Evaluating provider training in stepped care 2.0 and one-at-a-time services among mental health and addiction providers.

Abstract

Background: Stepped Care 2.0 (SC2.0) and One-at-a-Time (OAAT) approaches can help address challenges related to accessing effective addiction and mental health (A&MH) services. OAAT services, available by walk-in or appointment, were implemented in New Brunswick (NB) as the first step in developing a provincial stepped care framework in alignment with NB's A&MH action plan. This study sought to evaluate the impact of online training courses in SC2.0 and OAAT service delivery on providers' knowledge, readiness, and capabilities to implement OAAT services in A&MH clinics, within the broader context of the provincial SC2.0 model.

Methods: Providers employed with A&MH services (e.g., social workers, nurses, psychologists) across NB completed asynchronous training courses in SC2.0 and OAAT services as part of a provincial implementation initiative. Over 400 providers volunteered to complete questionnaires related to this training (N = 401). Knowledge acquisition questionnaires were developed based on SC2.0 course content and administered pre- and post-training. Providers also completed a post-training knowledge acquisition questionnaire on OAAT services. Providers completed questionnaires on acceptability, appropriateness and feasibility of training courses, and self-efficacy post-training. Qualitative interviews were conducted with 28 providers to further understand their experiences with training courses in SC2.0 (n = 12) and OAAT services (n = 16).

Results: Mean percentage of correct responses at post-course for SC2.0 and OAAT services was 67.2% (SD = 15.9%) and 75.7% (SD = 15.7%), respectively. A modest, but significant, increase in knowledge of SC2.0 was observed post-training. Courses were deemed acceptable, appropriate and feasible, and resulted in favorable outcome expectancies. Moreover, providers reported modest self-efficacy to enact SC2.0 following training. Providers made recommendations to receive additional resources and training in SC2.0 and OAAT services to further enhance confidence to integrate key principles into practice.

Conclusions: Asynchronous training courses in SC2.0 and OAAT services supported the provincial practice change initiative in NB. In line with the COM-B model of behavior change, course barriers and facilitators were identified and provide insights into ways in which these courses, and related implementation projects involving training healthcare professionals, could be adapted to help create and sustain change.