Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Jul 28;18(1):589.
doi: 10.1186/s12913-018-3395-0.

Pilot to policy: statewide dissemination and implementation of evidence-based treatment for traumatized youth

Lisa Amaya-Jackson  1   2 , Dana Hagele  3   4 , John Sideris  4 , Donna Potter  5   3 , Ernestine C Briggs  5   3 , Leila Keen  3 , Robert A Murphy  5   3 , Shannon Dorsey  6 , Vanessa Patchett  7 , George S Ake  5   3 , Rebecca Socolar
Affiliations

Pilot to policy: statewide dissemination and implementation of evidence-based treatment for traumatized youth

Lisa Amaya-Jackson et al. BMC Health Serv Res. .

Abstract

Background: A model for statewide dissemination of evidence-based treatment (EBT) for traumatized youth was piloted and taken to scale across North Carolina (NC). This article describes the implementation platform developed, piloted, and evaluated by the NC Child Treatment Program to train agency providers in Trauma-Focused Cognitive Behavioral Therapy using the National Center for Child Traumatic Stress Learning Collaborative (LC) Model on Adoption & Implementation of EBTs. This type of LC incorporates adult learning principles to enhance clinical skills development as part of training and many key implementation science strategies while working with agencies and clinicians to implement and sustain the new practice.

Methods: Clinicians (n = 124) from northeastern NC were enrolled in one of two TF-CBT LCs that lasted 12 months each. During the LC clinicians were expected to take at least two clients through TF-CBT treatment with fidelity and outcomes monitoring by trainers who offered consultation by phone and during trainings. Participating clinicians initiated treatment with 281 clients. The relationship of clinician and client characteristics to treatment fidelity and outcomes was examined using hierarchical linear regression.

Results: One hundred eleven clinicians completed general training on trauma assessment batteries and TF-CBT. Sixty-five clinicians met all mastery and fidelity requirements to meet roster criteria. One hundred fifty-six (55%) clients had fidelity-monitored assessment and TF-CBT. Child externalizing, internalizing, and post-traumatic stress symptoms, as well as parent distress levels, decreased significantly with treatment fidelity moderating child PTSD outcomes. Since this pilot, 11 additional cohorts of TF-CBT providers have been trained to these roster criteria.

Conclusion: Scaling up or outcomes-oriented implementation appears best accomplished when training incorporates: 1) practice-based learning, 2) fidelity coaching, 3) clinical assessment and outcomes-oriented treatment, 4) organizational skill-building to address barriers for agencies, and 5) linking clients to trained clinicians via an online provider roster. Demonstrating clinician performance and client outcomes in this pilot and subsequent cohorts led to legislative support for dissemination of a service array of EBTs by the NC Child Treatment Program.

Keywords: Child trauma; Coaching; Community implementation; Effectiveness; Evidence-based treatment; Implementation; Learning collaborative; Outcomes-oriented.

PubMed Disclaimer

Conflict of interest statement

Authors’ information

John Sideris, PhD, served as statistical expert for this study.

Ethics approval and consent to participate

The institutional review boards at the University of North Carolina at Chapel Hill and Duke University School of Medicine approved all study procedures. Written informed consent and assent (for youth under age 16) was obtained for all study procedures; parental consent was obtained for participants under 16.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Fidelity-mediated child PTSD outcomes: Pre-treatment to Post-treatment
See this image and copyright information in PMC

References

    1. Woolf SH. The meaning of translational research and why it matters. JAMA. 2008;299(2):211–213. doi: 10.1001/jama.2007.26. - DOI - PubMed
    1. Aarons GA, Sommerfeld DH. Leadership, innovation climate, and attitudes toward evidence-based practice during a statewide implementation. J Am Acad Child Adolesc Psychiatry. 2012;51(4):423–431. doi: 10.1016/j.jaac.2012.01.018. - DOI - PMC - PubMed
    1. Fixsen DL, Naoom SF, Blase KA, Friedman RM, Wallace F. Implementation research: a synthesis of the literature (FMHI publication no. 231). Tampa: University of South Florida, Louis de la parte Florida mental health institute, the National Implementation Research Network; 2005.
    1. Aarons GA. Mental health provider attitudes toward adoption of evidence-based practice: the evidence-based practice attitude scale (EBPAS) Ment Health Serv Res. 2004;6(2):61–74. doi: 10.1023/B:MHSR.0000024351.12294.65. - DOI - PMC - PubMed
    1. Sholomskas DE, Syracuse-Siewert G, Rounsaville BJ, Ball SA, Nuro KF, Carroll KM. We don’t train in vain: a dissemination trial of three strategies of training clinicians in cognitive-behavioral therapy. J Consult Clin Psychol. 2005;73(1):106–115. doi: 10.1037/0022-006X.73.1.106. - DOI - PMC - PubMed

Publication types