Measurement training and feedback system for implementation of evidence-based treatment for adolescent externalizing problems: protocol for a randomized trial of pragmatic clinician training

Aaron Hogue, Molly Bobek, Alexandra MacLean, Nicole Porter, Amanda Jensen-Doss, Craig E Henderson, Aaron Hogue, Molly Bobek, Alexandra MacLean, Nicole Porter, Amanda Jensen-Doss, Craig E Henderson

Abstract

Background: Innovations in clinical training and support that enhance fidelity to evidence-based treatment (EBT) for adolescent behavior problems are sorely needed. This study will develop an online training system to address this gap: Measurement Training and Feedback System for Implementation (MTFS-I). Using procedures intended to be practical and sustainable, MTFS-I is designed to increase two aspects of therapist behavior that are fundamental to boosting EBT fidelity: therapist self-monitoring of EBT delivery, and therapist utilization of core techniques of EBTs in treatment sessions. This version of MTFS-I focuses on two empirically supported treatment approaches for adolescent conduct and substance use problems: family therapy and cognitive behavioral therapy (CBT).

Methods/design: MTFS-I expands on conventional measurement feedback systems for client outcomes by adding training in observational coding to promote EBT self-monitoring and focusing on implementation of EBT treatment techniques. It has two primary components. (1) The training component, delivered weekly in two connected parts, involves self-monitored learning modules containing brief clinical descriptions of core EBT techniques and mock session coding exercises based on 5-8 min video segments that illustrate delivery of core techniques. (2) The feedback component summarizes aggregated therapist-reported data on EBT techniques used with their active caseloads. MTFS-I is hosted online and requires approximately 20 min per week to complete for each treatment approach. This randomized trial will first collect data on existing delivery of family therapy and CBT techniques for youth in outpatient behavioral health sites (Baseline phase). It will then randomize site clinicians to two study conditions (Implementation phase): Training Only versus Training + Feedback + Consultation. Therapists will choose whether to train in family therapy, CBT, or both. Study aims will compare clinician performance across study phase and between study conditions on MTFS-I uptake, reliability and accuracy in EBT self-monitoring, and utilization of EBT techniques in treatment sessions (based on observer coding of audiotapes).

Discussion: Study contributions to implementation science and considerations of MTFS-I sustainability are discussed.

Trial registration: ClinicalTrials.gov, NCT03722654. Registered on 29 October 2018.

Keywords: Adolescent conduct problems; Adolescent substance use; Cognitive behavioral therapy; Family therapy; Measurement feedback system; Training and consultation.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Training process schematic: Measurement Training and Feedback System for Implementation (MTFS-I) of FT and CBT techniques
Fig. 2
Fig. 2
SPIRIT diagram depicting the schedule of trial enrollment, interventions, and assessments
Fig. 3
Fig. 3
CONSORT flow chart of projected study enrollment
Fig. 4
Fig. 4
Sample of monthly feedback report based on ITT-ABP data

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