2 - (SYM 22) Training Milieu Staff to Deliver a Transdiagnostic Intervention with Fidelity on a Pediatric Inpatient Psychiatric Unit

Background:  Among many inpatient psychiatric units (IPUs), group interventions are facilitated by milieu staff with varying levels of education and training. As IPUs increasingly recognize the importance of implementing evidence-based treatments (EBTs), training and ongoing clinical supervision of milieu staff is imperative for the successful delivery of innovative EBTs. Our IPU sought to increase staff confidence and competence in delivering an innovative adaptation of the Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children/Adolescents (UP-C/A). To support milieu staff facilitating this intervention, a fidelity monitoring program was developed with 3 aims: 1) to develop onboarding and refresher trainings to support milieu staff in facilitating UP-C/A groups; 2) to design fidelity measurement tools and observation protocols that adequately assess fidelity to key UP-C/A concepts; 3) to identify and implement interventions to improve staff delivery of the UP-C/A.

Methods: Development of fidelity monitoring tools included the creation of content and process integrity measures which were reviewed and approved by a UP-C/A content expert. During a pilot period that included more than 90 observations, fidelity measures and observation protocols were optimized. After finalizing the fidelity monitoring tools, formal monitoring began including frequent group observations, tracking fidelity scores, and providing targeted feedback to milieu staff.

Results: Since the beginning of this fidelity monitoring program, 100% of milieu staff have received training in the delivery of UP-C/A and 100% of day-shift milieu staff have been observed and received feedback on facilitation of groups.  Additionally, all staff falling short of adequate fidelity scores receive individual skills coaching and co-facilitate multiple groups with a fidelity expert prior to independently facilitating groups again. Within the first 3 months of starting this initiative, 93% of staff are meeting fidelity expectations, and 72% are exceeding fidelity expectations.

Conclusion: Formal trainings on the UP-C/A intervention promote milieu staff’s understanding of the interventions used on the unit. The development of an innovative fidelity monitoring program has improved staff knowledge and delivery of the UP-C/A and increased the sustainability and effectiveness of the EBTs used in the milieu.