Considerable effort is being made in many states to implement evidence based interventions in community mental health service agencies. One big challenge to this goal is enabling providers to achieve an adequate level of fidelity to establishe treatment models. Provider fidelity is highly variable even among well-trained practitioners. This project will take an important step toward enhancing quality of care by capitalizing on recent advances in technology to improve the delivery of interventions in real-world community settings. The use of web-based applications optimized for use on mobile devices (e.g., iPad) represents a highly innovative approach to achieving this aim. Research is needed to inform these efforts and evaluate this approach. The current project aims to develop and establish the feasibility of eTF-CBT, a technology-based toolkit for Trauma- Focused Cognitive Behavioral Therapy (TF-CBT) that is designed to enhance the quality, accessibility, and efficiency of treatment. The eTF-CBT toolkit will consist of web-based applications optimized for use on mobile devices (e.g., videos, interactive games, drawing applications) that are used in session with children and caregivers. These activities will be designed to enhance patient engagement and support providers'delivery of each major component of the protocol with fidelity. Activities were selected based on data from a sample of national trainers in TF-CBT who identified treatment components for which barriers and challenges to providers are significant. After initial development, the eTF-CBT toolkit will undergo alpha and beta testing. The results of this testing will guide refinements to the eTF-CBT toolkit in preparation for more extensive evaluation. Next, we will conduct a feasibility trial in which we will recruit 10 local mental health providers who wll be trained in the eTF-CBT resource and will participate in a feasibility RCT of 20 families assigned to TF-CBT vs. eTF-CBT. Youth aged 8-15 years with clinically significant symptoms of posttraumatic stress disorder will be recruited from community-based mental health clinics. Baseline, mid-treatment, and post-treatment assessments will be conducted by an independent evaluator blind to study condition. Sessions will be audiotaped for fidelity coding, and rated for fidelity by an independent rater blind to study hypotheses. The trial will provide data on the feasibility of eTF-CBT and will demonstrate the feasibility of recruitment, assessment, and evaluation procedures used in the RCT. These data will be valuable as we prepare for a large-scale RCT that examines the incremental efficacy and efficiency of technology-assisted treatment. Although this initial project identifies a single treatment protocol, results will have broad implications because TF-CBT features several components (e.g., graduated exposure, behavior management principles, psychoeducation, risk reduction) that are of high relevance to a wide range of patient populations. The potential for technology-based applications to reach mental health services agencies nationally is high due to low maintenance costs and high accessibility.

Public Health Relevance

Nearly 9 million U.S. children (1 in 8) meet criteria for at least one mental health disorder at any point in time. Effective treatments exist for these disorders, but children and families who seek services rarely receive them;mental health providers need more support in the delivery of these interventions to ensure that children and families are receiving the best quality care. This project aims to improve the delivery of best practices for families who seek mental health care by developing creative, technology-based resources for providers.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Planning Grant (R34)
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Interventions Committee for Disorders Involving Children and Their Families (ITVC)
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Sherrill, Joel
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Medical University of South Carolina
Schools of Medicine
United States
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W Adams, Zachary; McClure, Erin A; Gray, Kevin M et al. (2017) Mobile devices for the remote acquisition of physiological and behavioral biomarkers in psychiatric clinical research. J Psychiatr Res 85:1-14
Ruggiero, Kenneth J; Bunnell, Brian E; Andrews Iii, Arthur R et al. (2015) Development and Pilot Evaluation of a Tablet-Based Application to Improve Quality of Care in Child Mental Health Treatment. JMIR Res Protoc 4:e143
Hanson, Rochelle F; Gros, Kirstin Stauffacher; Davidson, Tatiana M et al. (2014) National trainers' perspectives on challenges to implementation of an empirically-supported mental health treatment. Adm Policy Ment Health 41:522-34
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