Training the Frontline Workforce to Deliver Evidence-Based Therapy to People With Psychosis: Challenges in the GOALS Study.

Improving access to psychotherapies in psychosis requires workforce expansion in resource-challenged systems. The GOALS feasibility randomized controlled trial assessed training and implementation of an evidence-based intervention by frontline workers, targeting recovery goals. Training uptake and therapy fidelity were good. Case managers with crisis management responsibilities were less likely than clinical assistants to deliver therapy. Participants receiving "sufficient therapy" achieved goals, but therapy was usually provided by clinical assistants. This is consistent with implementation science principles, that training must be combined with supportive organizational structures, such as by focusing on roles that already include therapy delivery or developing stronger organizational supports for case managers.