Changes in community clinicians' attitudes and competence following a transdiagnostic Cognitive Behavioral Therapy training

Background: Although the literature suggests that attitudes toward evidence-based practices (EBPs) are associated with provider use of EBPs, less is known about the association between attitudes and how competently EBPs are delivered. This study examined how initial attitudes and competence relate to improvements in attitudes and competence following EBP training. Methods: Community clinicians (N = 891) received intensive training in cognitive behavioral therapy skills followed by 6 months of consultation. Clinician attitudes were assessed using the Evidence-Based Practice Attitude Scale, and competence was assessed using the Cognitive Therapy Rating Scale. Data were analyzed by fitting three latent change score models to examine the relationship between changes in attitudes and competence across the training and within its two phases (workshop phase, consultation phase). Results: Latent change models identified significant improvement in attitudes (Ms-latent change >= 1.07, SEs <= 0.19, zs >= 6.85, ps < .001) and competence (Ms-latent change >= 13.13, SEs <= 3.53, zs >= 2.30, ps < .001) across the full training and in each phase. Higher pre-workshop attitudes predicted significantly greater change in competence in the workshop phase and across the full training (bs >= 1.58, SEs <= 1.13, z >= 1.89, p < .048, beta >= .09); however, contrary to our hypothesis, post-workshop attitudes did not significantly predict change in competence in the consultation phase (b = 1.40, SE = 1.07, z = 1.31, p = .19, beta = .08). Change in attitudes and change in competence in the training period, the workshop phase, and the consultation phase were not significantly correlated. Conclusions: Results indicate that pre-training attitudes about EBPs present a target for implementation interventions, given their relation to changes in both attitudes and competence throughout training. Following participation in initial training workshops, other factors such as subjective norms, implementation culture, or system-level policy shifts may be more predictive of change in competence throughout consultation. Plain Language Summary Although previous research has suggested that a learner's knowledge of evidence-based practices (EBPs) and their attitudes toward EBPs may be related, little is known about the association between a learner's attitudes and their competence in delivering EBPs. This study examined how initial attitudes and competence relate to improvements in attitudes and competence following training in an EBP. This study suggests that community clinicians' initial attitudes about evidence-based mental health practices are related to how well they ultimately learn to deliver those practices. This finding suggests that future implementation efforts may benefit from directly targeting clinician attitudes prior to training, rather than relying on more broad-based training strategies.