For individuals with mental health conditions, obtaining high-quality mental health care is essential to their recovery. Over the past several years, new policies and practices have attempted to promote ways to seek and reduce barriers to care. These have included federal and state policies to ensure parity in reimbursement as well as implementation of public awareness campaigns that attempt to stamp out stigma related to mental health. While these initiatives can be important in motivating people to seek care, more work needs to be done to ensure that those who seek care get the best available.
Advances in mental health care have produced many effective treatments for mental health conditions, including certain types of medications and psychotherapy. Evidence-based psychotherapies are those shown by research to improve symptoms and accelerate recovery from specific mental health conditions. However, these therapies can only benefit patients when providers are trained to deliver them. Yet research suggests that lack of provider training contributes to relatively low usage of these therapies in the settings where most mental health care in the United States is delivered: independent private practices and community clinics.
For example, a 2014 RAND study found that only about a third of private-sector psychotherapists had been trained to provide at least one evidence-based psychotherapy for PTSD and at least one for depression. Further, only about 30 percent reported that they often or always used techniques associated with at least one of the evidence-based psychotherapies for PTSD and major depression. These findings suggest a need to enhance the tools available to the mental health workforce to deliver evidence-based psychotherapies.
Efforts to enhance provider training are underway. There are dozens of psychotherapy trainings with offerings for mental health care clinicians on various psychotherapy approaches. Because these trainings have been designed and implemented across multiple organizations, there is considerable variation across models and approaches, ranging from short one-session webinars to in-person, multiple-day trainings.
Unfortunately, little is known about the extent to which these approaches incorporate proven strategies for enhancing clinician knowledge of evidence-based psychotherapies and for changing clinician behavior to implement such strategies in their clinical settings.
To help training leaders, clinicians, purchasers, and credentialing bodies assess these trainings, RAND developed Training in Psychotherapy (TIP)—a new tool designed to assess how well a specific training aligns with the most critical features of effective training.
The TIP Tool incorporates scientific research and expert perspectives on the components of psychotherapy trainings that are the most critical to producing provider competency in delivering an evidence-based psychotherapy. Users enter information about a training to characterize that training in five domains: Format, content, availability of supervision, program evaluation by users, and implementation support. Averaging the ratings on all items yields an overall score for a training.
The tool helps organizations and clinicians assess and select the right training program for their needs. The TIP Tool can place a psychotherapy training on a continuum: from “raising awareness” about a particular therapy, to “skill-building” in preparation to delivering a given therapy, and “supporting competence” in delivering the therapy as intended.
The TIP Tool essentially offers something for each user. Clinicians can use the tool to select the training program that fits best with their training goals and clinical needs. Researchers can use the TIP Tool to document detailed elements of the psychotherapy training implemented in their studies. Training leaders can use the tool to assess their own training programs and determine whether they would like to make changes in their training approach. Effective training ensures that mental health clinicians can use these psychotherapies in real-world settings and in ways that maximize the benefit to patients.
If the mental health workforce wants to meet the needs of the communities it serves, then it requires the proper tools. A key element of this is high-quality training in how to deliver evidence-based treatments. Access to such treatments can provide patients with a much greater likelihood of improvement and ultimate recovery.
More information about the TIP Tool can be found at RAND.org
by Kimberly A. Hepner, Terri Tanielian, David M. Adamson Kimberly Hepner is a a senior behavioral scientist and a licensed clinical psychologist, Terri Tanielian is a senior behavioral scientist, and David M. Adamson is a senior research communications analyst at the nonprofit, nonpartisan RAND Corporation.