Implementing the Mindfulness-Based Interventions; Teaching Assessment Criteria (MBI:TAC) in Mindfulness-Based Teacher Training

Abstract

The Mindfulness-Based Interventions: Teaching Assessment Criteria (MBI:TAC) was originally developed as a tool to assess the teaching competence of mindfulness-based program (MBP) teachers. The tool was made freely available and has since been used by mindfulness-based teacher training organisations internationally. During this time the MBI:TAC has evolved in its usage, from an assessment tool to one which informally supports how MBP teachers are trained. In this article, we first examine the rationale for implementing the MBI:TAC in MBP teacher training; second, we offer practical guidance on ways of integrating the tool into teacher training pathways with awareness of its potential and possible pitfalls; and third, we offer guidance on using the tool as a framework for giving effective feedback to trainees on their teaching practice. Implementing the MBI:TAC in teacher training may support the quality and integrity of MBP teacher training, and thus ensure high quality MBP teachers graduating. In turn this may help avoid the ‘implementation cliff’ – that is, the quality of an intervention delivery is delivered in optimal conditions when it is being researched, and drops in quality when delivered in sub-optimal, ‘real world’ conditions.

There is an established research literature base showing that for both clinical and non-clinical populations, attending a mindfulness-based program (MBP) results in a range of positive outcomes such as increased well-being, reduced stress, anxiety, and depression.^1,2 Because MBPs are designed to encourage human flourishing and well-being – rather than just the alleviation of clinical symptoms - they have the potential to be broadly accessible to a wide range of populations.

Research studies on clinical interventions such as MBPs are usually based on ‘best practice’ and are conducted under controlled conditions, such as high fidelity to the MBP curriculum, using highly trained MBP teachers, and selected participant characteristics.^3,4 There is much less research about participant outcomes in ‘real world’ implementation of MBPs, where conditions are not as controlled, and practical considerations such as cost of delivery, time constraints, lack of administrative and managerial support, and lack of training can lead to sub-optimal delivery of MBPs.^4,5

Most research on MBPs has focused on stage I (intervention generation/refinement) and stage II (efficacy of interventions) of the National Institutes of Health (NIH) stage model.^3,6 As many organizations are currently offering MBP programs, it is important to balance the efficacy research with research on how MBPs are implemented in the community (i.e. NIH Stages IV and V). There is a dearth of Stage IV and V studies in MBP research, with under 2% of the MBP studies reviewed by Dimidjian and Segal falling into these two categories; more MBP research is therefore needed on the process of implementation and dissemination.³ A common occurrence in clinical research is the ‘implementation cliff.’⁴ This is a drop in benefit in real-world settings from what is observed under research conditions – especially as interventions are delivered outside of the developers’ control in successive generations. There is thus an inherent tension if the field moves rapidly from science to implementation, without evaluating the impacts of MBPs when delivered in real world conditions. Conversely, when MBPs are delivered optimally, this will contribute to improved mental health and well-being outcomes– with the potential for similar outcomes to those generated in the controlled settings of MBP research.

One potential route to ensuring that the promise of MBP research is realized outside of research conditions is through high-quality teacher training that builds the international community of competent, effective MBP teachers.⁷ Some researchers have noted the lack of published literature on teacher competence and intervention fidelity and recommended that the field should attend to “the thorny question of clinician training” (p. 605).³ There are many variables that contribute to the effectiveness of teacher training programs. Here we focus on the particular contribution the MBI:TAC can make within the training pathway.

The MBI:TAC⁸ was designed as an assessment tool, but has organically evolved to be a tool that informally supports MBP teacher growth in programs across the world.⁹ In this article we describe how the MBI:TAC can contribute to teaching standards and competence beyond its use as an assessment tool. We first examine the rationale for implementing the MBI:TAC in MBP teacher training programmes; second, we offer practical guidance on ways of integrating the tool into teacher training pathways with awareness of its potential and possible pitfalls of its use; and third, we offer guidance on using the tool as a framework for giving effective feedback to trainees on their teaching practice. The paper represents consensus on best practice from six international university and independent MBP teacher training programs. It links with three other papers within this special issue which also address how the MBI:TAC can contribute to MBP integrity and fidelity. One focuses on how to use the tool formatively within supervision;¹⁰ one presents research on the training of MBI:TAC assessors;¹¹ and the third examines good practice in using the MBI:TAC as an assessment tool.¹²

Why Implement the MBI:TAC in MBP Teacher Training Programs?

Beyond the MBI:TAC’s main usage as an assessment tool, there are two other broad areas of contribution within MBP teacher training. First, it offers a map of the territory of the skills that are being cultivated; second, it frames a developmental process for building skills over time.

Mapping the Territory of MBP Teaching Skills

Central to the development of the MBI:TAC was the identification of domains within the MBP teaching process.¹³ Within each of these domains, key features of the teaching process were described. Through a process of grounded theory generation and iterative testing of the tool, six distinct but closely linked domains within the teaching process were articulated: 1) Coverage, pacing and organisation of session curriculum; 2) Relational skills; 3) Embodiment of mindfulness; 4) Guiding mindfulness practices; 5) Conveying course themes through interactive inquiry and didactic teaching; and 6) Holding the group learning environment. One of the reasons for the MBI:TACs rapid adoption in practice has been the practical utility of this mapping. First, it offers to trainers and trainees a shared language of understanding; and second, it communicates alignment to the wider international context for MBP training, thus enabling trainees to have confidence that they are engaging in a process that has worldwide consensus. In a recent survey of mindfulness teacher trainers’ use of the MBI:TAC, typical comments were: “It gives structure to something as vast as the process of the development of a mindfulness teacher”, and offers “clear, consistent and comprehensive understanding of teacher competencies for teaching MBIs”.⁹

Developmental Processes for Building Skills

The framework for discriminating levels of competence within the MBI:TAC draws on a developmental model of skill acquisition.^14,15 This work on skill acquisition is based upon common patterns by which people develop complex skills, with subtle shifts occurring throughout development. Key to these shifts is the increasing role of intuitive decision making as the need to follow rules and formulas drops away as the person acquires greater knowledge and skill. The model thus underlines that competence naturally develops over time provided the right conditions are in place. Skills are gained through experience, instruction, and imitation, with changes in the type of support needed at each stage of development. For example, in our experience trainee MBP teachers can go through stages of believing they should be more skilled than they are. This skill acquisition model encourages them to allow themselves to be where they are, and to invest in their learning by practising their skills, confident in the understanding that as they develop familiarity with the teaching process and its underpinning theories, they will become more embodied, fluent, and intuitive.

Ways of Integrating the MBI:TAC Into Teacher Training Programs

Although there are variations in practice due to the unique context and structure of each MBP teacher training program, there are some common principles that guide the introduction of the MBI:TAC into training. At the core of this is a recognition that the MBI:TAC can contribute to MBP teacher growth when used with discernment. Conversely, it can interrupt the distinctive characteristics of the MBP pedagogical process if used unskilfully.

Introducing the MBI:TAC Early in Teacher Training

In the early stages of training, trainees need structure and clear frameworks within which they can develop the core skills of guiding practices and facilitating inquiry. The MBI:TAC is carefully introduced in the early stages of teacher training to enable trainees to see the map of skills they are developing. At this point in training, the MBI:TAC serves as ‘training-wheels’ to develop familiarity with the teaching process from the perspective of an aspiring teacher. The six domains are introduced in a summary version without the accompanying competence levels.¹⁶ This enables trainees to become familiar with the meta-map of teaching skill offered by the domains and use them to guide their teaching practice. For example, the descriptors for Domain 4 (Guiding mindfulness practices) offer key features related to the structure of the practice, the key learning points that are being conveyed, and elements to consider when guiding a particular practice. These provide a useful anchor from which to try out guiding, and a frame within which peers and trainers can offer feedback (see more on feedback below).

In the early stages of training, there is an emphasis on building skills in delivering the ‘explicit’ curriculum: i.e., the practical skills of teaching, such as learning to deliver the core meditation practices (i.e. body scan, mindful movement, sitting practice, short practices), how to facilitate inquiry, and ways of teaching the psychosocial elements of the curriculum. It is also important to emphasise the embodied qualities of the MBP teacher from the beginning through embedding this into the training process, ensuring that trainees have their own personal practice, and attend annual meditation retreats. However, it is generally at a later stage in training, when trainees have familiarised themselves with the curriculum and basic structures of the teaching process (the explicit curriculum), that they will be able to more fully discover how to teach from an embodied intuitive place (the implicit curriculum).

Trainees can feel intimidated by the tool when it is first introduced –because there is a lot of content, and it introduces the potential of assessment. Many come to training with historical conditioning around assessment and fear of failure. The ‘edge’ to be aware of here is that the introduction of the tool could tip trainees into an instrumental agenda-oriented mind-set with a focus on ‘doing it right’ or ‘how to become a competent mindfulness teacher.’¹⁷ Perhaps this is inevitable given that trainees are investing time and money into training to be an MBP teacher, so a balance is important - trainees are encouraged to build teaching skills whilst participating in the training process in a mindful way, with openness to how it unfolds. Importantly, the practices and other explicit training elements are ‘scaffolding’¹⁸ which offer a methodology within which trainees experientially learn about mindfulness as they are training. It is vital that these instrumental, explicit elements of the curriculum (i.e. the scaffolding) are in the service of enabling access to the non-instrumental, implicit possibilities that mindfulness practice is pointing to (rather than being seen as the main point, or as an end in themselves).

The MBI:TAC was designed as an observational tool which describes what can be seen, heard and felt from an observer’s perspective. It is critical that it is presented and used in training programs as a strength-based, reflective tool that supports teachers’ natural growth, rather than purely as an assessment tool (as this latter approach can trigger performance anxiety in trainees). It can be used as a light touch background reference point to guide experiential engagement with teaching practice. It is vital that it is used in ways that align with the core of the message that is communicated within MBP teaching – namely, that allowing yourself to be where you are in a non-striving, non-judging way is the optimal platform from which to grow and transform. The aim is therefore to create a supportive learning environment, based upon a ‘learning’ rather than a ‘performance’ focus. This allows the learner to concentrate on developing skills, as opposed to trying to appear competent.

To address the issue of trainees feeling intimidated by the MBI:TAC (it is necessarily long and detailed, and designed as an assessment tool), a reflective tool based on the MBI:TAC is in press which encourages self-reflection when teaching, named the Mindfulness Based Intervention: Teaching and Learning Companion (the TLC).¹⁹ In the TLC, the language of ‘competence’ or ‘incompetence’ is absent, and it is much shorter than the MBI:TAC to facilitate engagement and to reduce any sense of fear that an assessment tool can evoke in trainees. It is intended to be an informal ‘companion’ for trainees, supporting reflection and learning of the core skills of MBP teaching. We anticipate that the TLC would be useful to introduce to trainees before the MBI:TAC for these reasons.

Introducing the MBI:TAC in Later Stage MBP Teacher Training

In line with the principles of skill development outlined above,¹⁴ early-stage trainees will need to anchor to some structure. When they first engage in teaching practice, their attentional process will be dominated by the logistics of the teaching process. With practice and skill acquisition this naturally begins to fall away. As familiarity with the explicit curriculum elements builds, the theoretical underpinnings of the teaching become integrated. This movement away from a reliance on set ‘rules’ releases attentional capacity. Trainees can then orientate attention to the processes at play within their own being, within individuals and the group, and within the teaching process. This implicit curriculum becomes a primary focus for development. The MBI:TAC domains of relational skills, embodiment, and holding the group learning container offer particularly important guiding frames during this phase of learning these more implicit skills. Trainees are encouraged to reflect on their process as a teacher from both the inside-out (what was the immediacy of my felt experience whilst in that moment of teaching); and from the outside-in (taking in feedback and reviewing clips of themselves teaching), with the MBI:TAC continuing to offer a light touch guiding map. In training contexts where assessment using the MBI:TAC is included as part of the journey, this natural inclusion of the tool along the way ensures that the assessment can be held as part of the pathway.

Feedback to Trainees Using the MBI:TAC

Receiving feedback on teaching practice from both trainers and peers is a key vehicle for learning within MBP teacher training. The MBI:TAC can be used as a framework within which to offer verbal and written feedback on strengths and learning needs. As a supplement to this section, there is a more detailed online guide to framing trainee feedback.²⁰ Here, a high-level summary is offered.

Framing feedback within the structure of the MBI:TAC ensures a breadth of feedback across the whole terrain of teaching, and encourages specificity related to particular domains/key features. As highlighted above, the process is delicate. Feedback can build curiosity, reflective practice and motivation, or can inadvertently undermine confidence, and trigger a goal-oriented focus. Furthermore, the feedback offered in an MBP teacher training context is intensely personal. The main tool that trainees are developing to build their teaching skills is their own sense of embodiment of mindfulness while they are teaching.²¹ Feedback can therefore easily be felt as being about who one is, rather than feedback on the teaching process. The MBI:TAC is particularly helpful in this arena; it helps trainee and trainer to bring a less personalised orientation. The feedback is always explicitly directed at the teaching (e.g., guiding the body scan was skilful in these ways…, it could have been improved by …”), not the teacher (e.g., you are not skilled at guiding practices).

The main principle is to frame feedback from a strengths-based perspective. A default tendency can be to place priority on communicating what was missing or could be improved. We encourage an emphasis on feedback around what is going well, alongside areas for learning development. Trainees will be more able to take in critically constructive feedback if it is offered in a context of appreciation for strengths, and an intention to support growth. The quantity of feedback related to ‘learning needs’ should approximately equate to that of strengths. It is a good practice to offer a selected number of supportive constructive feedbacks (for example, two of each when offering verbal feedback).The trainee should come away with feedback that gives clear understanding of particular areas of skill development that they can reflect on and further develop (e.g., moments of disconnection or lack of clarity; practical issues such as voice volume), and aspects of their practice that are strong (i.e., the strengths and qualities that were demonstrated; what was skilful and why). The trainer needs to provide feedback on specific behaviours at specific time points, rather than making generalisations: i.e. “in that moment, when you said or did that, I felt …” rather than “well done” or “that was lovely”. The MBI:TAC is helpful in enabling specificity because it is entirely based on descriptors of observations of the teaching process.

When offering either verbal or written feedback, the personal experience of the trainees’ teaching is a helpful anchor point. Feedback is thus anchored in the direct experience of the teaching, combined with reference to the MBI:TAC as a shared map of the terrain. It can be helpful to think about the giving and receiving of feedback as a mindfulness practice – so inviting the trainer and trainee to approach the process from a grounded, attuned, and compassionate perspective. This then supports trainers to speak from connection with their own experience: about how it felt to be taught by that trainee, and what supported and hindered their learning.

Conclusion

In this article, we explored how the MBI:TAC has evolved to contribute to the training of high quality MBP teachers, how the MBI:TAC is implemented in teacher training programmes, and how it relates to established models of learning. We have offered broad suggestions on how to create a fruitful environment, and how to offer feedback skilfully, embodying the fundamental attitude and spirit of mindfulness. Skilful use of the MBI:TAC helps ensure high quality MBP teachers, who can deliver optimal MBPs. This not only helps avoid the ‘implementation cliff’, but also enables participants to access the full learning available from MBPs, thus contributing to the mental health and well-being of future participants.