Daniel W. Smith1, Benjamin E. Saunders1, Nicholas C. Heck2, & Leticia L. Duvivier1

1Department of Psychiatry and Behavioral SciencesMedical University of South Carolina

Charleston, SC2Department of Psychology, Marquette University

Milwaukee, WI

Presented at the BASPCAN Annual Congress, April 14, 2015, Edinburgh, Scotland UK

Online Training in Evidence-Based Trauma Treatments:

Lessons from TFCBTWeb and CTGWeb

Disseminating Evidence Supported Mental Health

Interventions Limited by a lack of training resources.

AvailabilityAccessibilityCost (actual costs, time, lost productivity)Effectiveness

Spread and reach of ESIs constrained by training capacity.

Online training is a promising mechanism for building training capability.AsynchronousStand aloneUnmonitored

Online Advantages

Virtually universal access worldwide Flexibility, training can fit into therapists’

schedules Time efficient, less lost productivity Multi-media, interactive Immediate access to clinical tools and resources Can be accessed repeatedly

Online Disadvantages

Static in presentation No interactivity with expert faculty Not all learners can engage with unmonitored

online learning. Expensive to construct Must be maintained Need for customer service

Questions

Will target trainees (therapists) engage with online training?

How effective are online training resources in… helping learners acquire knowledge of the treatment?helping learners develop clinical skills?promoting implementation with fidelityencouraging regular use of the treatment with

appropriate patients?promoting sustained use of the treatment over time?

Are online training tools cost effective?

TF-CBTWeb is a web-based, distance education training course for learning Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT).

TF-CBTWeb

www.musc.edu/tfcbt

Launched onOctober 1, 2005

Each module has:• Concise explanations• Video demonstrations• Clinical scripts• Cultural

considerations• Clinical Challenges• 4-item pre/post

knowledge tests

TF-CBTWeb

www.musc.edu/tfcbt

TF-CBTWeb was developed through grant No. 1-UD1-SM56070 from the Substance Abuse and Mental Health Services Administration of the U.S. Department of Health and Human Services.

CTGWeb is a follow-up course that teaches how to apply TF-CBT to cases of child traumatic grief

CTGWebwww.musc.edu/ctg

CTGWeb is offered free of charge.

CTGWeb was launched on September 1, 2008.

6 hours of CE

What do we know about how these things work?

Our basic questions:If we build it, will they come?If they come, will they:

Learn it?Like it?

TF-CBTWeb Learners

From October 1, 2005 to September 30, 2012:TF-CBTWeb had 123,848 unique registered

learners. About 40 learners registered for TF-CBTWeb

each day.

10,197 (8.9%) learners lived outside the U.S. and its territories 130 countries represented, Albania to Zimbabwe. Most learners were from countries where English is

prevalent.

Heck, N., Saunders, B. E., & Smith, D. W. (in press). Web-based training for an evidence-supported treatment: Training completion and knowledge acquisition in a global sample of learners. Child Maltreatment.

TF-CBTWeb Academic Degrees of

Learners

Graduate Student15.6%

Masters74.1%

Ph.D.8.5%

MD1.8%

N = 123,848

TF-CBTWeb Learners’ Professions

17.5%41.0%

26.4%

9.0%

0.9%1.8%

3.4%

PsychologySocial WorkCounselingM/ F TherapyNursingPsychiatryOther

N=123,848

62.7% 19.6% 12.1% 5.6%

<5 years5-10 years10-20 years>20 years

TF-CBTWeb Experience with Traumatized Children

N=123,848

TF-CBTWeb Registration and Completion

Results

Learners All U.S.1 Outside U.S.

Registered 123,848 113,651 10,197

Completed2 (by 12/31/12)

67,208(54.3%)

64,427(56.7%)

2,781(27.3%)

1Includes learners living in the U.S. and U.S. military and Department of Defense employed personnel living outside the U.S.2We are modifying the way we calculate completion rates.

TF-CBTWeb Days to Complete Course

71.8 (188) Mean (SD) days to complete course

2,545 days Longest number of days to complete course

1 day Shortest number of days to complete course (mode)

11 days 50% of completers finish within

43 days 75% of completers finish within

N=67,208

TF-CBTWeb Mean Pre- and Post-test Scores by

Module

PsychoEdRelxn

CtlBrth

ThghtSt

AffEx

CogCop TN

CogProcBMT

P-Ch

0102030405060708090

100

Post-test

Pre-test

Course Module

Me

an

Sc

ore

N = 67,208; All differences p<.001. Cohen’s d range: .54 – 1.22

Learner Evaluation of TF-CBTWeb

63.0% 55.2% 51.1% 57.8% 50.9% 55.4% 45.0%

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

EasyNavigation

Easy toLearn

Good Look &Feel

ClearDirections

VideosHelped

ScriptsPractical

ClinicalChallenges

Str.Dis+Disagree Agree Strongly Agree

66,497 EvaluationsHeck, N., Saunders, B. E., & Smith, D. W. (2015). Satisfaction and usage patterns of a web-based training course for an evidence-supported treatment. Manuscript in preparation.

Learner Evaluation of TF-CBTWeb

33.5% 55.6%45.9% 49.5% 45.3% 48.3%

54.1%

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

CulturalHelpful

TechniquesHelpful

LearnPsychoEd

Learn StressManagement

Learn Affect CognitiveCoping

TraumaNarrative

Str.Dis+Disagree Agree Strongly Agree

66,497 Evaluations

Learner Evaluation of TF-CBTWeb

49.4% 46.5% 47.9%33.8% 39.9% 43.3%

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

CognitiveProcessing

BehaviorManagement

Engage Parents AppropriateClients

AppropriateProblems

Will Use TF-CBT

Str.Dis+Disagree Agree Strongly Agree

66,497 EvaluationsTotal Satisfaction Score: M = 3.43 (.51)

Learner Attrition : Modules 1-5

Reg-istra-tion

Pre - 1

Post - 1

Pre - 2

Post - 2

Pre - 3

Post - 3

Pre - 4

Post - 4

Pre - 5

Post - 5

0

20000

40000

60000

80000

100000

120000

140000

-25,203

-8,783

n=123,848 n=75,754

Module Pre- Post-test Completion

-4,835

Learner Attrition: Modules 6-10

Pre -

6

Post - 6

Pre -

7

Post - 7

Pre -

8

Post - 8

Pre -

9

Post - 9

Pre -

10

Post - 1

020000

40000

60000

80000

100000

120000

140000

n=74,252 n=67,208

68% retention from Pre-179% retention from Pre-291% retention from Pre-6

Module Pre- Post-test Completion

CTGWeb Learners

From January 1, 2009 to September 1, 2013:TF-CBTWeb had 11,871 unique registered

learners. About 7 learners registered for CTGWeb each

day.

713 (6.0%) learners lived outside the U.S. and its territories 74 countries represented Australia (81), Germany, Japan, UK, Israel, Kenya,

Sweden, Norway/Singapore (10)

CTGWeb Academic Degrees of

Learners

Graduate Student16.6%

Masters76.4%

Ph.D.6.0%

MD1.0%

N = 11,871

TF-CBTWeb Learners’ Professions

14.8%40.6%

29.5%

10.2%

2.9%

0.9%0.8%

PsychologySocial WorkCounselingM/ F TherapyNursingPsychiatryOther

N=11,871

67.8% 18.0% 10.1% 3.9%

<5 years5-10 years10-20 years>20 years

CTGWeb Experience with Traumatized Children

N=11,871

CTGWeb Registration and Completion

Results

Learners All U.S.1 Outside U.S.

Registered 11,871 11,158 713

Completed8,825

(74.3%)8,390

(75.2%)435

(61.0%)

1Includes learners living in the U.S. and U.S. military and Department of Defense employed personnel living outside the U.S.

CTGWeb Mean Pre- and Post-test Scores by

Module

40

50

60

70

80

90

100

Post-test

Pre-test

Course Module

Me

an

Sc

ore

N = 8,825; All differences p<.001. Cohen’s d range: .20 – .89

Conclusions

Our basic questions: If we build it, will they come? – YES – and in much higher

numbers than we anticipated. If they come, will they:

Like it? – Overwhelmingly they do Learn it?

Knowledge: yes Skill: no idea yet

Though costly to construct (we estimate $250K per course), per use cost decreases over time, making online training a cost-effective training mechanism. As of 2014, we had over 120K TFCBTWeb completers, so it’s ~$2 +

change per learner

How does online learning compare to in-person? Is the combination better than either alone?

Under preliminary study (Cohen, Mannarino, & Deblinger)

Collaborator Acknowledgment

TF-CBTWeb (2005)

CTGWeb (2008)

Saunders Deblinger Cohen Mannarino

Saunders Deblinger Cohen Mannarino Goodman