Contains Video1
Show Me, Don’t Tell Me: Behavioral Rehearsal as a Training and Analogue Fidelity Tool

https://doi.org/10.1016/j.cbpra.2013.04.002Get rights and content

Highlights

  • Behavioral rehearsal (BR) is when a trainee engages in a simulated interaction with another individual

  • This methodology is important for implementation science

  • BR can be used to improve training in evidence-based practices

  • BR can be used as an analogue method to measure fidelity in community settings

Abstract

Behavioral rehearsal, when a trainee engages in a simulated interaction with another individual, is an underutilized but potentially cost-effective and feasible solution for two difficult questions in implementation science: how to improve training, a commonly used implementation strategy, and how to feasibly measure fidelity using analogue methods in community settings. This paper provides practical information on how to develop and use behavioral rehearsal for both of these purposes to implementation researchers. Therefore, we focus on development and use of behavioral rehearsal as a training and analogue fidelity tool in the context of three illustrative studies.

Section snippets

BR Is Critical for Implementation Science

BR is a methodology that has important implications for implementation science (IS) given its potential to improve training and reduce the resource intensiveness of fidelity measurement, when an analogue method is acceptable. A robust literature suggests that traditional passive training practices are ineffective at changing provider behavior (Beidas and Kendall, 2010, Farmer et al., 2008, Herschell et al., 2010, Rakovshik and McManus, 2010). Active learning may be the most effective way to

Illustrative Studies Using BR

To illustrate how to use BR as a training and/or analogue fidelity tool, we provide examples from three studies. Each study has a unique mental health intervention, trainee population, and context, demonstrating the utility for BR across heterogeneous settings. Our goal is to focus on BR methodology; therefore, only a brief description of each study is provided (see Beidas et al., 2012, Cross et al., 2011, Dorsey et al., in preparation). One limitation of the published manuscripts is that they

BR How-To

This paper provides practical support to implementation researchers aiming to use BR methodology to improve training or for analogue fidelity measurement purposes. Therefore, we focus on the development and use of BR as a training tool and as a analogue fidelity tool in the context of three illustrative studies. The purpose of this paper is not to provide empirical findings from these three trials; rather, our goal is to show researchers how BR might be used in three different contexts as a

BR as a Training Tool

Utilizing BR as a training tool requires two steps: (a) developing BR materials and (b) planning for BR in training.

BR as an Analogue Fidelity Tool

Fidelity is a multicomponent construct and includes treatment adherence (i.e., use of specified procedures) and competence (i.e., skill; Perepletchikova et al., 2007). Typically, fidelity is conceptualized as a construct that is measured in direct practice. However, given the challenges with observation of direct practice, we suggest that BR provides a promising analogue method to assess trainee adherence and skill. In comparison to using BR as a training tool, employing BR as an analogue

Lessons Learned

BR is a heterogeneous methodology that can be used as both a training and analogue fidelity tool across a variety of interventions and trainees. These examples illustrate that BR is a highly generalizable methodology that can be flexibly used in training, as well as a tool that can be used as an analogue for assessing fidelity when observation of actual practice is not possible. Based on our varied experiences, we have identified a number of recommendations for implementation scientists

Summary

We have presented BR as a methodology that can be used as both a training and analogue fidelity tool across multiple contexts and interventions. We believe that it is an important methodology that enhances learning for trainees and can also enhance researcher understanding of what trainees are able to learn. Through our examples, we hope we have illustrated the feasibility of this methodology and some of the important decision points that must be considered when adopting. Given that developing

Acknowledgments

Funding for this research project was supported by the following grants from NIMH: MH083333; MH099179 Beidas; MH095749; MH96633 Dorsey; MH073615; MH073615-03S1 Cross and funding from the WA State DSHS DBHR. Additionally, the preparation of this article was supported in part by the Implementation Research Institute (IRI), at the George Warren Brown School of Social Work, Washington University in St. Louis; through an award from the National Institute of Mental Health (R25 MH080916) and Quality

References (43)

  • Centers for Disease Control and Prevention

    WISQARS leading causes of death reports

    Injury Prevention and Control: Data and Statistics

    (2007)
  • B.F. Chorpita et al.

    Identifying and selecting the common elements of evidence based interventions: a distillation and matching model

    Mental Health Services Research

    (2005)
  • B.F. Chorpita et al.

    MATCH-ADTC: Modular Approach to Therapy for Children with Anxiety, Depression, Trauma, or Conduct Problems

    (2009)
  • W. Cross et al.

    Using standardized patients and remote methods for training clinicians in Problem Solving Treatment

  • W.F. Cross et al.

    Proximate outcomes of gatekeeper training for suicide prevention in the workplace

    Suicide and Life-Threatening Behavior

    (2007)
  • W.F. Cross et al.

    Does practice make perfect? A randomized control trial of behavioral rehearsal on suicide prevention gatekeeper skills

    Journal of Primary Prevention

    (2011)
  • Dorsey, S., Beidas, R., Jungbluth, N., Lyon, A., Pullmann, M., & Berliner, L. (in preparation). The use of behavioral...
  • J.M. Ducharme et al.

    Comparison of staff training strategies to promote generalized teaching skills

    Journal of Applied Behavior Analysis

    (1992)
  • A. Farmer et al.

    Printed educational materials: effects on professional practice and healthcare outcomes

    Cochrane Database Syst Rev

    (2008)
  • A.F. Garland et al.

    Change what? Identifying quality improvement targets by investigating usual mental health care

    Administration and Policy in Mental Health

    (2010)
  • N. Ivers et al.

    Audit and feedback: effects on professional practice and healthcare outcomes

    The Cochrane Library

    (2012)
  • Cited by (0)

    1

    Video patients/clients are portrayed by actors.

    View full text