An equivalence analysis of provider education in youth mental health care

ObjectiveTo test for equivalence between providers with and without advanced degrees in multiple domains related to delivery of evidence‐based treatment.Data SourceProvider 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 DesignWe 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 CollectionProviders 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 FindingsProviders 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 (Δ) = 2), number of case presentations (B = 0.64; CI = −0.49‐1.76; Δ = 2), total training hours (B = −4.57; CI = −10.52‐1.37; Δ = 3), and trainer‐rated competence in AF‐CBT (B = −0.04; CI = −3.04‐2.96; Δ = 4), and they were significantly more likely to complete training (odds ratio = 0.66; CI = 0.10‐0.96; Δ = 30%). Results for clinical outcomes were largely inconclusive.ConclusionsProvider‐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.