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An equivalence analysis of provider education in youth mental health care
Author(s) -
McGuier Elizabeth A.,
Rothenberger Scott D.,
Friedman Abbey,
Kolko David J.
Publication year - 2021
Publication title -
health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.706
H-Index - 121
eISSN - 1475-6773
pISSN - 0017-9124
DOI - 10.1111/1475-6773.13659
Subject(s) - medicine , competence (human resources) , family medicine , mental health , clinical psychology , randomized controlled trial , nursing , physical therapy , psychology , psychiatry , social psychology , surgery
Abstract Objective To test for equivalence between providers with and without advanced degrees in multiple domains related to delivery of evidence‐based treatment. Data Source Provider and client data from an effectiveness trial of Alternatives for Families: A Cognitive Behavioral Therapy (AF‐CBT) in a major metropolitan area in the United States. Study Design We tested for equivalence between providers (N = 182) with and without advanced degrees in treatment‐related knowledge, practices, and attitudes; job demands and stress; and training engagement and trainer‐rated competence in AF‐CBT. We also conducted exploratory analyses to test for equivalence in family clinical outcomes. Data Collection Providers completed measures prior to randomization and at 6‐month follow‐up, after completion of training and consultation in AF‐CBT. Children and caregivers completed assessments at 0, 6, 12, and 18 months. Principal Findings Providers without advanced degrees were largely non‐inferior to those with advanced degrees in treatment‐related knowledge, practices, and attitudes, while findings for job demands and stress were mixed. Providers without advanced degrees were non‐inferior to providers with advanced degrees in consultation attendance ( B = −1.42; confidence interval (CI) = −3.01‐0.16; margin of equivalence (Δ) = 2), number of case presentations ( B = 0.64; CI = −0.49‐1.76; Δ = 2), total training hours ( B = −4.57; CI = −10.52‐1.37; Δ = 3), and trainer‐rated competence in AF‐CBT ( B = −0.04; CI = −3.04‐2.96; Δ = 4), and they were significantly more likely to complete training (odds ratio = 0.66; CI = 0.10‐0.96; Δ = 30%). Results for clinical outcomes were largely inconclusive. Conclusions Provider‐level outcomes for those with and without advanced degrees were generally comparable. Additional research is needed to examine equivalence in clinical outcomes. Expanding evidence‐based treatment training to individuals without advanced degrees may help to reduce workforce shortages and improve reach of evidence‐based treatments.