Stacey D Espinet1, Sandra Gotovac2, Sommer Knight1, Larry Wissow3, Merrick Zwarenstein4, Lorelei Lingard5, Margaret Steele6. 1. Department of Psychiatry, Schulich School of Medicine & Dentistry, Centre for Education Research and Innovation, The University of Western Ontario, London, Ontario, Canada. 2. Division of Child and Adolescent Psychiatry, London Health Sciences Center, London, Ontario, Canada. 3. School of Medicine, University of Washington, DC, USA. 4. Department of Family Medicine, Centre for Studies in Family Medicine, The University of Western Ontario, Ontario, Canada. 5. Centre for Education Research and Innovation, Health Sciences Addition, The University of Western Ontario, London, Ontario, Canada. 6. Discipline of Psychiatry, Faculty of Medicine, Memorial University of Newfoundland, Saint John's, Newfoundland, Canada.
Abstract
OBJECTIVES:Rural primary care practitioners (PCPs) have a pivotal role to play in frontline pediatric mental health care, given limited options for referral and consultation. Yet they report a lack of adequate training and confidence to provide this care. The aim of this study was to test the effectiveness of the Practitioner Training in Child and Adolescent Psychiatry (PTCAP) program, which was designed to enhance PCPs' pediatric mental health care confidence. The program includes brief therapeutic skills and practice guidelines PCPs can use to address both subthreshold concerns and diagnosable conditions, themselves. METHODS: The study design was a pilot, cluster-randomized, multicenter trial. Practices were randomly assigned to intervention (n practices = 7; n PCPs = 42) or to wait-list control (n practices = 6; n PCPs = 34). The intervention involved 8 hr of training in practice guidelines and brief therapeutic skills for depression, anxiety, attention deficit hyperactivity disorder, and behavioral disorders with case discussion and video examples, while the control practiced as usual. A linear random-effects model controlling for clustering and baseline was carried out on the individual-level data to examine between-group differences in the primary (i.e., confidence) and secondary (i.e., attitude and knowledge) outcomes at 1-week follow-up. RESULTS: Findings were a statistically significant difference in the primary outcomes. Compared to the control group, the intervention group indicated significantly greater confidence in managing diagnosable conditions (d = 1.81) and general concerns (d = 1.73), as well as in making necessary referrals (d = 1.27) and obtaining consults (d = 0.74). While the intervention did not significantly impact secondary outcomes (attitudes and knowledge), regression analysis indicated that the intervention may have increased confidence, in part, by ameliorating the adverse impact of negative mental health care attitudes. CONCLUSION:PTCAP enhances PCPs' child/youth mental health care confidence in managing both general and diagnosable concerns. However, an 8-hr session focused on applying brief therapeutic skills was insufficient to significantly change attitudes and knowledge. Formal testing of PTCAP may be warranted, perhaps using more intensive training and including outcome assessments capable of determining whether increased PCP confidence translates to more effective management and better patient outcomes.
RCT Entities:
OBJECTIVES: Rural primary care practitioners (PCPs) have a pivotal role to play in frontline pediatric mental health care, given limited options for referral and consultation. Yet they report a lack of adequate training and confidence to provide this care. The aim of this study was to test the effectiveness of the Practitioner Training in Child and Adolescent Psychiatry (PTCAP) program, which was designed to enhance PCPs' pediatric mental health care confidence. The program includes brief therapeutic skills and practice guidelines PCPs can use to address both subthreshold concerns and diagnosable conditions, themselves. METHODS: The study design was a pilot, cluster-randomized, multicenter trial. Practices were randomly assigned to intervention (n practices = 7; n PCPs = 42) or to wait-list control (n practices = 6; n PCPs = 34). The intervention involved 8 hr of training in practice guidelines and brief therapeutic skills for depression, anxiety, attention deficit hyperactivity disorder, and behavioral disorders with case discussion and video examples, while the control practiced as usual. A linear random-effects model controlling for clustering and baseline was carried out on the individual-level data to examine between-group differences in the primary (i.e., confidence) and secondary (i.e., attitude and knowledge) outcomes at 1-week follow-up. RESULTS: Findings were a statistically significant difference in the primary outcomes. Compared to the control group, the intervention group indicated significantly greater confidence in managing diagnosable conditions (d = 1.81) and general concerns (d = 1.73), as well as in making necessary referrals (d = 1.27) and obtaining consults (d = 0.74). While the intervention did not significantly impact secondary outcomes (attitudes and knowledge), regression analysis indicated that the intervention may have increased confidence, in part, by ameliorating the adverse impact of negative mental health care attitudes. CONCLUSION: PTCAP enhances PCPs' child/youth mental health care confidence in managing both general and diagnosable concerns. However, an 8-hr session focused on applying brief therapeutic skills was insufficient to significantly change attitudes and knowledge. Formal testing of PTCAP may be warranted, perhaps using more intensive training and including outcome assessments capable of determining whether increased PCP confidence translates to more effective management and better patient outcomes.
Authors: John R Weisz; Bruce F Chorpita; Lawrence A Palinkas; Sonja K Schoenwald; Jeanne Miranda; Sarah Kate Bearman; Eric L Daleiden; Ana M Ugueto; Anya Ho; Jacqueline Martin; Jane Gray; Alisha Alleyne; David A Langer; Michael A Southam-Gerow; Robert D Gibbons Journal: Arch Gen Psychiatry Date: 2011-11-07
Authors: Joanna Henderson; Elizabeth Brownlie; Susan Rosenkranz; Gloria Chaim; Joseph Beitchman Journal: J Can Acad Child Adolesc Psychiatry Date: 2013-11
Authors: Jonathan D Brown; Lawrence S Wissow; Benjamin L Cook; Shaina Longway; Emily Caffery; Chris Pefaure Journal: J Behav Health Serv Res Date: 2013-01 Impact factor: 1.505
Authors: Richard Zayed; Brenda Davidson; Lucie Nadeau; Terrence S Callanan; William Fleisher; Lindsay Hope-Ross; Stacey Espinet; Helen R Spenser; Harold Lipton; Amresh Srivastava; Lorraine Lazier; Tamison Doey; Sarosh Khalid-Khan; Ann McKerlie; Neal Stretch; Roberta Flynn; Sabina Abidi; Kimberly St John; Genevieve Auclair; Vitaly Liashko; Sarah Fotti; Declan Quinn; Margaret Steele Journal: J Can Acad Child Adolesc Psychiatry Date: 2016-02-01