Anxiety a result youth seeking treatment do not garner

Anxiety
disorders are the most common mental health disorder diagnosis in children and
adolescents (McMillan, Francis, Rith-Najarian,
Bruce F. Chorpita, 2015). Treating youth anxiety with evidence-based treatments
is linked with response rates totaling 60-80% 
(Walkup et al., 2008). Despite
the efficacy of cognitive behavioral therapy to treat anxiety disorder in
children, few clinicians implement these empirically supported treatments in
the community setting (Li, 2017).  As a
result youth seeking treatment do not garner the full potential benefits of
therapy, with only 50% of youth showing a diagnostic response in the community
setting (Southam-Gerow et al., 2010).

            Therapists working in community
settings 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 for
therapists to learn and incorporate new treatment methods. Although it is
difficult for therapists to use new practices, it is the responsibility of the
Clinical Supervisor to stay-up to date with academic research, educate staff
with lower credentials, and monitor sessions to improve quality of care (CITATION). However,
implementing these supervision practices in the public mental health sector is
under-investigated (Kilminster, Jolly, 2000). Future research should address these
gaps in our knowledge surrounding supervision in community settings to alleviate
the disconnect between research and the practice of evidence-based treatments. To
improve anxiety disorder interventions for children in the community setting
clinicians need to adhere to stricter guidelines enforced by thoroughly trained
Clinical Supervisors; implement evidence based treatments, and enforce evidence
based supervision tactics in the public mental health sector. 

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            Copious
research has demonstrated that training without supervision is not sufficient
to alter a provider’s treatment methods (Beidas & Kendall, 2010).  A study that randomly assigned 115 community
therapists to an instructional presentation about the use of CBT for anxiety, computer
training, or a more active learning model, which included role-plays of
treatment strategies found limited improvements in clinician skillset and
adherence of evidence based-practices (Beidas et al., 2012).  After training participants partook in three
months of weekly consultation via the Internet or by phone. The consultation
included further instruction, role-playing opportunities, and case discussion. This
study found that regardless of condition one-day workshops fail to impact
clinician practice methods. However, the study also concluded that ongoing
consultation after workshops allowed clinicians to solidify concepts and
incorporate CBT as a part of their normal practice, subsequently increasing
criterion in skill from 65% to 85%.  This
finding suggests that receiving feedback from an expert is essential factor for
implementation.  Although Beidas demonstrated
improved efficacy of training therapists by including consultation, it remains
unclear if the therapists included in the study are representative of the
general therapist population. For example the participants were self-referred,
which may not be generalizable to real-world therapist who may be mandated to
receive training. Likewise, the sample was primarily composed of participants
that held a masters-level education, which is not representative of therapists who
treat youth in the community setting with varying education levels and
credentials.

            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 settings
to increase the quality of mental health care. In a community-based study, 57
therapists from 10 clinical service organizations received training and
supervision for evidence-based practices using either a Standard or Modular
manual. Study therapists treated 136 youth participants referred for primary
presenting anxiety, depression, or conduct disorder. Overall, supervision using
modeling and role-playing techniques coincided with higher clinician use of EBP
in following sessions (Bearman et al., 2014). Researchers found that therapist
degree, clinical experience, and attitudes toward EBP were not significant
predictors between implemented practices, with therapist use of EBT being
concordant more than half the time (57%). This research suggests that
therapists who vary in credentialing across the community mental health sector
are equally capable of treating clients using EBT with thorough supervision.

            These findings provide a deeper
understanding of the mechanisms that facilitate effective evidence based
practice in community.  Certain
supervision techniques including modeling and active learning may be the key to
the effective skill development of EBT. However, in this study internal
validity preceded generalizability. The supervisors in this study were
comprised of highly trained research staff. While providing highly trained
staff is important to understand the initial causal relationship between of
supervision and practice it is not necessarily applicable to Clinical
supervisors who are heterogeneous in their years of experience, primary
theoretic orientation, and training.

            Current research highlights the
causal relationship between evidence-based practice adherence and supervision
techniques as they relate to youth presenting with anxiety. The literature suggests
a gap of dissemination and implementation of evidence-based practices outside
of the research setting. To eliminate one of the barriers that inhibit
clinicians from effectively practicing CBT (inadequate training), future
research studies should move toward randomized trials, which include supervisor
participants from the community.  For
example a future study could recruit clinical supervisors from a variety of
community settings including school and private practice. Participants would
report their baseline measures, of clinician fidelity and client self-reports.
Participants would then be randomly assigned to a modeling and role-playing
condition, role-playing condition, or modeling condition. During the study
participants would be required to complete daily measures that track
counselor’s fidelity and clients would complete monthly self-report measures to
track their diagnostic response to treatment. These future study directions can
show the feasibility of performing certain supervision techniques in a
fast-paced environment.