Phd Study The transfer of training from the ‘classroom to the mental health practice setting Ian McGonagle

Context and shaping an interest NHS spends £4.3. billion on all forms of education and training. The vast majority of training programmes receive only superficial evaluation The estimated ROI on training is between 10 and 20%.

Multiple Case Study Design Pose the research question Identify the underpinning theories Determine the case – It’s context and the phenomena of interest Determine the specific case study approach Identify the data collection methods most suitable to answer the research question Select analysis strategies appropriate to each of these data collection strategies Determine conclusions and develop a ‘case description’ What is the role of personal factors (motivation etc) in the ability to transfer training in the learning system? What role do the training team play in the design and delivery of a training programme to deliver planned outcomes? What is the role or organisational /practice factors in the transfer system? Motivation Self Efficacy Individual and Team Identity Multiple Case Study Design Questionnaires Participant interview Focus group Statistical analysis Content analysis Thematic analysis Primary care providers who are beginning to integrate mental health services into their workforce. Secondary mental health care providers with a long history of providing secondary mental health services, but not in primary care Independent providers working in primary care

Defining the Terms Learning – not located solely in the individual it may take place in the system and be seen as a form of ‘transformation’. Not from position a – b but one that expands a learners potential range of options Transfer – the ability to extend what has been learned in one context into a new one Classroom – a space designed for creativity, social interaction and testing of ideas and skills. Practice Setting – not a steady state, subject to fluctuations, full of disparate components and may reflect complex arenas but with an inherent order. Spend time reflecting on the nature of practice settings We think in terms of hierarchy, pecking order etc this may a do a disservice to the complexity in organisations and teams

Kirkpatrick model for educational evaluation Level Outcome Method of measurement to review impact of training 1 Reaction A measure of how the learners reacted to the training by asking learners to numerically rate sections of the course, and asking for written feedback and suggestions on how the course could be improved 2a Modification of values and attitudes Measured through a ‘before’ and ‘after’ measure of attitudes 2b Acquisition of knowledge and skills Measured through changes in self-reported levels of knowledge of the subjects covered in the course and confidence before and after attending the training 3 Change in behaviour Measured through changes in learners’ specific behaviours before and after the training 4a Change in Organisational Practice Measured using agreed organisational outputs 4b Benefits to people who use services Could be measured through eliciting service user views a suitable length of time after the training

Holton et al (2000) Model of factors which influence the transfer of learning Motivation to Learn Reaction Learning Ability Motivation to Transfer Transfer Climate Individual Performance Transfer Design Expected Utility/ Return on Investment External Events Organisational Results Link to Organisational Goals Personality Characteristics Intervention Readiness Job Attitudes fulfilment

IAPT HI Training Course Employment Sept 09 Sept 10 Jul 11 IAPT HI Training Course Employment Prim care 2nd Care Priv/indep T1. T3 T2 HI Training Course Design features and application Motivation Job satisfaction Knowledge of CBT Self Efficacy Burnout TARS Barriers to Change Case Study x 3-5 Transfer of learning from the ‘classroom’ to the practice setting

Holton et al (2000) Model of factors which influence the transfer of learning Motivation to Learn Reaction Learning Ability Motivation to Transfer Transfer Climate Individual Performance Transfer Design Expected Utility/ Return on Investment External Events Organisational Results Link to Organisational Goals Personality Characteristics Intervention Readiness Job Attitudes fulfilment Questionnaires Case Studies

Training programme Leads Instructional Design Competencies Structured Interview Training Acceptability Rating Scale (TARS) Academic Motivation Scale Knowledge quiz Burnout inventory Job satisfaction scale Self Efficacy Scale Participants Clinical/practice Teams Team Climate Inventory interview Barriers to Change Questionnaire Self rating of the generalisability of training

Questionnaire Analysis t-test or non parametric equivalent by Wilcoxon signed ranks test. Repeated measures ANOVA might be useful and more efficient. Factor analysis for another perspective ?

Case Studies Transfer is not merely learning new knowledge and social interaction. The focus is on specific structures and processes (and patterns) Processes Structures Patterns see Pslek P.E. (2001) Redesigning health care with insights from the science of complex adaptive systems. In: Crossing the Quality Chasm: A New Health System for the 21st Century. Washington: National Academy Press. Note: Argyris: Double loop learning

Identity Patient outcomes System capacity Systemic Socialisation professional values accountability education Organisational structure philosophy/culture resources communication sustainability supervision protocols Moderating factors Attributes to be measured Purpose. Interdependency Of service Accountability responsibility Relationships Work relationships Trust reciprocity Communication supervisory relationships Respect hierarchy Values base to practice Outcomes Identity Patient outcomes System capacity