Uncovering determinants of perceived feasibility of TF-CBT through coincidence analysis

Introduction

A mental health provider's perception of how well an intervention can be carried out in their context (i.e., feasibility) is an important implementation outcome. This article aims to identify determinants of feasibility of trauma-focused cognitive behavioral therapy (TF-CBT) through a case-based causal approach.

Method

Data come from an implementation-effectiveness study in which lay counselors (teachers and community health volunteers) implemented a culturally adapted manualized mental health intervention, TF-CBT, delivered to teens who were previously orphaned and were experiencing posttraumatic stress symptoms and prolonged grief in Western Kenya. The intervention team identified combinations of determinants that led to feasibility among teacher- and community health volunteer-counselors through coincidence analysis.

Results

Among teacher-counselors, organizational-level factors (implementation climate, implementation leadership) determined moderate and high levels of feasibility. Among community health volunteer-counselors, a strong relationship between a clinical supervisor and the supervisee was the most influential determinant of feasibility.

Conclusion

Methodology and findings from this article can guide the assessment of determinants of feasibility and the development of implementation strategies for manualized mental health interventions in contexts like Western Kenya.

Plain Language Summary

A mental health provider's perception of how easy a therapy is to use in their work setting (i.e., feasibility) can impact whether the provider uses the therapy in their setting. Implementation researchers have recommended finding practices and constructs that lead to important indicators that a therapy will be used. However, limited research to our knowledge has searched and found practices and constructs that might determine feasibility of a therapy. This article uses existing data from a large trial looking at the continued use of a trauma-focused therapy to find practices and constructs that lead to moderate and high levels of feasibility. We found that in settings with a strong organizational structure that organization and leadership support for the therapy led to teachers in Kenya to perceive the therapy as easy to use. On the other hand, in settings with a weaker organizational structure, outside support from a clinical supervisor led to community health volunteers in Kenya perceiving the therapy as easy to use. The findings from this article can guide context-specific recommendations for increasing perceived therapy feasibility at the provider-, organization-, and policy levels.

Supervisor Cultural Humility and Supervisee Nondisclosure: The Supervisory Working Alliance Matters

Given that half or more of supervisees (therapist trainees) never have their clinical work monitored or observed, supervisees who withhold salient information in clinical supervision compromise supervisors' ability to monitor client welfare and promote supervisees' professional development. Attempting to further understand the factors explaining supervisee nondisclosure, we tested the supervisory working alliance as a mediator of the hypothesized inverse relations of cultural humility and collaborative supervision with supervisee nondisclosure (supervision-related and clinically-related nondisclosure) among a diverse sample of 214 supervisees in applied psychology and allied mental health programs. Results supported the hypotheses that (1) descriptively, supervision-related nondisclosure was more prominent than clinically-related nondisclosure, (2) cultural humility substantially inversely predicted supervisee nondisclosure, and (3) the supervisory working alliance fully mediated the inverse relations of cultural humility and collaborative supervision with supervisee nondisclosure. Understanding the mechanisms underlying supervisee nondisclosure have broad implications for clinicians and researchers alike.

A Behavior-based Coding Tool for Assessing Supervisors' Adherence and Competence: Findings From a Motivational Interviewing Implementation Study

Supervision seems to be an essential part of therapist training, and thus also of implementing evidence-based practices. However, there is a shortage of valid and reliable instruments for objective assessment of supervision competence that include both global measures and frequency counts of behavior - two essential aspects of supervisory competence. This study tests the internal consistency and inter-rater reliability of an assessment tool that includes both these measures. Additionally, strategies and techniques used by ten supervisors in 35 Motivational interviewing supervision sessions are described. Codings were conducted after two separate coding training sessions. The internal consistency across the global measures was acceptable (α = 0.70; 0.71). After the second training, the inter-rater reliabilities for all frequency counts were in the moderate to good range, except for two that were in the poor range; inter-rater reliability for one of the four global measures was in the moderate range, and three were in the poor range. A prerequisite for identifying specific supervisor skills central to the development of therapist skills, teaching these skills to supervisors, and performing quality assurance of supervision, is to create instruments that can measure these behaviors. This study is a step in that direction.

Vocational Rehabilitation in the COVID-19 Era: The Importance of Supervision

The rehabilitation counseling profession, as an essential career, has been facing unforeseen and unprecedented complications as a result of the coronavirus-19 pandemic. As practitioners were required to begin completing their work virtually or using telehealth modalities, it became apparent that may be gaps in preparation for such a shift. It is as yet unknown what implication these changes have on employment rates of people with disabilities, in addition to other markers for independence (e.g., independent living, etc.). Implications of the sudden shift to virtual practice are especially of interest following the changes to the comprehensive system of personnel development legislated by the Workforce Innovation and Opportunity Act reauthorization of 2014. Decreased educational requirements may lead vocational rehabilitation (VR) employees to navigate a national crisis without the essential knowledge domains required for qualified provider status. The current study asked VR personnel to indicate their comfort and preparedness in various areas, in light of the pandemic and virtual service provision ( n = 88). Items were assessed at three levels: Counselor, Agency, and Client. Taken together, the results indicate that the sample feels able to maintain evidence-based services, and that supervisors have been regularly available during this uncertain time. Implications for rehabilitation researchers, supervisors, and educators are discussed.

Online clinical pastoral education needs more research

In 2020, the COVID-19 pandemic forced many Clinical Pastoral Education (CPE) programs to cancel or move online. There is no research about online CPE, and it is unknown how effective it is compared with in-person CPE. Researchers in other related fields have studied online clinical supervision, specifically how technology-assisted supervision affects the supervisory relationship, the development of supervisees' competence and confidence, supervisees' satisfaction, and the overall quality of clinical supervision. This paper presents a review of the scientific evidence about online clinical supervision. It is generally agreed that online clinical supervision is a viable alternative to in-person supervision. More research about online CPE is needed to develop best practices and new accreditation standards that enable CPE supervisors to practice online CPE at the highest level, whether in a pandemic or not.

The supervisory relationship from an attachment perspective: Connections to burnout and sense of coherence in health professionals

Supervision is an essential part of the training and work environment of health professionals, especially of psychotherapists and clinical/health psychologists. However, although the supervisory process is always a relational one and may therefore be influenced by attachment dynamics, the importance of the supervisory relationship for the professional's performance and the well‐being of the supervisee has yet to be fully examined.

In this cross‐sectional observational study, the Experiences in Close Relationships‐Revised (ECR‐RD; avoidant and anxious attachment), the Supervisory Relationship Questionnaire (SRQ), the Maslach Burnout Inventory (MBI) and the Sense of Coherence Scale (SOC‐13) were analysed for 346 (81.8% female) health professionals.

Considering professional experience and number of supervision sessions as control variables, a better supervisory relationship negatively predicted burnout symptoms (β = −.31) but positively predicted sense of coherence (β = .31, both p < .01). The final model, including avoidant and anxious attachment as additional predictors, explained 30% of the variance in burnout symptoms and 41% of the variance in sense of coherence.

The results underline the importance of the supervisory relationship for the well‐being and the professional performance of health professionals. Interactions between the supervisory relationship and underlying attachment parameters should be further explored in future studies.