The B4DT provides a unique training format since each group is staffed with as many therapists as patients. The format serves as an excellent opportunity to get hands-on supervision by working side-by-side with, and observe- or be observed by experienced 4-day therapists. While model learning with hands-on supervision is an obvious approach for physicians who are going to learn surgery or any other medical discipline, it is rare in the mental health care. It is also a unique experience to be able to observe six patients with OCD going through major change in only four days.
It is important to note that individual therapists cannot independently sign up for the training. It is required that a clinic/program/center/hospital signs up and at the minimum 3 therapists sign up for the training at this particular site. In addition, the team at the site agrees to provide at the minimum 6 B4DT sessions a year. Applications to become a site will be routed to an independent Board at Bergen that will evaluate if the site appropriate to receive the training. Applications will be accepted in the spring of 2019 and link to the application form will be provided here at this cite beginning in March of 2019.
If your site is approved for training – this is what is expected:
- Introduction to the treatment rationale. Prior to participate as a B4DT therapist, it is required that each therapist complete an introduction course (approximately 2 days), followed by an exam
- Hands-on training. Before participating in a group, the trainee is provided with detailed specifications of what is required as a necessary minimum skills in order to deliver the B4DT competently. They participate in one B4DT group before they formally start the training. In order to become certified as a B4DT, the trainee has to be evaluated and deemed competent by an expert and this evaluation usually takes place in two groups. The number of groups that the trainee needs to participate in to reach this level, will depend upon the professional background and experience of the trainee. Additionally, the therapist who have already been certified as B4DT therapists participate in a Master Class seminars to become a group leader. Each B4DT needs to have one group leader and to become a group leader, the therapists needs to be evaluated as competent by expert B4DT therapist in a minimum of six groups
- The therapist/ group leaders have to be re-evaluated every two year in order to continue practice as a certified B4DT
A NOVEL APPROACH TO DISSEMINATION: ENSURING EVIDENCE-BASED PRACTICES
Drifting of therapist competence is one of the major identified challenges related to dissemination of treatments that work (ref “Mind the gap”), and the B4DT represents a new approach to ensure adhere to the protocol. Even though there exists a number of evidence based treatments for anxiety disorders, this does not necessarily mean that the clinics and the therapists who provide the care represent evidence based practices. In order to be coined as an evidence based practice, the clinic should be able to document results that are comparable to what is expected based on the original findings, which implies that assessment of treatment outcome should be an integrated part of the clinical practice.
When a particular clinic/site wants to be able to offer the B4DT, a formal agreement regarding training and certifying of therapists as well as monitoring of clinical outcome is made with the originator at Haukeland University Hospital. After a team has been trained, the particular clinic/site agrees to deliver a minimum of six treatment groups, and as long as the clinic/site wants to offer the B4DT, it needs to be part of the B4DT-network where monitoring of change and bench-marking are core elements.
The clinic/site also agrees to ensure that they have at any given time a minimum of three B4DT certified therapists that are competent in delivering the treatment. In order to deliver groups with six patients it is necessary to have the same number of certified therapists available, and it is highly recommended to train 6-10 therapists in order to possess the necessary flexibility to deliver groups with a reasonable frequency.
Since the B4DT was developed, standardized and independent assessment of outcome has been an integrated part of the approach, which means that standards for expected outcome are established.