,[object Object],Phase two: Supervised clinical practicum over two semesters. x Two clients, two case studies and two verbal case presentations. (all supervision in-house),[object Object],Final oral exam with the focus on case conceptualisation ,[object Object]
The study,[object Object],Questions:,[object Object],★Is CBT competence maintained and transferred beyond training?,[object Object], Is therapist self-reported competence in using CBT related to observed use of CBT?,[object Object],  Is professional development as therapist related to self-reported competence and observed competence?,[object Object],  Is work involvement positively related to self-reported and observed competence as a CBT therapist?,[object Object]
Measures,[object Object],*Cognitive Therapy Scale (Young & Beck, 1980, 1988) (the most widely used & validated instrument for assessing CBT competence McManus et al., 2010),[object Object],Adapted Survey of PGDipCBT (Kennedy-Merrick et al., 2006),[object Object],Therapist Professional Development questionnaire (Orlinsky & Rønnestad, 2005),[object Object],Psychotherapist work involvement questionnaire (Orlinsky & Rønnestad, 2005) ,[object Object]
The Cognitive Therapy Scale (Young & Beck, 1980, 1988),[object Object],General therapeutic  procedures & interpersonal  effectiveness,[object Object],Agenda,[object Object],Feedback,[object Object],Understanding,[object Object],Interpersonal effectiveness,[object Object],Collaboration,[object Object],Pacing & efficient use of time,[object Object],‘Red-line’ = 39-44  (RCT),[object Object],Specific  CBT skills ,[object Object],Guided discovery,[object Object],Focusing on key cognitions and behaviours,[object Object],Strategy for change,[object Object],Application of CBT Techniques,[object Object],Homework,[object Object],Each item rated on a (0-6) Likert scale yielding a total score of 66,[object Object]
Participants,[object Object],The participants were drawn from two groups of CBT trainees,[object Object],Group one: trainees enrolled in the PGDipCBT during 2009,[object Object],*Group two: Graduates from the PGDipCBT (2000-2009),[object Object],Mental health practitioners across multiple professions: psychologists, social workers, nurses, psychiatric registrars and consultants, GP’s, Occupational therapists, psychotherapists & counsellors,[object Object]
Participants : Group Two,[object Object],Of the 88 graduates between 2000-2009, 42% (n=37) were not contactable,[object Object],Of the remaining 58% (n=51), 20 were currently not practicing CBT and 9 declined to participate. ,[object Object],A total of 29 agreed to participate in the study but of this group only 12 provided recorded examples of their clinical work. ,[object Object],Of this sample one tape was unusable and only 11 clinicians eventually took part (12.5% of the total sample),[object Object]
Results: Cognitive Therapy Scale (Young & Beck,1980,1988),[object Object]
Competent?,[object Object],Out of 11 participants n=7 (64%) achieved competence scoring above the 39 ‘red-line’ competence for RCT criteria,[object Object],3 of 7 were clinical psychologists, 43%,[object Object]
Participants below the ‘red-line’,[object Object],Poor performance in specific CBT competencies and skills ,[object Object]
Difficulties: Participant recruitment,[object Object]
Difficulties,[object Object],Fear of negative evaluation,[object Object],Obtaining recorded clinical material (patient consent, graduate resistance, technological difficulties),[object Object],Expensive (scoring of competence measures),[object Object]
A way forward,[object Object],Providing a strong rationale for participation in competency evaluation,[object Object],Building in positive reinforcement for participation,[object Object],Building a culture of accountability,[object Object],Improving access to supervision,[object Object],Technological support & know how,[object Object],Deseminating feedback from research,[object Object]
Acknowledgements,[object Object],Robyn Gedye (PhD candidate),[object Object],Dr Mei Williams Senior Lecturer Massey University,[object Object],Lynley Stenhouse (Clinical Psychologist),[object Object],Sarah Kennedy-Merrick PhD,[object Object],Study participants Graduates of the Massey University Post Graduate Diploma in CBT 2000-2009.,[object Object]
questions,[object Object]

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