We set out to evaluate an educational intervention for social workers in cognitive behavioural strategies using a randomised controlled trial design. The intervention group showed substantial improvements in both objective and self-perceived competence in a range of cognitive behavioural therapy skills. The control group had a small but statistically significant improvement in objective competence between baseline and follow-up which can largely be explained by a testing effect, whereby the participants performed better due to repeating the same testing measure.
On average, the objective competence within the intervention group improved from below to above the base competency threshold on the Cognitive Therapy Scale whilst the control group remained below. Importantly, competence on the CTS has been demonstrated to be associated with positive patient outcomes when the therapists are trained clinical psychologists [36, 37]. While this study does not provide evidence that a brief training intervention can turn social workers into competent cognitive therapists, the findings do provide preliminary evidence that social workers can be trained to competently deliver targeted cognitive behavioural strategies.
The social workers' baseline competency scores were lower than anticipated. During the design of the study we had based our assumption about baseline competency scores on a similar study involving general practitioners in Australia . This may reflect the highly selected nature of those general practitioners who were training to be recognised as level 2 mental health accredited general practioners in the Australian system.
The study was undertaken in the context of major mental health reforms within Australia[18, 38] and the UK which have provided funding for health workers, including social workers in Australia, to deliver brief evidence-based psychological therapies. However, a systematic review of the literature had found that given the lack of relevant studies, it is difficult to determine the efficacy of social worker delivered CBT for depression and anxiety .
This study provided evidence that a brief educational intervention can prepare social workers to competently deliver targeted cognitive behavioural strategies. Notably, the training intervention encompassed specific elements of the broader CBT approach termed focused psychological strategies, delivered with a strong emphasis on role play and rehearsal of skills, and incorporated an eco-systemic perspective  to psychosocial assessment. While we did not perform a formal cost benefit or cost comparison analysis - the brief nature of training required to elevate the skills of the social workers indicates that such an approach may be a cost-effective manner to increase the number of mental health workers available in the general health workforce. In future studies, we wish to examine such issues formally (e.g. effectiveness and cost-effectiveness of therapy following measurement of patient outcomes).
Caution is required in generalising the findings of this study to all social workers. An important limitation of the study was the self selection of a relatively experienced cohort of social workers who had a particular interest in mental health. It is not clear if the same results would be achieved with a different sample, for example, a less experienced cohort of social workers. Additionally, the final sample of thirty social workers is a relatively small sample from which to draw broad generalisations regarding the capacity of social workers. However, despite the small sample, the effect size was sufficiently large to obtain a statistically significant increase in both competence and confidence.
A further limitation of this study was that the training covered a suite of practical psychological strategies and yet in the simulated consultations the social workers were instructed that the primary task was to assist the client with problem solving. Therefore although the trained social workers were able to more competently deliver the one strategy that we selected for the outcome measure, it's possible that they would not have performed as well in other specific skills. Notably there was also a significant increase in self-perceived competence across all of the strategies covered in the training, which in itself is unlikely to be educationally significant, but in conjunction with the improvements in objective competence provides some reassurance of broader skill improvement. Also by directing the participants to undertake problem solving we limited our ability to assess participants' capacity to choose the most appropriate CBT technique. Ideally, further studies are required to determine if social workers, who have received the educational intervention, can competently apply the full suite of cognitive behavioural strategies and make the appropriate choice as to which strategy(s) should be utilised.
It is unknown if the improvements in competence demonstrated in our study translate to in-practice performance, or indeed to improvements in patient outcomes, and these will be important research questions for future studies. The well documented benefits of CBT are largely based on delivery by clinical psychologists, and a brief training intervention is not going to deliver the same specialised depth of understanding and skill. It remains unknown whether brief training will provide social workers with the necessary ability to consistently apply cognitive behavioural strategies over a period of time, and to skilfully make clinical judgements as to the most appropriate technique for each patient. An important element that is missing from the training in this study is ongoing supervision, consultation and feedback for improving the application and retention of clinical skills . Without the use of these methods the skills taught in this intensive education intervention may decay over time.
Given the widespread unmet need for mental health care, it is a high priority for further research to investigate whether a brief educational intervention can teach social workers to competently deliver targeted psychological strategies that will translate to positive outcomes for patients in practice. The large number of social workers expressing interest in participating in the study demonstrates two important points; 1) social workers are interested in receiving training in evidence-based clinical mental health skills for working with common mental health problems, and 2) it is feasible to recruit sufficient numbers of social workers for mental health training and research.
Whilst the focus of this study has been on Australian social work professionals the findings are of broader international interest to other health workers. Social workers do have a strong element of psychosocial care in their practice yet in Australia they receive minimal training in evidence-based clinical psychological skills. Interestingly, the findings of this study are consistent with the significant gains in objective competence observed in a pre-test post-test pilot study  of a brief 10-day CBT training intervention conducted in the UK with graduate mental health workers and allied health professionals.
In a similar way to general practitioners, social workers are largely generalist professionals who work on the front line of health and community service provision. They are asked to perform a wide range of tasks with a wide range of client groups which in itself is a role of great expertise. Yet specialisation and clinical competencies are an increasingly important paradigm for social work practice as evidenced by the new opportunities for social workers in primary mental health care. This study provides encouragement for future research into Australian social work practice competencies in primary mental health care.