This Phase I SBIR proposes to develop and demonstrate the feasibility of an innovative computer-based program for training therapists to administer Comprehensive Behavioral Intervention for Tics (CBIT); an empirically supported nonpharmacological intervention for children and adults with Chronic Tic Disorders (CTD; including Tourette Disorder). CTD represents a class of neuropsychiatric disorders, occurring in 1-3% of the population that can lead to significant impairments in physical, social, academic, and interpersonal functioning and reduced quality of life. There is currently no cure for CTD, however in large-scale randomized controlled trials, CBIT has been shown to reduce tics without the adverse side effects associated with pharmacotherapy. A therapist-guided, empirically validated CBIT protocol is available, however the vast majority of individuals who desire CBIT do not have access to therapists trained in the delivery of this intervention. Given the need for nonpharmacological treatment options for individuals with CTD, a desire for such treatments by potential end-users, and the absence of practitioners adequately trained in the treatment, there is a clear need for innovative modes of dissemination. The current proposal partners two of the primary developers of CBIT with PsycTech, a company that specializes in developing effective computer-based products for repetitive behavior disorders. In the proposed project, we will use competency-based training methods and an innovative, contextualized technology adaptation process (CTAP) to adapt CBIT into an innovative online training program; a process that has been shown to increase satisfaction and adoption among stakeholders. In addition, to inform implementation, we will use an established conceptual model of evidence-based practice implementation whereby we will engage multiple stakeholders early in the product development process in order to begin to identify provider-level factors (e.g., attitudes, values, openness) and organizational-level factors (e.g., priorities, values, structural fit) shown to influence adoption and implementation of adapted interventions in other health-care models and settings. The resulting product (CBIT- Trainer) will be tested for feasibility, usability, and end-user satisfaction. This Phase I project will accomplish four aims: (1) To develop CBIT-Trainer concept materials and program flow through an iterative end-user feedback and development process; (2) To develop working online prototypes to train two core CBIT therapeutic techniques: education training and HRT; (3) To conduct usability, acceptability, and feasibility tests on the education and HRT CBIT-Trainer prototypes using CBIT-nave therapists; and (4) identify, early in the development process, provider and organizational factors that could impede adoption and implementation. !
Chronic tic disorders (CTD) occur in 1-3% of the population and are associated with significant impairments in physical, social, academic, and interpersonal functioning, along with diminished quality of life. There is no cure for CTD, but the symptoms are often managed with pharmacotherapies. Such medications are moderately effective for reducing tics for some, but high rates of side effects limit their use and often result in poor adherence. A non-pharmacological treatment known as Comprehensive Behavioral Interventions for Tics (CBIT) has shown results similar to those achieved with pharmacotherapy. CBIT is desired by patients/parents, but is not widely available. Surveys of families with CTD have shown that only 6% of treatment-seeking children/families and 4% of treatment seeking adults have received CBIT. While most respondents desired CBIT, a lack of providers trained in CBIT was among the most commonly cited barriers to receiving treatment. Surveys of mental health practitioners confirm that few professionals have been trained in CBIT and a high demand for CBIT training. Combined, these data highlight the need for novel therapist training strategies in order to increase the availability of CBIT for CTD. In the proposed project, we will use competency-based training methods and an iterative expert and end-user informed process to CBIT into a novel, online program for training therapists to administer CBIT (CBIT-Trainer). In addition to being universally available to any therapist with Internet access, CBIT-Trainer has the potential to significantly lower the cost of therapist training. An online training program also has distinct advantages over intensive in-person training methods including an individualized pace of training, ongoing continuing education, real-time practice updates, and the ability to incorporate technology to provide ongoing peer support and expert consultation. Finally, we will begin to identify and address, early in the product development process, needs and barriers among multiple stakeholders (providers, center directors) in order to proactively identify and address potential implementation barriers (e.g., therapist attitudes, organizational characteristics) that might impede adoption.