Remote Training in Evidence-based Practices for Clinicians Who Work With Migrant Workers

• ClinicalTrials.gov Identifier: NCT03515226
• Recruitment Status: Terminated
• First Posted: May 3, 2018
• Results First Posted: December 1, 2021
• Last Update Posted: December 1, 2021
• Sponsor: University of Washington
• Collaborator: National Institute of Mental Health (NIMH)
• Information provided by (Responsible Party): Eugene Aisenberg, University of Washington

Study Description

Brief Summary:

This study will compare training as usual to automated training using an intelligent tutoring system in training bachelors (BA) level social workers in cognitive behavioral therapy (CBT). The purpose of the study is to determine if time and cost of training front line clinicians in evidence-based treatments can be shortened, and if this new training model can reduce the need for clinicians to seek advice from experts.

Condition or disease	Intervention/treatment	Phase
Depression	Behavioral: ITS based training; Behavioral: Traditional Training	Not Applicable

Detailed Description:

The University of Washington (UW) School of Social Work, in partnership with Heritage University's School of Social Work in Yakima Valley recently partnered to develop a training program for bachelors (BA) level Social Workers to address limited clinician capacity in rural primary care settings. Currently the curriculum is a combination of didactic training in telephone based cognitive behavioral therapy (CBT; 20 hours), role play training (25 hours), and guided supervision. The scalability of these programs is limited, however, by expert time to conduct training activities, clinician time away from work to engage in training activities, and the fact that even when clinicians participate in training, there is no guarantee they will certify. Adaptive learning, an educational method that uses adaptive algorithms to may be a potential solution to these problems in capacity building. These programs can tailor the educational experience to the needs of the trainee, reduce time in training, improve competence in complex decision-making and standardize training. This study builds on the existing research base on clinical training, and adds to it by designing and testing an intelligent tutoring system (ITS) based on adaptive learning algorithms. Both CBT experts (Aisenberg) and past CBT trainees (Heritage University School of Social Work) will partner with experts in educational software development (Popovic) to create the ITS, which will be compared to training as usual on time to training, competence and skill drift. The investigators hypothesize that capacity building through improved learnability (target mechanism) will result in enhanced clinical ability to deliver CBT elements competently, and in a shorter time-period, and that greater competence will result in better quality of care.

Study Design

• Study Type: Interventional (Clinical Trial)
• Actual Enrollment: 25 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Intervention Model Description: Randomized clinical trial
• Masking: None (Open Label)
• Primary Purpose: Health Services Research
• Official Title: Remote Training in Evidence-based Practices for Clinicians Who Work With Migrant Workers
• Actual Study Start Date: June 30, 2018
• Actual Primary Completion Date: June 30, 2020
• Actual Study Completion Date: August 30, 2020

Arms and Interventions

Arm	Intervention/treatment
Active Comparator: Traditional Training; 20 hours of didactic education and training in CBT principles, depression assessment and cultural competency and 25 hours in dyad role playing of CBT manualized treatment sessions with supervision.	Behavioral: Traditional Training; Training using didactics and role plays
Experimental: ITS based training; Traditional training plus the addition of an algorithmic based training computer program that trains clinicians in clinical micro-competencies.	Behavioral: ITS based training; Training using computerized adaptive training in addition to role play

Outcome Measures

Primary Outcome Measures :

1. Acceptability of Intervention Measure (AIM) - Goal Setting [ Time Frame: This measure will be administered to participants in each training group after they complete the 25 hours of training. ]
   This is a four item measure of intervention acceptability; where each item is rated on a 1-5 scale, with 1 = not at all appropriate and 5 = very appropriate. The total scale range is 4-20. Each group will be compared on the degree they find the specific clinical skill acceptable to use after they complete the training. We administered the AIM twice asking the students to respond to the acceptability of goal setting as a clinical skill and of identifying challenges as a clinical skill. This section reports on goal setting.
2. Acceptability of Intervention Measure (AIM) - Identifying Challenges [ Time Frame: This measure will be administered to participants in each training group after they complete the 25 hours of training. ]
   This is a four item measure of intervention acceptability; where each item is rated on a 1-5 scale, with 1 = not at all appropriate and 5 = very appropriate. The total scale range is 4-20. Each group will be compared on the degree they find the specific clinical skill acceptable to use after they complete the training. We administered the AIM twice asking the students to respond to the acceptability of goal setting as a clinical skill and of identifying challenges as a clinical skill. This section reports on identifying challenges.
3. Intervention Appropriateness Measure (IAM) - Goal Setting [ Time Frame: This measure will be administered to participants in each training group after they complete the 25 hours of training. ]
   This is a four item measure of intervention appropriateness; where each item is rated on a 1-5 scale, with 1 = not at all appropriate and 5 = very appropriate. The total range for this measure is 4-20. Each group will be compared on the degree they find the specific clinical skill appropriate to use after they complete the training. We administered the IAM twice asking the students to respond to the acceptability of goal setting as a clinical skill and of identifying challenges as a clinical skill. This section reports on goal setting.
4. Intervention Appropriateness Measure (IAM) - Identifying Challenges [ Time Frame: This measure will be administered to participants in each training group after they complete the 25 hours of training. ]
   This is a four item measure of intervention appropriateness; where each item is rated on a 1-5 scale, with 1 = not at all appropriate and 5 = very appropriate. The total scale range is 4-20. Each group will be compared on the degree they find the specific clinical skill appropriate to use after they complete the training. We administered the IAM twice asking the students to respond to the acceptability of goal setting as a clinical skill and of identifying challenges as a clinical skill. This section reports on identifying challenges.
5. Feasibility of Intervention Measure (FIM) - Goal Setting [ Time Frame: This measure will be administered to participants in each training group after they complete the 25 hours of training. ]
   This is a four item measure of intervention feasibility; where each item is rated on a 1-5 scale, with 1 = not at all appropriate and 5 = very appropriate. The total scale range is 4-20. Each group will be compared on the degree they find the specific clinical skill feasible to use after they complete the training they participated in. We administered the FIM twice asking the students to respond to the feasibility of goal setting as a clinical skill and of identifying challenges as a clinical skill. This section reports on goal setting.
6. Feasibility of Intervention Measure - Identifying Challenges [ Time Frame: This measure will be administered to participants in each training group after they complete the 25 hours of training. ]
   This is a four item measure of intervention feasibility; where each item is rated on a 1-5 scale, with 1 = not at all appropriate and 5 = very appropriate. The total scale range is 4-20. Each group will be compared on the degree they find the specific clinical skill feasible to use after they complete the training they participated in. We administered the FIM twice asking the students to respond to the feasibility of goal setting as a clinical skill and of identifying challenges as a clinical skill. This section reports on identifying challenges.
7. Intervention Usability Scale (IUS) - Goal Setting [ Time Frame: This measure will be administered to participants in each training group after they complete the 25 hours of training. ]
   The IUS is a 10-item measure with a possible total score ranging from 0 to 100; higher scores indicate a more usable intervention. Although this measure has not yet been normed as a measure of intervention usability, the System Usability Scale upon which the IUS is based defines scores of 70 or above as indicative of acceptable usability.
8. Intervention Usability Scale (IUS) - Identifying Challenges [ Time Frame: This measure will be administered to participants in each training group after they complete the 25 hours of training. ]
   The IUS is a 10-item measure with a possible total score ranging from 0 to 100; higher scores indicate a more usable intervention. Although this measure has not yet been normed as a measure of intervention usability, the System Usability Scale upon which the IUS is based defines scores of 70 or above as indicative of acceptable usability.

Eligibility Criteria

• Ages Eligible for Study: 18 Years and older (Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: Yes

Criteria

Inclusion Criteria:

• BA level social work student
• Bilingual Spanish Speaking

Exclusion Criteria:

• none

Contacts and Locations

Locations

United States, Washington

University of Washington Department of Psychiatry and Behavioral Sciences

Seattle, Washington, United States, 98105

Sponsors and Collaborators

University of Washington

National Institute of Mental Health (NIMH)

Investigators

• Principal Investigator: Patricia Arean; UWMC Psychiatry
• Study Director: Brenna Renn, PhD; UWMC Psychiatry

  Study Documents (Full-Text)

Documents provided by Eugene Aisenberg, University of Washington:

Study Protocol and Statistical Analysis Plan  [PDF] July 30, 2020

Informed Consent Form  [PDF] September 10, 2019

More Information

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Lyon AR, Munson SA, Renn BN, Atkins DC, Pullmann MD, Friedman E, Areán PA. Use of Human-Centered Design to Improve Implementation of Evidence-Based Psychotherapies in Low-Resource Communities: Protocol for Studies Applying a Framework to Assess Usability . JMIR Res Protoc. 2019 Oct 9;8(10):e14990. doi: 10.2196/14990. Erratum in: JMIR Res Protoc. 2020 Mar 4;9(3):e18241.

• Responsible Party: Eugene Aisenberg, Associate Professor, School of Social Work; Adjunct Associate Professor, Health Services, University of Washington
• ClinicalTrials.gov Identifier: NCT03515226
• Other Study ID Numbers: STUDY00004268; 1P50MH115837-01 ( U.S. NIH Grant/Contract )
• First Posted: May 3, 2018
• Results First Posted: December 1, 2021
• Last Update Posted: December 1, 2021
• Last Verified: November 2021

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: Yes
• Plan Description: We will be creating a register of study outcomes for all projects under the UW ALACRITY center that researchers and request permission to access.
• Supporting Materials: Study Protocol; Statistical Analysis Plan (SAP); Informed Consent Form (ICF); Clinical Study Report (CSR); Analytic Code
• Time Frame: Data for this study will be made available in January of 2021
• Access Criteria: Any interested party who wishes to use our data for research or educational purposes may contact Dr. Renn who will review the request and provide access to information requested.

• Studies a U.S. FDA-regulated Drug Product: No
• Studies a U.S. FDA-regulated Device Product: No

Keywords provided by Eugene Aisenberg, University of Washington:

workforce development; intelligent tutoring systems

Additional relevant MeSH terms:

Depression; Behavioral Symptoms