A Survey of Mental Health Clinicians' Motivation to Invest in Training: Implications for the Implementation of Evidence-Supported Treatments

Background and Purpose. Training in evidence-supported treatments (ESTs) typically involves substantial financial and time investments. Given the need to move these interventions into real-world care on a large scale and clinician’s interest in learning ESTs, we sought: (1) to explore what motivates and deters clinicians from participating in clinical training, and (2) to determine how much time and money clinicians are willing to spend to learn new interventions. These were questions for which the previous literature was silent.

Methods.  1,246 Missouri Therapy Network members were emailed a link to a survey about their preferences for clinician training.  Those who did not respond to the email were sent a paper survey. These efforts yielded 318 useable responses for an effective response rate of 25%.  Respondents were compared to nonrespondents using data from a previous survey. Respondents were more likely to be in private practice versus agency only practice (61% to 53%), χ²  = 7.75, p < .01.). 

Items asked about clinicians’ training attendance and experiences within the past year, factors that motivated them to seek training (rated on a 0-4 scale), potential training “deal breakers” and the amount of time and money that clinicians were willing to invest in learning a new intervention. OLS regression was used to predict financial investment.

Results. Clinicians were willing to spend an average of $359 (SD = $344, Range = $0-1,500) and to invest an average of 35 hours (SD = 45 Range = 0-320) to learn a new intervention. Practitioners were highly motivated by the intervention’s fit with their clients (M = 3.75/4) and receipt of continuing education credits (M = 3.59/4). Clinicians were not motivated to attend clinical training aimed at beginning clinicians (M = 1.55). The most frequently endorsed deal breakers were the opposites of the top motivators: beliefs that the intervention did not fit their clients (62%), training aimed at beginning clinicians (53%), and the absence of continuing education credits (43%).  Income and caseload characteristics predicted financial investment.  Every 1% increase in the percentage of clinicians’ caseloads that were Medicaid funded was associated with a $2.06 reduction in the amount of money that clinicians would pay for training. Conversely, moving from an annual salary of less than $50,000 to greater than $50,000 was associated with a willingness to pay $123 more for training.

Conclusions and Implications. While it is encouraging that clinicians are willing to invest their own resources (especially a significant amount of time) to receive training, their willingness to invest does not rise to the level necessary for them to attend most initial EST trainings. This is especially true for clinicians who primarily bill through Medicaid or have lower incomes. Cheaper, lower investment options to deliver clinician training are needed to exploit the potential of evidence supported mental health treatments. The results also demonstrate how iterative surveys of PBRN practitioners can quickly build a PBRN research agenda, but also show how low participation rates in individual PBRN projects threaten external validity, a research criterion PRBNs are supposed to enhance.