Anxietydisorders are the most common mental health disorder diagnosis in children andadolescents (McMillan, Francis, Rith-Najarian,Bruce F. Chorpita, 2015).
Treating youth anxiety with evidence-based treatmentsis linked with response rates totaling 60-80% (Walkup et al., 2008). Despitethe efficacy of cognitive behavioral therapy to treat anxiety disorder inchildren, few clinicians implement these empirically supported treatments inthe community setting (Li, 2017). As aresult youth seeking treatment do not garner the full potential benefits oftherapy, with only 50% of youth showing a diagnostic response in the communitysetting (Southam-Gerow et al., 2010). Therapists working in communitysettings often have large caseloads and inadequate supervision (Southam-Gerow,M.
A., Rodriguez, A., Chorpita, B.
F., & Daleiden, E. L., 2012).
These conditions make it difficult fortherapists to learn and incorporate new treatment methods. Although it isdifficult for therapists to use new practices, it is the responsibility of theClinical Supervisor to stay-up to date with academic research, educate staffwith lower credentials, and monitor sessions to improve quality of care (CITATION). However,implementing these supervision practices in the public mental health sector isunder-investigated (Kilminster, Jolly, 2000). Future research should address thesegaps in our knowledge surrounding supervision in community settings to alleviatethe disconnect between research and the practice of evidence-based treatments.
Toimprove anxiety disorder interventions for children in the community settingclinicians need to adhere to stricter guidelines enforced by thoroughly trainedClinical Supervisors; implement evidence based treatments, and enforce evidencebased supervision tactics in the public mental health sector. Copiousresearch has demonstrated that training without supervision is not sufficientto alter a provider’s treatment methods (Beidas & Kendall, 2010). A study that randomly assigned 115 communitytherapists to an instructional presentation about the use of CBT for anxiety, computertraining, or a more active learning model, which included role-plays oftreatment strategies found limited improvements in clinician skillset andadherence of evidence based-practices (Beidas et al., 2012).
After training participants partook in threemonths of weekly consultation via the Internet or by phone. The consultationincluded further instruction, role-playing opportunities, and case discussion. Thisstudy found that regardless of condition one-day workshops fail to impactclinician practice methods. However, the study also concluded that ongoingconsultation after workshops allowed clinicians to solidify concepts andincorporate CBT as a part of their normal practice, subsequently increasingcriterion in skill from 65% to 85%. Thisfinding suggests that receiving feedback from an expert is essential factor forimplementation. Although Beidas demonstratedimproved efficacy of training therapists by including consultation, it remainsunclear if the therapists included in the study are representative of thegeneral therapist population. For example the participants were self-referred,which may not be generalizable to real-world therapist who may be mandated toreceive training. Likewise, the sample was primarily composed of participantsthat held a masters-level education, which is not representative of therapists whotreat youth in the community setting with varying education levels andcredentials.
In the community setting,supervision tactics account for the variance in client outcomes (Callahan,Almstrom, Swift, Borja, 2009).Current research emphasizes the importance of supervision in community settingsto increase the quality of mental health care. In a community-based study, 57therapists from 10 clinical service organizations received training andsupervision for evidence-based practices using either a Standard or Modularmanual. Study therapists treated 136 youth participants referred for primarypresenting anxiety, depression, or conduct disorder. Overall, supervision usingmodeling and role-playing techniques coincided with higher clinician use of EBPin following sessions (Bearman et al., 2014). Researchers found that therapistdegree, clinical experience, and attitudes toward EBP were not significantpredictors between implemented practices, with therapist use of EBT beingconcordant more than half the time (57%).
This research suggests thattherapists who vary in credentialing across the community mental health sectorare equally capable of treating clients using EBT with thorough supervision. These findings provide a deeperunderstanding of the mechanisms that facilitate effective evidence basedpractice in community. Certainsupervision techniques including modeling and active learning may be the key tothe effective skill development of EBT. However, in this study internalvalidity preceded generalizability. The supervisors in this study werecomprised of highly trained research staff.
While providing highly trainedstaff is important to understand the initial causal relationship between ofsupervision and practice it is not necessarily applicable to Clinicalsupervisors who are heterogeneous in their years of experience, primarytheoretic orientation, and training. Current research highlights thecausal relationship between evidence-based practice adherence and supervisiontechniques as they relate to youth presenting with anxiety. The literature suggestsa gap of dissemination and implementation of evidence-based practices outsideof the research setting.
To eliminate one of the barriers that inhibitclinicians from effectively practicing CBT (inadequate training), futureresearch studies should move toward randomized trials, which include supervisorparticipants from the community. Forexample a future study could recruit clinical supervisors from a variety ofcommunity settings including school and private practice. Participants wouldreport their baseline measures, of clinician fidelity and client self-reports.Participants would then be randomly assigned to a modeling and role-playingcondition, role-playing condition, or modeling condition. During the studyparticipants would be required to complete daily measures that trackcounselor’s fidelity and clients would complete monthly self-report measures totrack their diagnostic response to treatment. These future study directions canshow the feasibility of performing certain supervision techniques in afast-paced environment.