I always have the best intentions when I leave a workshop.
The trainers are so knowledgeable and skilled at presenting their work. In their presence, I can really see myself following their lead, transporting the best that science has to offer to my clients back home. But I have to be honest, often that optimism is diminished by the realities of everyday clinical practice.
When I was in an intensive clinical research environment, there was massive support for making sure new principles and techniques made it into practice. There was ongoing consultation and supervision, field observation, fidelity checks…. Most importantly, there was a real culture of learning. Consultation and supervision were not just helpful, but necessary, to really master and implement new skills. This culture allowed me to develop my skills and my confidence as my understanding increased over time. Now having worked in less rigorous, clinical environments, I know this kind of support and oversight is rare, and is often viewed as a lower priority in the face of very real productivity demands, wait lists, and (ahem), hiring freezes.
Unfortunately, without support, implementing a new technique can make us feel like novices again, stumbling here and there, unsure and unprepared. It is even more difficult to change entrenched habits and practices, especially those that might have served us well in some ways. If you work in a large health system, you are facing not only your own habits and practices, but those of your entire work culture as well. It is soooooo much easier to go with the flow.
It is not just a matter of confidence and comfort zone, there are real ethical and clinical concerns. Most of our professional practice guidelines require us to practice within the scope of our training. A two-day workshop may not be sufficient to prepare most clinicians to implement an unfamiliar technique or protocol without additional support and consultation. What if we make mistakes with the very real and suffering people that we treat? It seems much safer to stick with what we are already proficient at doing.
So the excitement fades and we return to business as usual. We may cherry-pick a few solid techniques or metaphors and add those to our repertoire, but like our clients, significant change is difficult to realize without help.
So how do we turn knowledge into practice? We are talking about real, lasting behavioral change. The reality is, we know a lot about changing behavior. It is, after all, what we do with our clients every day. Those concepts apply to us as well. What are the critical elements?
Our workshop has already given us a well-documented and convincing rationale for adopting new practices and a clear description of the changes needed to bring about the desired outcomes. So MOTIVATION and KNOWLEDGE are covered.
Next, we need to PRACTICE to a standard, in order to develop our skills. I am sorry to break the news, but roleplay and rehearsal are the best ways to practice outside a real clinical session. Find a partner, or do it into a tape recorder and listen critically.
During practice, and especially during actual sessions, there are also numerous practice aids that can help you achieve adherence to a protocol. I still keep the relevant PE session outline on my clipboard so I can glance down and make sure I haven’t forgotten anything. Other aids include cheat sheets, treatment manuals, or skill sheets aimed at "just in time" coaching, such as those you might find in our blog, website features, or your workshop notes.
We need FIDELITY CHECKS throughout the learning period. Using the manual outline, or a prepared fidelity checklist to review your work, or to guide you in session, can help you stay on track. If you are learning with a group, it is even better to review each other’s work. That way you learn from each other’s experiences as well.
We need CONSTRUCTIVE FEEDBACK all along the way, to make sure we are headed in the right direction, and adhering to the principles of the treatment. Conversations with more experienced colleagues can be helpful, but if you don’t have a local colleague, there are numerous consultation opportunities. CDP has regularly scheduled Telephone Consultation, an “Ask The Expert” web feature, a Provider Portal Forum for peer discussions, and Subject Matter Experts available by appointment. You can reach us on the website, by telephone, e-mail, Skype, Google Chat, Adobe Connect, or just about any other geektastic, technological means you can think of – just ask! There are even more opportunities out there if you use on-line resources to make contact with experts and peer consultation groups around the country.
Finally, we need CONSISTENCY, so that our developmental trajectory is smooth and efficient. On the spot problem-solving is critical, but if you want to get the most for your effort, arrange for regular consultation. Don’t wait until a problem arises. Use consultation to build your confidence as you prepare for a session, get help with on-going cases, and reach your goals more efficiently.
As your knowledge and experience increases so does your CONFIDENCE – in both the treatment, and in your own ability to deliver the new behavior/skill “in the wild,” so to speak.
This is after all, a shameless plug for regular consultation, and I am one of several Subject Matter Experts here at CDP, who will answer your call for consultation and help you implement ESTs in your regular practice. "Train and hope" is not sufficient to meet our professional standard. We all know it. "Train and hope" is the reason why we don’t implement the shiny new tools after the workshop. A critical piece of our professional development is absent without regular consultation.
So hey, call me! I am at my desk all day, OK?
I promise it will be fun……there may even be cookies.
Dr. Kelly Chrestman is the Lead for Online Consultation Services at the Center for Deployment Psychology. In this capacity, she is responsible for the development of the CDP’s web-based consultation services to DoD and military mental health providers.