Book Description

Development and evaluation of evidence-based treatments (EBTs) for mental health disorders have proceeded at an impressive rate in recent years (Kazdin, 2008). However, such EBTs have often proved less effective in community settings, as compared with randomized controlled trials (Warren, Nelson, & Burlingame, 2009; Weisz et al., 2013). Community behavioral health organizations face several challenges that contribute to such findings. Specifically, many community organizations struggle to develop and maintain an appropriately trained therapist workforce in light of high therapist turnover rates and limited training resources (Gallon, Gabriel, & Knudsen, 2003). The Agency Supervisor model, in which interventions are disseminated sequentially from master trainers to supervisors to therapists, has shown promise as a potential solution for community organizations that need to quickly train new therapists while maintaining strong therapist performance outcomes (Southam-Gerow et al., 2014; Weisz et al., 2018). The Agency Supervisor pathway depends on agency-based supervisors to transfer training: to disseminate interventions (including EBTs) to therapists, and ensure that therapists apply those interventions as intended. Such transfer of training is especially difficult in community settings where therapists often assume large caseloads with complex clinical presentations. A broad literature covering human resource development, medicine, mental health, public health and technology has identified supervisory techniques designed to support therapist transfer of training (Baldwin, Ford, & Blume, 2012; Ford, Baldwin, & Prasad, 2018a). It is unclear, however, whether such transfer supports are applied with any regularity or effectiveness in supervision in community behavioral health. This dissertation sought to identify and measure transfer supports in the service of increasing dissemination and implementation of EBTs in community settings. The first study examined the effectiveness of the Agency Supervisor model in developing (1) supervisors who engage in transfer supporting behaviors, and (2) therapists who apply their learning in supervision to their clinical work. Findings highlighted the quality of training offered by the Agency Supervisor approach, and advanced an instrument designed to capture therapist perceptions of supervisory behaviors within Managing and Adapting Practice (MAP), a system of evidence-informed care. The second study examined supervisory implementation of transfer-supporting strategies outside of the MAP framework through the development the Transfer of Training Inventory (TTI), a therapist-reported measure of supervisory implementation of transfer supports. Findings suggest that therapist evaluations of supervisory behavior are heavily influenced by the supervisory working alliance, and are flawed indicators of supervisor implementation of transfer supports. Taken together, findings from this dissertation highlight the importance of using behaviorally-anchored measures to evaluate supervisor behavior.