An Equivalence Analysis Of Provider Education In Youth Mental Health Care

Objective To test for equivalence between providers with and without advanced degrees in multiple domains related to delivery of evidence-based treatment.Data Source Provider and client data from an effectiveness trial of Alternatives for Families: A Cognitive Behavioral Therapy (AF-CBT) in a major metropolitan area in the United States.Study Design We tested for equivalence between providers (N = 182) with and without advanced degrees in treatment-related knowledge, practices, and attitudes; job demands and stress; and training engagement and trainer-rated competence in AF-CBT. We also conducted exploratory analyses to test for equivalence in family clinical outcomes.Data Collection Providers completed measures prior to randomization and at 6-month follow-up, after completion of training and consultation in AF-CBT. Children and caregivers completed assessments at 0, 6, 12, and 18 months.Principal Findings Providers without advanced degrees were largely non-inferior to those with advanced degrees in treatment-related knowledge, practices, and attitudes, while findings for job demands and stress were mixed. Providers without advanced degrees were non-inferior to providers with advanced degrees in consultation attendance (B = -1.42; confidence interval (CI) = -3.01-0.16; margin of equivalence (Delta) = 2), number of case presentations (B = 0.64; CI = -0.49-1.76; Delta = 2), total training hours (B = -4.57; CI = -10.52-1.37; Delta = 3), and trainer-rated competence in AF-CBT (B = -0.04; CI = -3.04-2.96; Delta = 4), and they were significantly more likely to complete training (odds ratio = 0.66; CI = 0.10-0.96; Delta = 30%). Results for clinical outcomes were largely inconclusive.Conclusions Provider-level outcomes for those with and without advanced degrees were generally comparable. Additional research is needed to examine equivalence in clinical outcomes. Expanding evidence-based treatment training to individuals without advanced degrees may help to reduce workforce shortages and improve reach of evidence-based treatments.