Evaluating Virtual Training for Increasing Clinicians’ Fidelity of Implementation of the Facing Your Fears Curriculum
Evidence indicates that Facing Your Fears (FYF), a manualized, group-based cognitive-behavioural therapy (CBT) that utilizes graded exposures, is effective for reducing anxiety and increasing emotion regulation in children with autism. Treatment fidelity, or the accuracy of treatment delivery, is a critical component for sustainable implementation and positive child outcomes. Few studies have focused on clinicians' fidelity implementing FYF and lack of follow-up data raises questions about maintenance of accuracy over time for clinicians with limited CBT experience. While evidence shows that the usual didactic teaching used for clinician CBT training has poor maintenance of fidelity over time, it is unknown how the FYF training-as-usual (i.e., a combination of didactic teaching, role-plays, and experiential activities) fares over time. To our knowledge, no research has examined the impact of virtual behaviour skills training (BST) with self-monitoring on clinicians’ fidelity implementing FYF. In a multiple-baseline design across three clinicians, we evaluated the efficacy of the training for increasing fidelity of FYF graded-exposures skills (preparing for and conducting exposures), identified by the clinicians. All clinicians met the fidelity mastery criterion (i.e., 90% across two sessions) within three sessions, and their performance maintained at two- and six-month follow-up. Clinicians rated their confidence and competence of FYF implementation pre-and post-training, and at six-month follow-up. All clinicians’ ratings increased post-training and maintained at follow-up. Clinicians reported that the training procedures were acceptable on a social validity measure administered at post-training and six-months follow-up. Incorporating evidence-based training to improve FYF treatment fidelity could optimize training and improve child outcomes.
facing your fears, behaviour skills training, self-monitoring, fidelity of implementation, cognitive-behavioural therapy
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