Dissemination of Empirically Supported, Trauma-Foucsed Treatment Via the Internet: TF-CBT Web

Daniel W.Smith,PhD & Benjamin E. Saunders, PhD - National Crime Victims Research & Treatment Center Medical University of South Carolina

The mental health service commu­nity faces increasing pressure to pro­vide empirically supported treatments to children and families. The good news is that there is a growing body of knowledge about effective treat­ments. But knowing what works is only part of the solution. There is still a substantial gap between what is known to be effective and what is actually provided in real-life practice. Part of this “research to practice” gap is attributable to the challenges that front line clinicians face in gaining access to training in the latest empiri­cally supported interventions. This article describes the development of TF-CBTWeb, an innovative Web-based training course on Trauma-Focused Cognitive-Behavioral Therapy (TF­CBT) designed for busy, front-line clinicians who work with traumatized children and their families.

Training clinicians to adopt and conduct empirically supported treat­ments is a complex enterprise. Several factors significantly limit the availability of adequate training. First, clinicians are busy, with high caseloads and limited time for learning new treatment methodologies. Second, training is time-intensive.

Thoroughly reading a book or manual requires hours; attending a workshop typically requires a day or more away from the office. Clinical programs often must select just a few staff mem­bers to attend training because it is impractical and financially prohibi­tive to shut down clinical operations. Third, typical training methods have limitations. Books and manuals do not allow the learner to interact with the author or observe and engage in simulated practice. Workshops typi­cally allow interaction with an expert and experiential exercises to facilitate learning, but clinicians return to their practice without continued access to expert assistance to reinforce key points or help apply the training to new clinical situations.

One challenge facing the mental health field is to create meaningful training experiences that convey practical information, can be accessed repeatedly as needed, and incorpo­rate information of high learning value (demonstrations, role plays, etc.). The Internet is a powerful tool for disseminating such training.

In partnership with Drs. Judith Cohen and Anthony Mannarino of the Center for Traumatic Stress in Children and Adolescents of Allegheny General Hospital and Dr. Esther Deblinger of the CARES Institute at the University of Medicine and Dentistry of New Jersey, we set out to develop TF-CBTWeb (www.musc.edu/tfcbt), a Web-based, multimedia, distance education course for mental health practitioners seeking to learn TF­CBT.

We chose TF-CBT for several rea­sons. First, TF-CBT is one of the best-supported interventions in the child trauma field. Multiple random­ized, controlled clinical trials have demonstrated its efficacy for children with PTSD symptoms related to sex­ual abuse, and it has been applied successfully to children with PTSD symptoms resulting from other trau­matic events. Second, TF-CBT has a treatment manual (Cohen, Mannarino, & Deblinger, 2006) that clearly describes treatment components and procedures. Third, we had consider­able experience implementing TF­CBT in our own work and a strong working relationship with the treat­ment developers. Finally, successfully disseminating TF-CBT was a high priority of the National Child Traumatic Stress Network (www.nctsn.org).

In developing TF-CBTWeb, we conducted an extensive review of the literature on distance education, Web-based learning, and adult learning principles. Asynchronous, Web-based learning for adult professionals is quite different from teaching a graduate course or providing a training workshop. The design of TF-CBTWebwas based on specific learning principles related to its target audience and modality.

TF-CBT Web follows the organization of the treatment manual, presenting information about each TF-CBT component: Psychoeducation, Stress Management (including relaxation, controlled breathing, and thought stopping), Affect Identification and Expression, Cognitive Coping, Creating a Trauma Narrative, Cognitive Processing of the Trauma Narrative, Behavior Management, and Conjoint Parent-Child Sessions. Each component of TF-CBT Web includes:

• a streaming video introduction to the technique;
• pre- and post-tests of relevant content knowledge;
• an overview of learning objectives;
• a description of techniques and step-by-step instructions for implementation, including sample scripts for introducing techniques to clients;
• multiple streaming video demonstrations of techniques being used;
• suggested homework assignments or follow-up exercises;
• cultural considerations relevant for using the technique with diverse groups;
• discussion of clinical challenges that commonly arise in real-life practice; and
• directions for including parents or guardians in the therapeutic activity.

The Web-based format of the course allows learners to proceed at their own pace, to complete the training at convenient times and places, and to return to the site as needed to refresh previous learning. TF-CBT Web is offered at no charge, and mental health professionals who complete the course receive 10 contact hours of continuing education from the Medical University of South Carolina.

Since its launch October 1, 2005, over 5000 learners have registered for TF-CBT Web. Learners come from all 50 states and 48 countries outside the United States, and all mental health professions are well represented. Most hold masters degrees in a mental health profession, and about 20 percent have doctoral or medical degrees. TF-CBT Web has been adopted by many professors for use in their practice courses. Consequently, approximately 10 percent of TF-CBT Web users are students. TF-CBT Web is also being used in several innovative learning collaborative and implementation projects within the NCTSN. Learners have reported utilizing TF-CBT Web in their own study, supervision, and peer consultation groups. Most important, evaluation data indicates that TF-CBT Web learners have significant and substantial gains in knowledge about TF-CBT procedures and techniques and are highly satisfied with the learning experience.

Successfully disseminating evidence-based treatments will remain a challenge for the traumatic stress field for some time. We believe that creative, Web-based, multi-media tools such as TF-CBT Web can help make progress towards this important goal.

To learn more about TF-CBT Web, go to www.musc.edu/tfcbt and click the Introduction tab or e-mail questions to [email protected]. To register for the course, go to www.musc.edu/tfcbt and click the Register tab.

Reference
Cohen, J. A., Mannarino, A. P., & Deblinger, E., (2006). Treating Trauma and Traumatic Grief in Children and Adolescents. New York: Guilford Press.