The April 2013 newsletter of Behavioral Health Resources, LLC focuses on CARF standards related to assessment of competency and evidence-based practices.
What is competency? Competency refers to a professional’s level of skill in delivering a particular treatment. Adherence is the extent to which techniques match what is described in the training curriculum. Consistent adherence to the identified approach results in better client outcomes. Competence requires a good understanding of the theory, treatment outcome literature, and demonstration of techniques.
Evidence-based practice implies that: 1) there is a definable outcome; and 2) it is measurable. When assessing competence, it is beneficial to have an objective measurement of conformance to the evidence-based practice. ______________________________________________________________
How do we know if a professional is competent? Ideally, competence assessment should be based on multiple sources and methods, to include a mixture of subjective and objective information. Clinical supervision can be a helpful approach to evaluate knowledge. However, objective measures are needed to evaluate performance based on a clearly defined criteria of competence. This can be done by the use of competency rating scales developed for the therapy approach for which the provider is being evaluated.
Demonstration of Competency. Phoenix House is a substance abuse treatment center that uses more than 35 evidence-based practices in their treatment programs. According to Britta Muehlbach, Vice President and Director of New Business Development at the Phoenix House Foundation, “The clinical supervisors observe evidence-based sessions twice a year to monitor implementation fidelity.” This is perhaps the best way to evaluate performance and adherence to therapy techniques and approaches.
As described by Manring, Beitman, and Dewan in their article, “Evaluating Competence in Psychotherapy,” the following is a list of skills for evaluating competency in Cognitive Behavioral Therapy (CBT). Can the clinician: 1) state the cognitive model; 2) socialize the client into the cognitive model; 3) use structured cognitive model activities (mood check, bridging to prior session, agenda setting, homework review, capsule summaries, and patient feedback; 4) identify and elicit automatic thoughts; 5) state and employ knowledge of cognitive triad of depression; 6) use dysfunctional thought records as a tool in therapy; 7) identify common cognitive errors in thinking; 8) use activity scheduling as a tool in therapy; 9) use behavioral techniques as a tool in therapy; and 10) plan booster sessions, follow-up, and self-help sessions appropriately with patients when terminating active therapy.
For Eye Movement Desensitization and Reprocessing (EMDR) therapy, there is an 8-phase protocol that includes: 1) history and treatment planning; 2) preparation; 3) assessment; 4) desensitization; 5) installation; 6) body scan; 7) closure; and 8) re-evaluation. Assessment of competency would include evaluation of how closely the clinician follows the established protocol.
Importance of Individualized Treatment. In addition to technique, competence also includes a good working alliance with the client. As stated by the American Psychological Association, “Evidence-based practice in psychology . . . is the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences.” Rigid adherence to techniques and protocols that do not consider client factors can be negatively related to therapist competence. Therefore, client satisfaction surveys can also be a useful tool.
Additional Assessments for Competency. Other methods used to evaluate competency include client record audits, performance evaluations, oral exams, written exams (multiple choice, essay, short answer, and case review), and global rating scales.
Competency-Based Training. Does your organization have an individualized training program for each direct-service provider? For example, if a clinician uses EMDR therapy, is it expected that the therapist will obtain continuing education (i.e.,attend EMDR workshops for CEUs) during the evaluation period to maintain competency? Does the therapist participate in individual or group consultation with an approved EMDR consultant? For information about how organizations can develop competency-based training from the 2007 issue of CARF Connect, click here.
Integrated Treatment for Co-Occurring Disorders. To obtain a copy of SAMHSA’s “Integrated Treatment for Co-Occurring Disorders Evidence-Based Practices (EBT) Toolkit, click here.
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