An Examination of Training Quality and Provider Outcomes Across Two Generations of Train-the-Trainer

Train-the-trainer (TTT) is a promising method for implementing and sustaining evidence-based psychological treatments (EBPTs) in routine practice. In TTT, external "expert" trainers train an initial provider cohort (i.e., Generation 1) and then train "local" trainers to train the next provider cohort (i.e., Generation 2). This study evaluated whether training quality and provider outcomes are maintained across two generations of TTT in a hybrid type 2 effectiveness-implementation trial. TTT was used to implement the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) in community mental health centers (CMHCs) across California, United States. CMHCs were randomized to receive training in either Standard or Adapted TranS-C. Data from both conditions were combined to maximize power. Two expert trainers trained 115 providers (Generation 1), and 25 local trainers trained 42 providers (Generation 2). Trainings were coded for gold standard training elements (TranS-C content, training techniques) using the Gold Standard Training Checklist. Providers completed a post-training assessment which measured TranS-C knowledge, acceptability, appropriateness, and feasibility of TranS-C, and willingness and confidence to use TranS-C. Local trainers delivered more gold standard training techniques than expert trainers. No differences were found between generations on provider outcomes after correcting for multiple comparisons. Sensitivity analyses excluding outliers revealed that providers trained in Generation 2 rated TranS-C as more appropriate to their setting. The extent of gold standard elements delivered in trainings were not related to provider outcomes. These findings support the potential of TTT to sustain, and even improve, training quality and provider outcomes in a CMHC setting. TRIAL REGISTRATION: The parent study was registered on ClinicalTrials.gov (NCT04154631) on 11 April 2019, https//clinicaltrials.gov/study/NCT04154631. This study was preregistered on the Open Science Framework (osfregistrationsx7v38v1).