INTERVENTION MANUAL
8.3 SELECTION OF INTERVENTIONISTS
2. Personal attributes: These relate to general personality style and relational or interpersonal skills. Examples of personality style are: extroversion, humor, attachment, reflective and introspective capacities (Degnan et al., 2016;
Lingiardi et al., 2018). Interpersonal skills are illustrated with interventionists demonstrating: warmth, empathy, helpfulness, hopefulness, verbal fluency, and persuasiveness (Anderson et al., 2009). These personal attributes affect the nature of the interventionists’ interactions with clients during the delivery of the intervention, as well as the development of a therapeutic relationship or working alliance. Facilitative interactions and working alliance contribute to clients’ motivation, engagement, and enactment of the treatment recommen- dations, which lead to improvement in outcomes.
8.3.1.2 Professional Characteristics
Despite mixed results (presented in Section 8.2.2), some professional characteristics should be carefully considered in selecting interventionists.
1. Professional qualifications: These represent formal education or training, licensing, and experience. Formal education and training and licensing are required by professional regulatory organizations to practice and/or deliver some interventions. For instance, prescription of medications requires advanced education in medicine or nursing (i.e. nurse practitioners) and the delivery of some types of psychotherapy requires at least a master’s degree in clinical psychology. Advanced education or training is believed necessary for high-quality and safe practice and delivery of interventions. With advanced education, interventionists are exposed to different theoretical orientations, therapeutic approaches, and practice opportunities. This in turn, helps them develop an understanding of different health problems and interventions, a positive attitude and flexibility to learn new interventions, and enhanced self- efficacy in the technical and interpersonal skills (Campbell et al., 2013).
Professional experience is another quality to consider in light of evidence sug- gesting that less experienced interventionists are likely to deliver interventions with fidelity. In contrast, more experienced interventionists tend to have a solidified working style, which hinders new learning (Campbell et al., 2013).
Further, experienced health professionals embrace flexibility in delivering interventions with the aim to attend to clients’ individual concerns. Accordingly, experienced health professionals are not supportive of strict adherence to the intervention manual. They view manuals as conceptually at odds with the principles of care or treatment, which should be tailored to individuals’ needs, and as potentially detrimental to the achievement of client outcomes (e.g.
Addis & Krasnow, 2000; Brose et al., 2015).
2. Knowledge and attitudes toward the intervention: Interventionists’ prior the- oretical and practical knowledge of the intervention they are responsible to deliver may enhance their training and delivery of the health intervention under evaluation. Interventionists who are aware of the intervention and who have theoretical orientations compatible with the theoretical underpinning of the intervention may easily grasp the intervention theory. This theoretical understanding helps them appreciate the potential contribution and identify the main components of the intervention. Interventionists who have experience, even if limited, in carrying out the intervention or some of its components, are familiar with and may have some confidence in the technical
8.3 Selection of Interventionists
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skills required to deliver the intervention. The training reinforces their self- efficacy in these skills. Interventionists’ attitudes toward, specifically their perceived acceptability or endorsement of, the intervention represent other characteristics to consider. Interventionists who do not embrace the theoret- ical underpinning of the intervention and who view the intervention as unac- ceptable to them and to their clients are likely to question its utility, to decline its delivery, or to deviate the delivery of its components toward those they endorse (Becker-Haimes et al., 2017; Borrelli, 2011).
8.3.2 Strategies to Ascertain Interventionists’ Characteristics
Ascertainment of interventionists’ characteristics is an ongoing process. It begins with the recruitment and an initial formal interview, and continues with monitoring of interventionists’ performance.
8.3.2.1 Recruitment
Different venues and strategies can be used to recruit interventionists in research and practice. Advertisement for the position can be disseminated in local newspapers, professional journals, and organizational newsletters or websites. Flyers can be posted in academic institutions or affiliated healthcare organizations. Information about the position can also be spread through word-of-mouth; for instance, academic researchers may refer graduate students and clinicians may refer health professionals.
Regardless of the venue used, the recruitment information should identify the general category (e.g. cognitive behavioral therapy) or the specific type (e.g. stimulus control therapy) of health interventions to be delivered, as well as the main professional qualifications (i.e. education, licensing) that interventionists should have in order to deliver the intervention, as required by professional regulatory orga- nizations. For example, recruitment of interventionists for the study that evaluated the effectiveness of cognitive behavioral therapy for insomnia specified the following requirements: a master’s degrees in nursing, psychology, or other health-related dis- ciplines and knowledge or training in the principles of cognitive-behavioral therapy.
Those interested are encouraged to apply for the advertised position. The application contains a cover letter (highlighting their qualifications), a resume or curriculum vita (CV), and letters of references (commenting on their technical and interpersonal skills). A careful review of the applications is necessary to determine those who have the required professional qualifications. These individuals are invited to a formal interview.
8.3.2.2 Formal Interview
The individual formal interview is scheduled prior to contracting interventionists and aims to assess the remaining personal and professional characteristics that are preset for selecting interventionists. Although the interview can be done through different modes, the in-person mode is preferable as it enables the assessment of nonverbal behaviors that may be reflective of some characteristics such as ability to listen and communicate clearly. A list of open- and close-ended questions is prepared and asked of all applicants. The questions cover indicators of the personal and professional characteristics deemed as prerequisites for the role of interventionists, while providing applicants the opportunity to elaborate on points of interest.
Open-ended questions explore applicants’ theoretical orientation, knowledge and attitudes toward the intervention they are to deliver, as well as prior training in providing the intervention or some of its components. Examples of open-ended ques- tions used in interviewing interventionists for the cognitive behavioral therapy for insomnia are: Have you had any training in cognitive-behavioral therapy in general and/or for the management of insomnia in particular? What are the basic principles and features of this therapy? How useful or effective do you think it is?
Close-ended questions may be developed to assess specific personal or professional qualities. Alternatively, available instruments can be administered to measure some qualities such as interpersonal skills or capacity to build a working alliance with cli- ents. For example, applicants may complete the six-item measure of therapeutic alli- ance developed by Joyce et al. (2003) during the interview.
Applicants’ responses to open- and close-ended questions are clearly docu- mented. In addition, the interviewer may attend to and record comments on the applicants’ communication, interactional style, and interpersonal skills exhibited during the interview. As well, during in-person interviews, the interviewer may observe and record applicants’ demeanor and nonverbal behaviors. Applicants’
responses and interviewer’s observations and comments form the basis for selecting interventionists.
Audition-style interviews, also called simulation job interviews, are emerging in a number of fields as an approach to assessing potential hires (Friedman, 2014;
Schwantes, 2017; Brooks 2010). Given that intervention research often occurs within academic settings through funded studies, students are commonly recruited for inter- ventionist roles. When this is the case it is possible to offer pre-interview and training about the skills required of an interventionist as a component of the research educa- tion program. For example, teaching students enrolled in health professional pro- grams about the importance of fidelity in intervention research (Eymard &
Altmiller, 2016) as well as incorporating skills training in interviewing for an inter- ventionist role (Huss et al., 2017) can strengthen the candidate pool.
8.3.2.3 Interventionist Selection
Applicants’ responses to questions and interviewer’s observations are then compared to the applicants’ CV and letters of references. These comparisons are done to look for convergence of information regarding the extent to which applicants have the characteristics of interest. For example, the CV may confirm educational background, licensure, training, and experience, whereas letters of support may point to the quality of the applicants’ interpersonal skills.
Once interviews with all applicants are completed, the information gathered is compared and contrasted across applicants, for the purpose of identifying those who have the pre-specified personal and professional characteristics. A ranking system is designed and followed to choose applicants demonstrating high levels on all charac- teristics. It may be useful to select a number of applicants that exceeds (e.g. by one or two) the number of interventionists needed to deliver the interventions to all clients participating in a research study or expected to receive care in practice. The selected applicants are trained in the implementation of the intervention (as discussed in Section 8.4).
Securing a large number of carefully selected and trained interventionists is essential to offset possible interventionists’ (1) attrition, where some may withdraw for various reasons such as moving out of town to pursue further education; (2) schedule conflict, where some may not be able to facilitate intervention sessions