Evaluating the Impact of an Interprofessional Training on Early-Stage Psychosis: Collaborative Research in Behavioral Health

Background

Early-stage psychosis is a specialized area of behavioral health (BH) assessment, intervention, and referral that is not typically included in standard curricula for BH disciplines. However, research indicates that early- intervention for psychosis can lead to better clinical outcomes (e.g. Howes et al., 2021) and is thus an important unmet training need for clinicians who will be working with adolescents and young adults in a range of settings. Interprofessional Education (IPE) is a best practice in training, given the benefits of students learning with and from one another (Reeves et al., 2013). However, most interprofessional training has been done with health versus behavioral health students. Additionally, the current project is novel because training evaluation too often ends with immediate post-test data, and nearly all psychosis trainings have been conducted with professionals, not trainees (e.g., Andorko et al., 2022).

The aim of the study is to evaluate the short and mid-term impact of an IPE training and identify longitudinal barriers and facilitators to practice implementation.

Methods

We (researchers from social work, psychology, and counseling) collaboratively conducted a 75-minute in-person training on psychosis with interdisciplinary BH trainees at a US university. A mixed-methods approach was used, with surveys conducted pre, post, and 6-weeks post training. Kirkpatrick's Model of Training Evaluation was used to measure outcome variables of reaction, learning, and behavior.

Results

Matched participant data were analyzed (N=21) as well as qualitative data from 6-week survey (N=9). The matched sample was primarily white (81%), graduate students (76%), female (67%), and aged 18-34 (81%). There was a relatively even distribution of trainees from psychology, social work, counseling, psychiatric nursing, and marriage/family therapy.

Reaction: Satisfaction was high (M=9.2/10.0, and >95% agreed the training was useful and applicable to clinical work).

Learning:

Knowledge: One-third of participants reported limited psychosis knowledge at pre-test, with qualitative analysis showing increases at post & 6-week surveys. Paired-sample t-tests showed pre/post change in understanding disciplinary roles on teams (p=.056).

Attitudes: T-tests also revealed significant pre/post changes in attitudes toward teaming (p=.029) and psychosis stigma (negative stereotypes [p=.002]).

Confidence: Clinical self-efficacy was also significant (knowledge [p<.001] and skills [p<.002]).

Behavior: Of the 9 trainees who responded to the 6-week survey, 2 reported they had applied training in clinical work (e.g. provided treatment recommendations). Barriers (post & 6-week data) to implementing training included structural (e.g., too many screeners at intake; reimbursement), stigma (providers & clients) and lack of confidence due to limited experience. Facilitators to application at 6-week follow-up were information from training that participants were able to use clinically (e.g. client testimonial; information about peer-support programs).

Conclusion/Implications

This brief IPE training, in which facilitators also modeled interdisciplinary teaming, demonstrated acceptability and initial effectiveness in knowledge, skills, and confidence. Gains were related to both the topic of psychosis and knowledge about teaming. Further, trainees identified structural and personal barriers to application of training material as well as facilitators provided by the training program. Future research should further explore barriers and facilitators as well as collect more longitudinal, practice-based data.