This proposal is a response to PAR-10-038 "Dissemination and Implementation Research in Health." Despite major advances in developing evidence-based psychotherapies, the adoption of such treatments by community therapists has been slow. Hence, it is important to develop and test different methods to effectively train therapists to implement evidence-based psychotherapies in community settings. College campuses have a relatively high prevalence of eating disorders (EDs) and therefore present an efficient environment to test the implementation of strategies to treat these disorders. We propose to train therapists to implement interpersonal psychotherapy (IPT), evidence-based treatments for EDs. Therapists usually learn about new therapies via a workshop and treatment manual. However, it has been shown that this method does not effectively increase therapist skills, nor does it sustain utilization of these interventions. Hence, in this study we will compare two implementation strategies designed to improve upon this approach. The first is a low intensity strategy with the addition of external expert consultation following the workshop. The second is a theoretically-grounded high intensity approach focused on building internal expertise. In this strategy, a staff member from the counseling center will be trained in IPT and coached to train other staff members within the site to implement IPT. This strategy includes quality-control procedures designed to improve implementation and to ensure treatment fidelity. Twenty-six college counseling centers with approximately 230 therapists will be allocated at random to one of the two implementation strategies. Three centers: Washington University (Implementation and Cost Analysis Center), Rutgers University (Fidelity Monitoring Center), and Stanford University (Data Coordinating Center) will conduct the study. The primary aim is to compare therapist fidelity to IPT for the two training strategies and its consequent impact on client outcome. A secondary aim is to examine the generalization of use of IPT for depression. We hypothesize that the high intensity approach will prove significantly more effective than the low intensity strategy, particularly in sustainability. Exploratory moderator and mediator analyses will illuminate the institutional and therapist variables that affect implementation and client outcomes. Because the two approaches differ in resources, the implementation and service costs for each of the training methods will be determined. Implementation will proceed over a twenty month period with a 12-month follow-up to test sustainability, during which period consultation from Washington University will have ceased. This project continues a long-standing collaboration among the three PIs and centers that have focused in the past on understanding factors underlying eating disorders and on the development of evidence- based psychotherapies. To extend our expertise on implementation theory and procedures, we have established collaborations with faculty from the Dissemination and Implementation Core at Washington University, including Drs. Proctor and Raghavan who are co-investigators on this project.
Eating disorders occur most frequently in late adolescence and early adult life, and therefore constitute, along with mood disorders, a serious and prevalent mental health problem for college students. Although evidence-based treatments such as interpersonal psychotherapy (IPT) have been shown to be effective for both of these disorders, few community therapists use such treatments. Hence, the present study will involve partnering with college counseling centers to determine the most effective method to implement IPT for eating and mood disorders in these settings, and will establish a platform for future large-scale dissemination of evidence-based interventions to mental health service providers.
|Wilfley, Denise E; Agras, W Stewart; Taylor, C Barr (2013) Reducing the burden of eating disorders: a model for population-based prevention and treatment for university and college campuses. Int J Eat Disord 46:529-32|