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DEVELOPment: Evidence Based Training for Evidence Based Practice – Sample Chapter
1
Chapter One
A DEVELOPment problem
“Evidence-based treatments (EBTs) for substance abuse and dependence have demonstrated
superiority over treatment as usual when applied with strict fidelity in controlled clinical
trials. Effective counselor training is critical if substance abuse programs are to realize these
interventions’ full potential to enhance client outcomes in community practice”
Steve Martino, 2010
“A most surprising finding is the lack of proficiency in treatment adherence, competence, and
skill reached by therapists trained in the current gold standard (i.e., workshop, manual, and
clinical supervision)”
Rinad Beidas and Philip Kendall, 2010
In 2011 six sites across the UK piloted a Payment-By-Results (PBR) approach to substance
misuse treatment. Many in the field watched with interest, curious to see how services
performed under such constraints. Few could ignore the implications of PBR extending
nationally. The intense interest (and concern) in PBR is understandable: PBR places a
DEVELOPment: Evidence Based Training for Evidence Based Practice – Sample Chapter
2
financial consequence on outcomes; and, outcomes inherently place a strain on capability.
Under PBR, treatment services which are not capable don’t get paid!
The truth is, PBR is but one (albeit extreme) manifestation of the current zeitgeist
within substance misuse treatment. Regardless of one’s involvement with PBR, all have felt
the shift toward outcome-attainment in recent years. More than ever, practitioners are
expected to demonstrate the ability to resolve their clients’ problems. And, treatment
services are increasingly scrutinising their choice of intervention and the quality of its
delivery. There is little doubt: these are demanding times work in the substance misuse field.
Of course, for those passionate about the work, the strain between outcomes and
capability demands attention. It is clear that practitioners and treatment services are actively
reviving an interest in effective intervention, innovation, and workforce development. But,
there is much work to be done. Take, for example, a study by Best, Day, Morgan, Oza,
Copello, and Gossop (2009). These researchers assessed the quality of support provided in a
Birmingham Drug Intervention Programme (DIP). After reviewing 344 case files and
interviewing thirty-five practitioners, they found that, on average, only ten minutes of each
one-to-one session could be classified as evidence-based psychosocial intervention.
Unfortunately, the ‘ten minutes’ finding was later replicated (see Best, Wood, Sweeting,
Morgan, & Day, 2010), suggesting the effectiveness of client-practitioner interactions, in
many treatment services, could be vastly improved.
It is a truism that a competent workforce is an organisation’s primary resource for
achieving outcomes. Much faith is invested in its impact. The National Treatment Agency
(2009) recognised this when they recommended, “Continuous improvement of the capacity
and effectiveness of adult drug treatment depends upon sustained attention to workforce
development for commissioners, managers and treatment delivery staff.” By all accounts,
DEVELOPment: Evidence Based Training for Evidence Based Practice – Sample Chapter
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workforce development ought to be high on any treatment service’s agenda. Yet, it is
surprising how perfunctory this task is approached. Research in the USA, for example, found
that many services (between 20% and 72% of those surveyed) did not provide practitioners
with formal training in Motivational Interviewing, Cognitive Behaviour Therapy,
Contingency Management, or Brief Strategic Family Therapy (Olmstead, Abraham, Martino,
& Roman, 2012). This was despite the fact that, in these services, practitioners were
expected to deliver these interventions. Often, gaps in training like this can be attributed to
pressures that organisations face. Alavi and Leidner (2001), for example, have made the
observation that, “Many organisations are so lean that people do not have time to make
knowledge available, share it with others, teach and mentor others, use their knowledge and
expertise to innovate and find ways of working smarter. Instead, they are task-focused,
shifting existing workloads to fight deadlines.” It is unfortunate how common this scenario is
in the substance misuse field and other helping professions. In the UK, at least, substance
misuse treatment services operate within short three-year contracts. There really is little time
to establish one’s service before discussions turn to keeping the contract. This means that
achieving one’s performance targets within tighter and tighter budgets usually renders (true)
staff development low as a priority. But, it is worth noting that Alavi and Leidner’s
observation is actually a concern about what prevents organisations from being successful.
Their warning is that the services provided by an organisation is not just the sum of its
available resources. Sustained competitive advantage is actually gained through the way
resources are applied, and how new and innovative solutions are identified. This requires a
process of utilizing existing knowledge to create new knowledge. Arguably, the majority of
an organisation’s knowledge sits within the workforce. So, it would be wise to heed the
National Treatment Agency’s call for ‘sustained attention to workforce development’.
DEVELOPment: Evidence Based Training for Evidence Based Practice – Sample Chapter
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Would additional investment in training resolve the issue? Maybe. But, it is
becoming clear that the situation is more complicated that first anticipated. Research is
showing that, even when substantial training is provided, the benefits can be small. Training
methods such as one or two day didactic workshops are proving ineffective (Beidas &
Kendall, 2010). And, within all this, there is growing recognition that changing practitioner
behaviour is about as challenging as changing the behaviour of the clients they support. Of
course, there are many reasons for this, and none are unique to practitioners per say. For
example, Miller, Sorensen, Selzer, and Brigham’s (2006) have reflected that, “There is a
certain inertia in clinical practice, a tendency to continue doing what is familiar and
comfortable, and perhaps a discomfort in considering that long-practiced methods may not
be optimal.” Most would agree that this sentiment could apply to us all, and in many areas of
life. One encouraging finding is the identification of psychosocial interventions which help
people change their behaviour, including difficult to change behaviours such as substance
misuse. So, it stands to reason that methods can also be found to support practitioners and
organisations to change their behaviour with clients. Identifying these methods, as is often
the case, lies in first understanding the problem.
The DEVELOPment Problem
All workplaces require workers to possess skills which enable them to fulfil their role. For
practitioners in the substance misuse field, many of these skills relate to therapeutic ability –
the ability to help a person initiate and maintain changes to their substance use. Invariably,
this involves the application of psychosocial interventions, which, in turn, requires good
interpersonal, relational, and communication skills. Unlike some other job related tasks,
these skills are complex and often difficult to acquire. Moreover, attempts to train these
DEVELOPment: Evidence Based Training for Evidence Based Practice – Sample Chapter
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complex skills typically falls short (Beidas & Kendall, 2010). This book proposes that this
failure is largely attributable to the way training is approached. All too often, training
consists of short, isolated events, disconnected from actual client-work. They constitute a
‘day out the office’ where information and guidance is provided to up-skill the practitioner for
when they return to their workplace. When approached this way, training is considered to be
like installing new software on a computer: At the training event, practitioners are uploaded
with new information and procedures. Once installed, they can return to their workplace and
run it with service users. Of course, experience suggests that the installation is not always
effective: Sometimes, the installation fails completely. Other times, the program is installed
but never gets run with service users. Still other times, the program is run with service users,
but the program runs differently; it has somehow been corrupted. The computer metaphor, it
seems, does not guide us well.
Another way to thinking about training – and one this book strongly advocates – is
that it resembles the self-assembly of large cranes. When cranes self-assemble, they do so by
using a jack to lift the entire crane upward, creating a space. This allows the crane itself to
winch in a new section of shaft. This section of shaft is then secured, allowing the crane to
crank itself up further, creating another space. More sections can be winched in, secured,
and so on. Unlike the computer metaphor, the crane metaphor implies that training comprises
several distinct tasks: Firstly, it requires the crane be receptive to accommodating new
sections. Secondly, it implies that the right sections of crane must be made readily available;
they must be a good fit for the crane itself, but also support the weight of the work. Thirdly,
it recognises that, although support can be provided, practitioners need to play an active role
in winching in new sections. Finally, it emphasises the need to secure new sections firmly
into place before the heavy work commences.
DEVELOPment: Evidence Based Training for Evidence Based Practice – Sample Chapter
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The crane metaphor is useful in that it highlights a number of important challenges.
However, metaphor only brings us half-way; we need to be specific. The remainder of this
chapter extends this metaphor to describe seven challenges within the training of therapeutic
skills. Each challenge is characterised by a Promise and a Pitfall. Collectively, they can be
called the ‘DEVELOPment problem’.
The D in DEVELOPment: Dissemination
Dissemination refers to the combined process of making psychosocial interventions available
and motivating practitioners to adopt them. Dissemination is an important, but neglected,
aspect of training. All too often, training is limited to what is locally available, and with
little consideration given to practitioner’s readiness to adopt these approaches.
The past few decades have seen a range of effective interventions identified for
substance misuse issues. Many of these approaches are within traditions which value
ongoing advancement in both theory and practice. Unfortunately, few of these advances have
filtered into routine practice. In fact, research shows that the interventions used in practice
typically lags a decade or more behind current innovation (Corrigan, Steiner, McCracken,
Blaser, & Barr, 2001). Worse still, there are multiple instances where interventions of
unknown efficacy disseminate far more readily that those proven to be effective. The sad
truth is, exciting innovations within substance misuse treatment remain unknown and
underutilized. This means practitioners and treatment services are often limited to using out-
of-date, convenient, or popular interventions.
All this is widely acknowledged, and not limited to the substance misuse field. In her
commentary on Evidence Based Practice more generally, Enola Proctor (2004) concluded
DEVELOPment: Evidence Based Training for Evidence Based Practice – Sample Chapter
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that, “...the gap between the availability and actual use of evidence-based treatments remains
wide and persistent.” What creates this gap? Unfortunately many factors have been
identified, ranging from the attributes of individual practitioners (e.g., attitudes and
motivation) to broad systemic factors (e.g., organisational support) (Corrigan et al., 2001).
To close this gap means finding ways to overcoming these barriers. Doing so is crucial for
getting the right interventions in the hands of the right practitioners.
The promise of dissemination is that beneficial innovations will become available and
established in practice.
The pitfall, however, is that this process can takes an inordinate amount of time to
happen naturally. And, considering that some highly effective interventions have
never achieved widespread adoption, it is also an unreliable process when left to its
own devices.
The E in DEVELOPment: Empirical Support
Empirical Support refers to the use of research-based evidence to selectively advocate
psychosocial intervention. This approach is most familiar within the Evidence Based
Practice (EBP) movement, commonly defined as, “the conscientious, explicit, and judicious
use of current best evidence in making decisions about the care of individual patients”
(Sacket, Rosenberg, Gray, Haynes, & Richardson, 1996). There is one primary advantage
for using empirical support in this way: namely, to gain certainty that one’s actions will
result in positive outcomes for a service user.
Dissemination and Empirical Support are two sides of the same coin: Dissemination
implies the need for selection, and Empirical Support stands as a logical selection criteria.
DEVELOPment: Evidence Based Training for Evidence Based Practice – Sample Chapter
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Conversely, the fact that Empirical Support continuously evolves (Rycroft‐Malone, Seers,
Titchen, Harvey, Kitson, & McCormack, 2004), highlights the importance of seeking out and
disseminating innovation.
Traditionally, in the substance misuse field, widespread and popular interventions
have not been well supported. In some instances, the evidence has even demonstrated
detrimental effects. This disconnect between dissemination and empirical support was
evident in Miller, Wilbourne, and Hettema’s (2003) review of treatments for alcohol
dependence. They famously concluded that, “The negative correlation between scientific
evidence and treatment-as-usual...could hardly be larger if one intentionally constructed
treatment programs from those approaches with the least evidence of efficacy.”
Since then, some progress has certainly been made. Service monitoring in the UK,
for example, currently lists nine empirically supported psychosocial interventions (referred to
as sub-interventions in the National Drug Treatment Monitoring System (NDTMS)). Such
lists certainly create an expectation as to the type of work one should find in substance
misuse treatment services. It also means practitioners must select from these alternatives
when describing their work with clients. However, the use of these interventions in practice
routinely differs from the protocols found in research trials. And, in its worst form,
empirically supported brand name are used to describe interventions which bear little
resemblance to the original approach (e.g., when Relapse Prevention is used to refer to any
form of aftercare). This highlights that Empirical support always entails a need for fidelity:
The less an intervention resembles what was tested in research, the more disconnected it
becomes from its empirical support; and, the more disconnected it gets from its empirical
support, the more questionable becomes its efficacy. Unfortunately, attempts to increase
practitioners’ fidelity to interventions can be experienced as a violation of personal freedom
DEVELOPment: Evidence Based Training for Evidence Based Practice – Sample Chapter
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and clinical judgement. As such, empirically supported interventions, and especially the use
of manuals, have been resisted (Addis, Wade, & Hatgis, 1999).
Whilst Empirical support is undoubtedly of value. The extent of its usefulness has
continued to remain a topic of debate (e.g., see Mullen & Steiner, 2004). Some have raised
concerns that the outcomes found in efficacy research may not generalize to the real-world
environment of substance misuse services (e.g., Rothwell, 2005; Flay, Biglan, Barouch &
Castro et al., 2005). Others have highlighted that, while we know what interventions are
effective, we know relatively little about why they work (Longabaugh & Morgenstern, 1999).
This is an undoubtedly an issue for training. If strongly supported interventions, such as
Cognitive Behaviour Therapy, do not work through the mechanisms specified by its theory
(see Longabaugh & Morgenstern, 1999; Morgenstern & Longabaugh, 2002; Longmore &
Worrell, 2007), how should one teach the approach? Which aspect of the approach should be
emphasised? Any confidence gained from training an empirically supported intervention is
somewhat undermined by the realisation that one may be teaching inert treatment
components.
The promise of Empirical Support is that research based findings will inform
the work of practitioners.
The pitfall is that it rarely does.
The V in DEVELOPment: Vocational Skills Training
Together, Empirical Support and Dissemination address the questions of ‘What’ is to be
disseminated and ‘How’ practitioners are motivated to adopt them. To disseminate,
psychosocial interventions are quite complex. They consists almost entirely of knowledge
DEVELOPment: Evidence Based Training for Evidence Based Practice – Sample Chapter
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and behaviours. The term Vocational Skills describes the acquisition of this knowledge,
made relevant to the setting into which it is to be applied.
Whilst the purpose of training is to convey this knowledge, training does not always
impart the type of knowledge needed to competently deliver an intervention. Training, it
turns out, needs to emphasise both know-what (e.g., knowledge about an intervention) and
know-how (e.g., the behavioural ability to implement an intervention). Research is showing
that these two types of knowledge do not develop in tandem. In a review of therapist skills
training methods, Beidas and Kendall (2010) found that knowledge and attitudes change
quite readily from training. The development of skill, competence, and adherence,
meanwhile, proved far harder to achieve. Much of this can be attributed to the training
methods used. There is a general over-reliance on didactic and educational methods in
training, and these are generally poor at developing know-how. It seems that knowing about
an intervention is ‘necessary but not sufficient’ to competently deliver it. This failure is
particularly difficult to see because the impact of training is rarely objectively measured (e.g.,
observation of skills). And, the assumption that self-reported competency resembles
observed competency is, unfortunately, untenable (e.g., see Miller & Rollnick, 2009). This
creates the illusion that training is actually more effective than it is.
As a side note, it is telling that we expect educational strategies to change practitioner
behaviour. In parallel, many in the substance misuse field overuse the strategy of educating
clients about the risks associated with their drug use. The assumption being that, when a
client fully appreciates the harm involved, they will change their behaviour. Unfortunately,
despite its widespread use, little empirical support supports its value as a method for
changing drink/drug use. In fact, in some cases, such strategies have been shown to
exacerbate use (Kinder, Pape & Walfish, 1980). Interestingly, the same trend is proving true
for the training of practitioners.
DEVELOPment: Evidence Based Training for Evidence Based Practice – Sample Chapter
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The promise of vocational skill training is that the training methods used will
help practitioners acquire the right types of knowledge to be competent.
The pitfall is that they often develop conceptual knowledge but fail to develop
behavioural skill. This severely limits practitioners’ ability to effectively
deliver an intervention.
The E in DEVELOPment: Embedding into Practice
Successful training methods are clearly important. But, what if those skills - competently
demonstrated within a training event - are hardly used when back in the workplace?
Extensively researched under the heading Transfer of Training, this set of large literature has
shown that only a small proportion of what is trained is ultimately used. Worse still, recently
trained skills appear to decay after only short periods of time. For example, based on the
results of survey data, Saks and Belcourt (2006) estimated that only 62% of training is used
in the workplace directly after the training event, dropping to 44% after 6 months, and 34%
after one year. A significant implication of this is that the majority of an organisation’s
training budget is wasted. Training, by itself, is certainly not cost effective. Research has
identified a variety of factors which improve the likelihood that new skills become embedded
in a practitioner’s work with clients. But, they are rarely considered in training design.
The promise of Embedding into Practice is that knowledge and skill acquired
within the training event will later be applied in the workplace.
The pitfall, however, is that most of these skills will remain unused.
DEVELOPment: Evidence Based Training for Evidence Based Practice – Sample Chapter
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The L in DEVELOPment: Learning to Integrate
Like many others, Kendall and Beidas (2007) have noted that interventions are used far more
flexibly in practice, commenting that, “Our experience is that competent and reasonable
practicing professionals pick and choose features of ESTs [Empirically Supported
Treatments] that they see as holding promise or being of merit. Entire EST programs are not
as readily adopted as are the personally selected strategies or ideas that are a part of the
larger program.” In many ways, this is the reality of practice. Ask a practitioner what
psychosocial interventions they use and, more times that not, they say, ‘a bit of everything’,
or, ‘I don’t limit myself to one approach’. Indeed, surveys have showing that between one-
third and one-half of psychotherapists claim to be eclectic in the sense that they don’t
associate themselves with any single theoretical position (Beitman, Goldfied, & Norcross,
1989).
One the one hand, this seems to add to the fidelity issues described above. But, on the
other hand, there is a strong rationale for doing this. The finding that all effective
psychosocial interventions are, by-and-large, comparably effective (e.g., Imel, Wampold,
Miller, & Fleming, 2008) seems to practitioners with the freedom to legitimately select from
a range of empirically supported interventions. Furthermore, it might be argued that
providing practitioners with more ways of working with clients, empowers them to respond
with greater flexibly to their client’s needs.
Eclecticism is a reality of practice, and rather that shy away from that fact, it should
perhaps be embraced as the normal end-point for most practitioners’ learning. A question
does arise, however, when one considers the best way to integrate multiple interventions?
Two difficulties are immediately obvious: Firstly, by combining strategies from multiple
interventions, the resulting practice can quickly result in a hodgepodge of techniques, and a
DEVELOPment: Evidence Based Training for Evidence Based Practice – Sample Chapter
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reduced role for intervention theory. Theory, within psychosocial intervention, is important
as it functions as a guide, informing when and how techniques should be applied. Without
theory, the selection of technique must be revert to ‘common sense’ or ‘clinical wisdom’
(both of which are viewed as biased sources of evidence within evidence based practice).
Secondly, not all interventions are compatible. All psychosocial interventions are based upon
theoretical assumptions about behaviour, addiction, the intervention’s mechanism of action,
and so on. In some cases, these assumptions are so different that they are essentially
irreconcilable. For some, their use together may even be contraindicated.
Certainly, attempts to formally integrate interventions have not been completely
successful. As Patterson (1989) concludes, “The existing proposals for an eclectic
psychotherapy are independent of each other. Each incorporates limited combinations of
methods, strategies and techniques from existing theories or approaches, with little attention
to any philosophy or theory. What appears to be happening is the development of a number
of new approaches on the way to becoming schools.” Rather than truly integrating
interventions, it seems that integration merely adds further variety, feeding into the eclectic
range of interventions already available.
The promise of Learning to Integrate, then, is that practitioners will be
supported to work more creatively, competently, and flexibly.
The pitfall is that this greater flexibility can easily extend to haphazard
application. Paradoxically, this may reduce competence and flexibility.
The O in DEVELOPment: Orienting toward self-DEVELOPment
DEVELOPment: Evidence Based Training for Evidence Based Practice – Sample Chapter
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The ultimate responsibility for adopting, learning, practicing, and applying new skills rests
with individual practitioners. Unfortunately, practitioners approach training with different
levels of enthusiasm. Many factors have been found to influence the utilisation of newly
trained skills. Motivation to learn, perceived utility of training, and self-efficacy to engage in
learning tasks (Blume, Ford, Baldwin & Huang, 2009; Pham, Segers & Gijselaers, 2010)
have been implicated. So have practitioner attitudes toward the intervention itself (Knudsen,
Ducharme, Roman & Link, 2005; Varra, Hayes, Roget & Fisher, 2008). And, organisational
factors have a considerable influence on both training outcomes (Rouller, Janice, Irwin, &
Goldstein, 1993) and utilisation of empirically supported interventions (Nelson, Steele, &
Mize, 2006). How optimal are these factors? Alavi and Leidner’s (2001) comments at the
start of this chapter suggest cause for pessimism. Organisations are often so preoccupied
with fulfilling their contractual requirements that there may be little slack to support a
practitioner’s training. An example many will be familiar with is the practitioner who returns
from attending a workshop only to be briefly asked by their line manager, “How was the
training?” If the answer is, “It was good...but it was pretty much what I was doing already”
the training may never be discussed again. The line manager, perhaps reassured that the
practitioner has the necessary skills, turns their attention to the day’s tasks, and so does the
practitioner. The practitioner’s day is full of opportunities to practice, apply, and integrate
new learning. But, distractions, demands, and pressures will all negatively affect the
engagement in ongoing learning.
Interestingly, some common training methods – for example, short workshops - have
also been shown to adversely affect practitioner motivation. In one study examining the
impact of one workshop on motivational interviewing skills, a significant reduction in
motivation was found to engage in further learning about the approach (Miller & Mount,
2001).
DEVELOPment: Evidence Based Training for Evidence Based Practice – Sample Chapter
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The promise of Orienting toward Self-DEVELOPment is that practitioners
will be motivated to engage in the learning tasks required of them to develop
adequate competence.
The pitfall is that this motivation is not stable, and practitioners vary in their
competence to self-direct their learning tasks.
The P in DEVELOPment: Practice Based Evidence
Margison, Barkham, and Evens at al. (2000) describe Practice Based Evidence as, “Good
quality data from routine practice”. There are many good reasons for gaining quality data
from one’s practice. One, however, is particularly pertinent to training: Feedback. The
importance of feedback in learning is nicely described in the following passage by Miller,
Sorensen, Selzer, and Brigham (2006):
“Learning any new skill does not occur without feedback. One of the most consistent
findings in motivational psychology is that feedback improves performance. Trying to
learn a counseling method without feedback is like learning to bowl in the dark: One
may get a feeling on how to release a ball and subsequent noise will provide some
clue about accuracy, but without information about where the ball struck, years of
practice may yield little improvement”.
Feedback, when it does occur as part of training, almost always occurs away from the
workplace. This is unfortunate. Although Practitioners rarely think of it this way: current
clients are the best sources of feedback for ascertaining the effectiveness of one’s
interventions. Practice Based Evidence is probably the most relevant source of feedback one
could obtain. Yet relatively little is actively sought out. When this information is sought out,
DEVELOPment: Evidence Based Training for Evidence Based Practice – Sample Chapter
16
however, it has been instrumental in improving practitioner effectiveness (Horn & Gassaway,
2007; Duncan, Scott, & Sparks, 2011).
Practice Based Evidence, it is worth noting, also seems to complement research-based
empirical support in a number of ways (Barkham & Mellor‐Clark, 2003). Practitioners who
are critical of evidence from research trials may be more open to locally obtained evidence of
effectiveness. Likewise, research trials typically report as comparisons between aggregated
group overages. These averages provide only a probability of individual client success
(Seeman, 2001) and hide the significant variance in outcome created by practitioner variables
(Elkin, 1999). Both these factors are important from a training and development point of
view.
The promise of Practice Based Evidence is that the use of feedback ensures
effective interventions are used, that training needs are identified, and that
practitioners continue to develop their skills.
The pitfall, however, is that routine work is rarely approached as opportunity
for improvement.
Insert Figure 1a here
DEVELOPing a way forward
The DEVELOPment problem outlined above describes seven challenges. Each is
characterised by a promise and a pitfall (see Figure 1a). However, it is clear that some levels
are closely connected. For example, Dissemination and Empirical Support are jointly
DEVELOPment: Evidence Based Training for Evidence Based Practice – Sample Chapter
17
involved in the task of selecting and making available the content of training. Vocational
Skills Training and Embedding into Practice jointly address the acquisition and elicitation of
training content. Leaning to Integrate and Orienting toward self-DEVELOPment seem
concerned with individualism within the DEVELOPment process. While Practice Based
Evidence provides a common mechanism whereby the impact of the other six levels can be
evaluated. Because of these natural divisions, this book is structured into four sections. Each
section corresponds to the groupings outlined above.
The chapters are further structured around two primary aims: 1) to review theory and
research which provides insights into how the DEVELOPment problem can be resolved, and,
2) to describe practical applications of those insights. Therefore, each section might be
thought of as an hourglass. The top half of the hourglass represent the chapters on research
and theory. These chapters will always conclude by describing a number of guiding
principles. These guiding principles represent the narrow, middle portion of the hourglass.
The bottom half of the hourglass describes various practical applications and strategies
informed by the identified guiding principles. In the final chapter, a holistic overview of the
DEVELOPment model will be provided.
DEVELOPment: Finding our Map and Compass
This chapter has outlined the DEVELOPment problem and specified its inherent promises
and pitfalls. The chapters that follow should be thought of as a map and compass. Each level
of the DEVELOPment problem is a different territory, each with its own landscape and
unique challenges. Guiding principles serve as compass points; they specify directions
which, if pursued, offer a good chance of successfully navigating through a given territory.
DEVELOPment: Evidence Based Training for Evidence Based Practice – Sample Chapter
18
For those wishing to reduce the tension between capabilities and outcome, DEVELOPment
offers a promising way forward.
DEVELOPment: Evidence Based Training for Evidence Based Practice – Sample Chapter
19
Level Promise Pitfall Dissemination Beneficial innovations will
become available and promptly
established in practice.
Dissemination is an unreliable
process, taking an inordinate
amount of time to occur naturally.
Innovation lags considerably
behind current practice.
Empirical
Support
Research based findings will
inform the work of practitioners.
Empirical support is underutilised.
Interventions are not delivered
with fidelity.
Vocational Skills
Training
Training methods will help
practitioners acquire the right
types of knowledge.
Training methods tend to develop
conceptual knowledge but fail to
adequately develop behavioural
skill.
Embedding into
Practice
Knowledge and skills acquired
in the training event will
subsequently be applied in
practice.
Most new skills will not be used on
return to the workplace.
Learning to
Integrate
Practitioners will be supported
to use interventions creatively,
competently, and flexibly.
Greater flexibility can easily
extend to haphazard application,
paradoxically reducing
competence and flexibility.
Orienting
toward self-
DEVELOPment
Practitioners will be motivated
to engage in required learning
tasks
Distractions, demands, and
pressures negatively affect use of
new skills. Practitioners vary in
their competence to self-direct
learning tasks.
Practice Based
Evidence
Good quality feedback ensures
effective interventions are used,
that training needs are
identified, and that practitioners
continue to development their
skills.
Routine work is rarely approached
as a source of feedback to improve
performance.
Figure 1a: Summary of the DEVELOPment Problem Promises and Pitfalls