Evidence-based Training Program Research Articles

The development and evaluation of a natural helpers' training program to increase the engagement of urban, Latina/o families in parent-child interaction therapy

Latina/o immigrant children are at increased risk for developing conduct disorders, and are simultaneously less likely to access services. Natural helpers are uniquely positioned to promote effective parent training programs to address service disparities in these communities. This study describes one effort to train natural helpers to increase engagement in parent-child interaction therapy (PCIT), an evidence-based parent training program. An academic-community partnership prompted the development and evaluation of this natural helpers training program. Five natural helpers were trained to recruit Latina/o families into PCIT, address barriers to treatment, and support parents' skill development. Over the course of training, natural helpers increased their knowledge of PCIT and their ability to use and model treatment targeted parenting skills. Additional consultation was necessary to improve the natural helpers' abilities to conduct behavioral observations of parent skill use and provide feedback on these skills. Natural helpers expressed overall satisfaction with PCIT and the training program. Suggestions for incorporating natural helpers into PCIT services are discussed based on the strengths and challenges identified from the evaluation of this training program.

The role of a group coach in the professional learning of school leaders

ABSTRACTGroup coaching has the potential to foster social learning for school leaders. In this article, we investigate the role of the coach in a group coaching process drawing on data from interviews and observations in a pilot study. The Professional Learning through Feedback and Reflection (PROFLEC) study ran in 10 countries and was funded by the European Commission. We report on data from two countries which took part in the study: Norway and Australia. We examine the steps used in an established group coaching protocol and identify critical aspects of the coaching role. We discuss the complexities of the role of the group balancing a goal-oriented coaching process along with the facilitation process. We suggest that the coaching role requires a unique set of skills and argue that research is needed to support the development of evidence-based training programmes to prepare coaches for this complex and challenging role.

Factors Affecting Korean Registered Nurses' Intention to Implement Smoking Cessation Intervention

ObjectivesNurses have been identified as an instrumental partner in tobacco reduction. This study aimed to examine factors affecting Korean nurses' intention to implement smoking cessation intervention in Busan, Korea. MethodsThe participants were a total of 215 Korean registered nurses. A self-administered questionnaire evaluated predisposing factors, motivational factors (attitude, social influence, and self-efficacy) and intention to implement smoking cessation intervention. Data were analyzed by t tests, Pearson's correlation, and hierarchical multiple regression. ResultsThe mean age of the participants was 28.12 ± 5.72 years. The majority of the participants were staff nurses (85.6%), and 64.2% of the sample had < 5 years of work experience. Significant predictors of intention to implement smoking cessation intervention included perceived barrier of smoking cessation intervention (β = −0.128, p = 0.023), willingness to receive smoking cessation training (β = 0.123, p = 0.034), more positive attitude (β = 0.203, p = 0.002), higher social influence (β = 0.292, p < 0.001), and higher self-efficacy toward smoking cessation intervention (β = 0.151, p = 0.021), which explained 45% of the total variance of intention to implement smoking cessation intervention. ConclusionAttitude, social influence, and self-efficacy towards smoking cessation intervention had a significant positive influence in determining the intention to implement smoking cessation intervention. These findings can be used to develop evidence-based smoking cessation training programs for nurses in Korea. The programs should aim for positive attitude, higher social influence, and higher self-efficacy in hospital settings.

Evaluation of an online training program in eating disorders for health professionals in Australia.

BackgroundEarly detection and treatment of eating disorders is instrumental in positive health outcomes for this serious public health concern. As such, workforce development in screening, diagnosis and early treatment of eating disorders is needed. Research has demonstrated both high rates of failure to accurately diagnose and treat cases early and low levels of perceived access to training in eating disorders by health professionals–representing an urgent need for clinician training in this area. However, significant barriers to the access of evidence-based training programs exist, including availability, cost and time, particularly when large geographic distances are involved. Online learning presents a solution to workforce challenges, as it can be delivered anywhere, at a fraction of the cost of traditional training, timing is user controlled, and a growing body of research is demonstrating it as effective as face-to-face training. The Centre for Eating and Dieting Disorders in Australia has developed an Online Training Program In Eating Disorders, to educate health professionals in the nature, identification, assessment and management of eating disorders. The aim of the current study was to evaluate the ability of this online learning course to improve clinician levels of knowledge, skill and confidence to treat eating disorders. As well as its effect on stigmatised beliefs about eating disorders known to effect treatment delivery.MethodsOne-hundred-eighty-seven health professionals participated in the program. A pre training questionnaire and a post training evaluation examined participants’ levels of knowledge, skill and confidence to treat eating disorders, as well attitudes and beliefs about people with eating disorders.ResultsSignificant improvements in knowledge, skill, and confidence to treat eating disorders was found between pre and post program assessment in health professionals who completed the course, along with a significant decrease in stigmatised beliefs about eating disorders.DiscussionThe results of this study demonstrated that the online training program was an effective tool in increasing health professionals’ level of knowledge, skill and confidence to treat people with eating disorders. The results also demonstrated that online training reduced health professionals’ personal bias towards people with eating disorders. Limitations of this study include the use of self-report measures rather than observation of the health professional in clinical practice. As a result, it is not possible to make determinations regarding the translation of these results to clinical settings.ConclusionsThe findings of this study suggest that online training programs may present an innovative solution to the considerable workforce development challenges faced by clinicians needing training in eating disorders.

A descriptive study of baccalaureate nursing students' responses to suicide prevention education

Internationally, little is known regarding the amount of educational content on suicide in undergraduate nursing curriculum. The literature conducted found few published research studies on implementation of suicide prevention instruction in baccalaureate nursing curriculum, even though various international healthcare and nursing initiatives address suicide prevention. The aim was to describe senior baccalaureate students' responses to an evidence-based suicide prevention gatekeeper training program entitled Question-Persuade-Refer implemented in a required course. This is a multi-method descriptive study. Data were collected utilizing a pre–post-survey questionnaire administered to 150 students in four classes of a psychiatric nursing course over a two-year period. The quantitative data were statistically significant (p < 0.000) indicating an overall positive rating of the training. From the qualitative data, the main theme was ‘becoming capable intervening with persons at risk for suicide’. Students responded very positively to the evidence based suicide prevention gatekeeper training program. The instruction addresses various national initiatives and strategies filling a void in nursing curriculum, as well as empowering students to engage in suicide prevention interventions.

EMG Assessment of Muscle Fatigue in Elite Paralympic Athletes

PURPOSE: The Paralympic Research and Sport Science Consortium (PRSSC) has identified electromyography (EMG) analysis of wheelchair sport performance to be a major research need. EMG analysis can be used to design evidence-based training programs through the understanding of sport-specific fatigue.The purpose of the current study was to document fatigue and associated compensation among push and recovery muscles during a Paralympic Rugby training camp. METHODS: Wheelchair rugby players were recruited from a Paralympic training facility (Lakeshore Foundation, Birmingham, AL, USA). Three national team wheelchair rugby players completed 5 training sessions (3 hours each) over 2 training days. A 16-channel Noraxon EMG system 1400A (Scottsdale, AZ) with telemetry (Telemyo DTS) was used to assess EMG data of the pectoralis major (PM), anterior deltoid (AD), posterior deltoid (PD), upper trapezius (UT), biceps (B), triceps (T), and latissimus dorsi (LD). To assess fatigue, changes in EMG median frequency and mean amplitude across each training session and each training day were examined. IRB approval and informed consent were obtained prior to the study. RESULTS: Fatigue of the PM was most substantial, approaching 30% within an hour of training activity. A 25% fatigue of the AD was also present during the first training session. Some fatigue was demonstrated in BB and T during the first training session (<8%) but these muscles recovered over a training day and generated greater force production over additional training sessions. Increased force production was demonstrated in the UT throughout a training day to compensate for shoulder flexor fatigue. Function of the PD and LD were varied across participants. CONCLUSIONS: In the current study, Paralympic rugby athletes demonstrated fatigue in shoulder flexors, namely pectoralis major and anterior deltoid. Fatigue was demonstrated within the first training session of a prolonged training camp and was typically present across a training day. Whereas shoulder joint muscles fatigued, the elbow joint muscles demonstrated recovery and ultimately increased force output across a training day to compensate. This finding is typical in wheelchair users as force production moves from the shoulder joint to elbow and wrist joints when the prime movers become fatigued.

Adopting Evidence-Based Caregiver Training Programs in the Real World: Outcomes and Lessons Learned From the STAR-C Oregon Translation Study.

This article describes the translation and evaluation of STAR-Community Consultants program (STAR-C), an evidence-based dementia caregiver training program, within the Oregon Department of Human Services. Staff from two regional Area Agencies on Aging (AAAs) were trained to implement all aspects of STAR-C, including screening, recruitment of caregiver/care-receiver dyads, and treatment delivery. Mailed assessments of caregiver depression, burden, and care-receiver mood, behavior, and quality of life were collected at pre-treatment, post-treatment, and 6-month follow-up. One hundred fifty-one dyads entered the program; 96 completed the 8-week intervention. Significant positive post-treatment effects were obtained for caregiver depression, burden, and reactivity to behavior problems, and care-receiver depression and quality of life. At 6-month follow-up, improvements in caregiver reactivity and care-receiver depression were maintained. Caregivers reported high levels of satisfaction with the program. STAR-C was successfully and effectively implemented by participating AAAs. Recommendations for replication, including training, recruitment, and assessment procedures are provided.

Optimal or Typical Performance? The Impact of Instructional Set on the Behavioral Assessment of Parent-Child Interactions

The behavioral assessment of parent-child interactions is an important component of treatment planning and evaluation in many evidence-based parent training programs. However, numerous factors unrelated to the parent-child interaction may add error to the assessment. This study investigated the impact of task instructions on parents’ behaviors during the analogue parent-child interaction observation, the Dyadic Parent-Child Interaction Coding System (DPICS). Forty-eight mother-child dyads were randomly assigned to one of two conditions that differed on level of specificity of instructions. Significant differences were observed between groups, with parents who received specific instructions using more praises during the DPICS tasks. Specific instructions may shift parents’ behaviors toward optimal, rather than typical, interaction patterns and should be considered in the context of the assessment goals.

Cultural adaptation and implementation of evidence-based parent-training: A systematic review and critique of guiding evidence

With advances in knowledge regarding efficacious evidence-based interventions, there have been significant attempts to culturally adapt, implement, and disseminate parent training interventions broadly, especially across ethnic and cultural groups. We sought to examine the extent to which researchers and developers of evidence-based parent training programs have used cultural adaptation models, tested implementation strategies, and evaluated implementation outcomes when integrating the interventions into routine care by conducting a systematic review of the literature for four evidence-based parent training interventions: Parent-Child Interaction Therapy (PCIT), The Incredible Years (IY), Parent Management Training-Oregon Model (PMTOTM), and the Positive Parenting Program (Triple P). A total of 610 articles across the four programs were identified. Of those, only eight documented a rigorous cultural adaptation process, and only two sought to test the effectiveness of implementation strategies by using rigorous research designs. Our findings suggest that there is much work to be done to move parent-training intervention research towards a more rigorous examination of cultural adaptation and implementation practices.

Trajectory of Externalizing Child Behaviors in a KEEP Replication

Objective: The purpose of this study is to examine the correlates of child behavior change over time in a replication of the KEEP intervention. Method: The study sample was drawn from the treatment group of the Maryland replication of KEEP (n=65). Change over time was analyzed using multilevel linear mixed modeling. Results: Parents’ use of positive reinforcement relative to discipline was associated with the rate of child behavior change among program participants; parents with the lowest initial levels of reinforcement reported the greatest decrease in child problem behaviors. Other participant characteristics were not associated with child behavior change during the study period. Conclusions: The results indicate the efficacy of an evidence-based foster parent training program for reducing child problem behaviors and underscore the utility of teaching parents to use more positive responses relative to discipline as a robust path to improved child outcomes.

Recent Progress in Psychosocial and Psychopharmacologic Treatments for ADHD

In this article, we review several new psychosocial and psychopharmacologic treatment approaches for attention deficit hyperactivity disorder (ADHD). Several of the treatments reviewed are promising and offer opportunities for augmenting current evidence-based approaches. However, others are not yet ready for prime time. Consequently, existing algorithms for ADHD treatment should still be followed. Current guidelines include those from the American Academy of Pediatrics (Wolraich et al. Pediatrics. 128 5:1007–22 2011), the American Academy of Child and Adolescent Psychiatry (AACAP) (Pliszka S and AACAP Work Group on Quality Issues. J Am Acad Child Adolesc Psychiatry. 46 7:894–921 2007), and the Texas Department of Mental Health and Mental Retardation (Pliszka et al. J Am Acad Child Adolesc Psychiatry. 45 6:642–57 2006). These treatment recommendations and algorithms are based on results from both controlled clinical trials and expert opinion. For core symptoms, medication is considered superior to psychosocial treatment. However, the full range of ADHD-associated impairments is best addressed by combined treatment, with an emphasis on behavioral interventions as first-line approaches when treating preschool children with ADHD. The availability of an evidence-based organizational skills training program is a welcome addition for targeting problems with organization and attention-related impairments in children. Among available medication treatments, stimulants are considered to have the most robust effects on core symptoms; however several non-stimulant medications are available and others are being investigated for possible utility. Combined pharmacotherapy with stimulants and α2 agonists is now an FDA-approved treatment and can be considered in youth who are not fully responsive to stimulants or who have other problems which may represent indications for α2 agonist treatment. Combined treatment with stimulants plus risperidone has merit in youth with severe aggressive behavior but remains off-label and should generally be considered when other options fail. The potential risk and benefits of stimulant treatment for subsequent substance abuse remains an important topic. In the main, stimulant treatment is considered safe and may even provide protection against development of substance abuse. However, the possibility that stimulant exposure could be problematic in youth with elevated risk for substance abuse disorders should be considered.

Developing the eCPP: adapting an evidence-based parent training program for digital delivery in primary care settings.

Developing innovative delivery methods is needed to overcome time and logistic barriers to in-person participation in evidence-based parent training (PT) programs. The purpose of this paper is to (a) describe the systematic process for adapting an evidence-based group PT program (the Chicago Parent Program) to a tablet-based delivery format, (b) present the adapted program, and (c) discuss opportunities and challenges of adapting evidence-based programs for alternative delivery methods. To ensure consistency with the original program and relevance to the intended program recipients, three groups-parents (n = 10), CPP developers (n = 3), and digital delivery experts- were engaged throughout the systematic steps of the delivery adaptation of the Chicago Parent Program (eCPP). Group meetings were used to identify the program's core components, develop the adaptation program model, assess potential mismatches for the new delivery context, and adapt the original program model and materials. The final eCPP is a six-module Internet-based intervention that includes: interactive activities, video examples and explanations of parenting strategies, reflection questions, assessment of parent knowledge with feedback, and module practice assignments. Developing innovative delivery approaches for evidenced-based interventions are promising to increase intervention sustainability and participant access and engagement. It is critical that these adaptations are systematic and developed with expert consultation and community input.

Comparing two evidence-based parent training interventions for aggressive children

Purpose – The purpose of this paper is to explore whether the changes in externalising behaviour for young aggressive children differ between two evidence-based parent training (PT) programmes after treatment. The treatment formats between these programmes differ, and the authors were particularly interested in whether this influenced the results for participants with co-occurring problems (child variables such as heightened levels of attention and internalising problems, and parental variables such as marital status and education) and the consequent additional risk of poorer treatment outcomes. Design/methodology/approach – A comparison of the individual treatment programme “Parent Management Training – Oregon model” (PMTO) and the group intervention programme “The Incredible Years” (IY) basic training sessions. Outcomes were explored in matched samples from two earlier Norwegian replication studies. The participants were matched on pre-treatment characteristics using a quasi-experimental mis-matching procedure. Findings – There were no significant differences between the two interventions in parent ratings of externalising behaviours and the lack of differing effects between the two treatments remained when the co-occurring risk factors were introduced into the analyses. Research limitations/implications – The participants were matched on pre-treatment characteristics using a quasi-experimental mis-matching procedure. Practical implications – A possible implication of these findings is that parents should be allowed to choose the treatment format of their preference. Further, individual PT may be more appropriate in rural settings with difficulties in forming group interventions. Social implications – Treatment effects did not differ between these two evidence-based interventions. Originality/value – To the best of the knowledge independent comparisons of two evidence-based PT interventions are not previously conducted.

Validated Chinese Translation of the Fresno Test for Evidence-based Health Care Training

To elevate quality of care for the ever-increasing number of elderly patients in Taiwan, staff in geriatric medicine frequently attend training to promote evidence-based health care. However, such training programs must be effective. Evaluation of evidence-based health care training requires a valid instrument to assess learners' competence. The Fresno test has robust psychometric properties, but there is no validated Chinese translation of this tool yet available. The English Fresno test was translated into Chinese and then back-translated to English to ensure equivalence of concepts and semantics. First-year postgraduate physician trainees (novices) recruited from an evidence-based medical training program completed the Chinese Fresno test prior to and after the program. Experienced instructors (experts) in the program also completed the test for comparison. The correlation and consistency of the Chinese version were analyzed and validated. Forty (20 experts and 20 novices) completed the tests. The inter-rater correlation ranged from 0.65 to 0.98. Internal consistency was good (Cronbach's α = 0.98). Item difficulty ranged from 23% to 72%. Item discrimination indices ranged from 0.40 to 0.90. Experts scored significantly higher than novices (experts = 165, novices = 93; p < 0.001). Test–retest correlation 2 weeks after the first test was 0.98 ( p < 0.001). This Chinese version of the Fresno test is a reliable and valid instrument for evaluating evidence-based health care knowledge and skills.

Attitudes associated with alcohol and marijuana referral actions by resident assistants.

This exploratory study examined associations between resident assistant (RA) attitudes and referral actions to identify training strategies for strengthening the ability of these paraprofessionals to recognize and refer college students in their living units who misuse alcohol and marijuana. The study's hypotheses were that (1) referral self-efficacy and perceived referral norms would be positively associated with RA referral actions and (2) perceived referral barriers and referral anticipatory anxiety would be negatively associated with RAs' referral actions. A total of 317 RAs at eight residential campuses in different regions of the U.S. took part in the study. All participating RAs had at least one semester of work experience. Just prior to the Fall semester of 2012, RA's responded to an online survey that assessed their alcohol and marijuana referral attitudes and referral actions. Overall, RAs reported considerable anxiety about approaching and referring students who may have an alcohol and/or marijuana problem. Perceived referral norms among RAs indicated substantial variability in perceptions about others' expectations of them for referring students who may have alcohol and marijuana problems. Results from two multivariable logistic regression analyses showed that referral self-efficacy distinguished RAs who took alcohol referral actions and marijuana referral actions from those who did not do so. Neither length of RA service nor time spent on campus was associated with referral actions. RA training programs could give attention to strengthening referral self-efficacy through a series of increasingly difficult skill-building activities during pre- and in-service training. In addition, senior residence life and housing professional staff may consider assessing the extent to which RAs under their supervision follow established protocols for assisting students with possible alcohol and marijuana problems. The development of evidence-based RA training programs will require additional research.

Accelerating preparedness: leveraging the UNC PERLC to improve other projects related to public health surveillance, assessment, and regionalization.

The co-location of the University of North Carolina at Chapel Hill (UNC) Preparedness and Emergency Response Learning Center (PERLC) and the UNC Preparedness and Emergency Response Research Center (PERRC) and other smaller projects within the North Carolina Institute for Public Health, a public health practice-oriented unit of the UNC Gillings School of Global Public Health, facilitated many successful collaborations. By sharing personnel, space, and other resources, the UNC PERLC and PERRC and other projects were able to meet the needs of the public health workforce by developing evidence-based training programs and tools around topics including epidemiology, surveillance, and vulnerable populations.

Faculty buy-in to teach alcohol and drug use screening.

Educating nursing faculty about the use of an evidence-based practice to screen and intervene earlier along the continuum of alcohol and other drug use, misuse, and dependence is essential in today's health care arena. Misuse of alcohol and other drugs is a significant problem for both individual health and societal economic welfare. The purpose of this article is to describe nursing faculty buy-in for the implementation of an evidence-based addiction training program at a university-based school of nursing. Derived from an academic-community partnership, the training program results suggest implications for continuing education and curriculum innovation in schools of nursing and clinical practice. The training content presented can be used in continuing education for nursing faculty across all types of nursing school programs and professional nursing staff employed in multiple settings. The training program was funded by the Health Resources and Services Administration.

Changes in success rates of smoking cessation treatment associated with take up of a national evidencebased training programme

ObjectiveThe English ‘stop smoking services’ provide behavioural support to some 700,000 smokers annually. Success rates of the services varied considerably before 2010 and had been in slight decline so, to improve performance, a national programme of evidence-based practitioner training was developed to improve knowledge and skills-based competences. This study evaluated whether uptake of the training was associated with improvements in success rates of services. MethodsMean 4-week biochemically verified abstinence rates were compared for 146 (of 151) stop smoking services between 2008–10 (before roll-out of training) and 2011–13 (after roll-out), and the change in success rates for each service was regressed on to the number of practitioners per service trained in a) knowledge (online) and b) skills (face-to-face). ResultsSuccess rate across all services improved between the two periods (34.1% to 36.5%, p=0.01 1-tailed; 95% CI for difference 0.44–4.48). The magnitude of improvement for each service was associated with the number of practitioners who completed the knowledge and skills training (beta=0.22, p=0.005 1-tailed), and marginally with the number who completed the knowledge training (beta=0.14, p=0.047 1-tailed). ConclusionEnglish stop smoking services that have greater uptake of a national evidence-based training programme showed greater improvements in success rates.

Need Is Urgent for Better Dementia Care

Need Is Urgent for Better Dementia Care

Effect of Supervised, Periodized Exercise Training vs. Self-Directed Training on Lean Body Mass and Other Fitness Variables in Health Club Members

Conventional wisdom suggests that exercise training with a personal trainer (PTr) is more beneficial for improving health-related fitness than training alone. However, there are no published data that confirm whether fitness club members who exercise with a PTr in the fitness club setting obtain superior results compared with self-directed training. We hypothesized that club members randomized to receive an evidence-based training program would accrue greater improvements in lean body mass (LBM) and other fitness measures than members randomized to self-training. Men, aged 30-44 years, who were members of a single Southern California fitness club were randomized to exercise with a PTr administering a nonlinear periodized training program (TRAINED, N = 17) or to self-directed training (SELF, N = 17); both groups trained 3 days per week for 12 weeks. Lean body mass was determined by dual-energy x-ray absorptiometry. Secondary outcomes included muscle strength 1 repetition maximum (1RM), leg power (vertical jump), and aerobic capacity (V[Combining Dot Above]O2max). TRAINED individuals increased LBM by 1.3 (0.4) kg, mean (SEM) vs. no change in SELF, p = 0.029. Similarly, significantly greater improvements were seen for TRAINED vs. SELF in chest press strength (42 vs. 19%; p = 0.003), peak leg power (6 vs. 0.6%; p < 0.0001), and V[Combining Dot Above]O2max (7 vs. -0.3%; p = 0.01). Leg press strength improved 38 and 25% in TRAINED and SELF, respectively (p = 0.14). We have demonstrated for the first time in a fitness club setting that members whose training is directed by well-qualified PTrs administering evidence-based training regimens achieve significantly greater improvements in LBM and other dimensions of fitness than members who direct their own training.