| Prior empirical evidence suggests didactic training alone inadequately sustains community integration of evidence-based treatments(EBTs). Hence, most implementation models, such as Learning Collaboratives (LCs), includeexpert consultation to promote EBTimplementation with fidelity. In contrast, the role in-house supervision plays in EBTadoption–particularly during a LC–remains unknown, thoughprevious findingssuggestsupervision’s effects may varybased on the content orfoci of supervisiontechniques(e.g., EBT-specific versusgeneral supervision practices). Thus, this studyhas two primary goals: (1) to examine how the quantity (i.e., frequency, duration) and qualityof supervision (i.e., EBT-specific or generalcontent) changed before and aftera LC,and (2) to examine relations between general and EBT-specific supervision practices and therapists’ general as well as protocol-specificadherence. Based on archival data, participants were 139therapists from 49 agencies involved in one of six LCs conducted as part of a statewide initiative to implement trauma-informed EBTs, with a focus on Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). Participants completed online surveys, pre-and post-LC, to assess factors related potentially to EBTimplementation, with a particular focus on TF-CBT. For thisstudy, analyzed measures included: (1) the TF-CBT Supervision Checklist, which assessed therapist-reported receipt of TF-CBT-specific and general supervision practices, and (2) the TF-CBT Practices Scale, which assessed therapist-reported use of TF-CBT-specific and general evidence-based practiceswith child trauma cases. Therapist-reportedfrequency and durationof supervision, pre-and post-LC, wereanalyzedrespectivelywith Wilcoxon and paired samples t-tests.Results indicated thatthe reported frequency of planned supervision did not significantly change,pre-to post-LC (r= -.04, p = .72); however, frequency of unplanned supervision significantly decreased,pre-post-CBLC (r= -.24,
ixp = .02).Reported supervision duration also decreased significantly pre-to post-LC (d= -0.38, p= .006). Hypothesized pre-to post-LC improvementsin supervision content and therapist adherence wereanalyzed viarepeated measures MANOVAs.Findings indicated that,pre-to post-LC, TF-CBT specific supervision content (per therapist-report) increased significantly (d = 0.56, p< .001); whereas, generalsupervision content did not (d= -0.01, p = .45). Similarly, TF-CBT-specific adherence (per therapist-report) increased significantlyto a moderate degree,pre-to post-LC (d = 0.53, p< .001), whilegeneral adherence increased to a trivial, nonsignificant degree (d= 0.15, p= .08).Moreover, multiple multivariate regressionresults indicated that,when controlling for pre-to post-LC change in general supervision content, increases in TF-CBT-specific supervision content significantly predictedgains in therapist-reportedadherence to general (r= .30, p= .006) and TF-CBT-specific practice elements(r = .22, p = .04). In contrast, when controlling for LC-related changesin TF-CBT-specific supervision content, increasesin general supervision content only significantly predictedimprovementsin general adherence (r = .28, p= .01), but not TF-CBT-specific adherence (r= .16, p= .14). Taken together, results suggest the LCmodelcansignificantly improve the quality (i.e., content)of community supervision, particularly EBT-focused content, and that these gains may improve therapists’ adherence to LC-targeted LCs. Although preliminary, these findingssuggest implementation initiatives should focus on EBT-specificrather thangeneralsupervision practices to most effectively improveclinicians’ adherence to both EBT-specific andgeneralpracticeelements. Keywords: dissemination, implementation, Trauma-Focused Cognitive Behavioral Therapy(TF-CBT), community-based learning collaborative (CBLC), supervision, fidelity, adherence |