Using blended learning to implement evidence-based psychotherapies.

Abstract

SUMMARY AND RECOMMENDATIONS FOR FUTURE RESEARCH This article explored the concept of BL and examinedhow it can be useful in facilitating the implementation ofEBPs. This article distinguished the concepts of dissemi-nation and implementation to highlight the distinctionbetween traditional efforts of distributing informationabout EBPs to providers and the complexities involvedin promoting the implementation or sustained adoptionof such practices. Traditionally, delivery mechanisms,such as therapy manuals or training workshops, havebeen used as the primary method by which EBPs aredisseminated. Recent research shows that these methods,when used alone, are not sufficient to ensure the sustainedadoption of EBPs (Miller et al., 2004; Sholomskas et al.,2005). In contrast, research shows us that blendingmechanisms known to be useful in knowledge and skillsacquisition can be more effective in changing clinicians’behavior in the long term when compared to using asingle learning strategy alone (e.g., workshop). BL offerssuch advantages as increasing the extent to which skillsand information are acquired, extending the reach ofinformation, optimizing costs and time, and, perhaps insome instances, providing a more cost-effective way toimplement EBPs. Using BL can also require additionalresources and skill sets that can limit both the size ofthe learning system and which components are chosento be included (e.g., BL systems that focus more heavilyon traditional versus technology-based learning strategies).With regard to future research, the outcome studiescited in this article are excellent examples of how onemight systematically evaluate the effectiveness of BLsystems in facilitating aspects (e.g., provider training)important to the implementation of EBPs. There arecurrently no empirically based guidelines for recom-mending how to optimally integrate various learningstrategies into BL systems for training providers in EBPs.However, studies, such as Miller et al. (2004), providesome evidence for the integration of workshops, personalfeedback of taped sessions, and telephone coaching, andperhaps more crucial, how one might optimally configurethese strategies to optimize the implementation of EBPs,such as MI. Furthermore, based on the findings of Milleret al. (2004) and Sholomskas et al. (2005), it appears thatBL systems that provide learning opportunities for mentalhealth providers focused on (a) acquiring basic knowledgeabout EBPs, (b) practicing relevant skills and techniques,and (c) receiving some form of ongoing supervision/feedback play an important (and perhaps necessary) role inoptimizing the sustained adoption (or implementation) ofEBPs.Future research should also consider additional outcomeswhen studying various BL systems in the context ofimplementing EBPs and attempt to answer such questionsas “which learning strategies are most effective for theimplementation of EBPs and how should these strategiesbe arranged to optimize training?” and “what are thecosts associated with delivering these blends relative totheir success in implementing various EBPs?” (i.e.,cost-effectiveness analysis). The latter question wouldrequire researchers to provide cost data in their outcomestudies associated with the many aspects of implementingEBPs. Some of these cost aspects include hiring trainers,printing materials, time away from work (for both trainersand trainees), and renting space. These outcomes arerarely reported in the empirical literature on the trainingof EBPs, and providing them may help us understandhow to most successfully design BL systems for imple-menting EBPs in a wide variety of clinical settings andwith various practitioner groups.