Dissemination methods and attitudes to family intervention for psychosis in trainee clinical psychologists

This thesis broadly explores evidence-based practice (EBP) in mental health, with a particular focus on dissemination and implementation of research evidence regarding family intervention in psychosis. Chapter one comprises a review of evidence-based practice in mental health, including the uptake of evidence-based practice, the effects of training, research dissemination and implementation strategies. A brief narrative review is presented followed by a systematic review examining uptake of evidence-based therapies by mental health practitioners. Eleven papers were selected for review and were measured against the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) guidelines (von Elm, Altman, Egger, Pocock, Gøtzsche & Vandenbroucke, 2007). Following this, conclusions regarding the current evidence and areas which need to be developed are discussed, primarily the need for standardised measures, an indication of clinical change and provision of follow-up studies. Chapter Two comprises an empirical paper intended to be submitted to the journal ‘Implementation Science’. The aim was to address some of the issues identified in Chapter One, namely the use of standardised measures and the measure of a change in clinical practice. Mixed methods were used to assess attitudes to EBP in Trainee Clinical Psychologists and the effect that different dissemination methods had on their attitudes to a specific facet of EBP, family interventions in psychosis. A total of 104 trainee clinical psychologists from 23 UK training programmes participated in the online study, and were randomly allocated to one of four conditions. i. ‘Minimal information’: Participants viewed a brief summary of a fictitious service-user with psychosis, this served as the baseline condition. ii. ‘Case study’: Participants viewed a detailed case study describing the use of family interventions with a fictitious service-user with psychosis iii. ‘Research summary’: Participants viewed a detailed research summary showing research into the effectiveness of family interventions in psychosis iv. ‘Combined’, participants viewed both the case study and research summary Following this, participants completed a survey of their experience with different therapies and demographic information and a standardised measure of attitudes to EBP. Participants then viewed the minimal information about the fictitious client, followed by the summary specified in the condition they were allocated to. Participants then completed a questionnaire designed to assess their attitudes to family intervention in psychosis and their willingness to engage in further training. Responses to these served as the dependent variables. Participants were also given the opportunity to give their own views on the use of family interventions in clinical practice. Data were analysed using MANOVA and multiple regression, with thematic analysis (Braun & Clarke, 2006) employed for the qualitative data. Participants who viewed both case and research information showed a greater willingness to train than those who viewed research information alone. Chapter Three, the concluding section, consists of a general discussion of the research, focusing on the findings and their relation to previous findings in the area, the implications of the findings for research and clinical training and practice, as well as strengths and limitations of the research. The main limitations identified were the lack of a follow-up and the suitability of willingness to train as a measure in trainee clinical psychologists. Recommendations for future research in this area are made. Following the general discussion section a proposal for a follow-on study, extending the current study and improving the methodology is presented. Lastly, the research is presented in the form of a report intended for submission to ‘Clinical Psychology Forum’