Online training for evidence-based child trauma treatment: evaluation of the German language TF-CBT-Web

The impact of trauma and how to intervene: a narrative review of psychotraumatology over the past 15 years

To mark 15 years of the European Journal of Psychotraumatology, editors reviewed the past 15-year years of research on trauma exposure and its consequences, as well as developments in (early) psychological, pharmacological and complementary interventions. In all sections of this paper, we provide perspectives on sex/gender aspects, life course trends, and cross-cultural/global and systemic societal contexts. Globally, the majority of people experience stressful events that may be characterized as traumatic. However, definitions of what is traumatic are not necessarily straightforward or universal. Traumatic events may have a wide range of transdiagnostic mental and physical health consequences, not limited to posttraumatic stress disorder (PTSD). Research on genetic, molecular, and neurobiological influences show promise for further understanding underlying risk and resilience for trauma-related consequences. Symptom presentation, prevalence, and course, in response to traumatic experiences, differ depending on individuals' age and developmental phase, sex/gender, sociocultural and environmental contexts, and systemic socio-political forces. Early interventions have the potential to prevent acute posttraumatic stress reactions from escalating to a PTSD diagnosis whether delivered in the golden hours or weeks after trauma. However, research on prevention is still scarce compared to treatment research where several evidence-based psychological, pharmacological and complementary/ integrative interventions exist, and novel forms of delivery have become available. Here, we focus on how best to address the range of negative health outcomes following trauma, how to serve individuals across the age spectrum, including the very young and old, and include considerations of sex/gender, ethnicity, and culture in diverse contexts, beyond Western, Educated, Industrialized, Rich, and Democratic (WEIRD) countries. We conclude with providing directions for future research aimed at improving the well-being of all people impacted by trauma around the world. The 15 years EJPT webinar provides a 90-minute summary of this paper and can be downloaded here [http://bit.ly/4jdtx6k].

Qualitative focus group study of interprofessional healthcare providers to inform the development of a virtual psychoeducational training program for the treatment of childhood interpersonal trauma

The shortage of adequately trained healthcare providers (HCPs) able to treat adults who have experienced childhood interpersonal trauma (CIT) is a pressing concern. This study explored HCPs' training needs for a trauma-focused psychoeducational group intervention and the potential barriers and facilitators to accessing such training. Three 1-hour focus group sessions were conducted with HCPs (n = 17) from two urban and one rural community healthcare organization serving diverse populations in Ontario, Canada, including under-housed people, women struggling with mental health and addiction, and LGBTQ+ populations. On average, participants had 2.4 years in their current role and 18.1 years of mental health field experience. Thematic analysis revealed key findings: a strong clinical need for trauma services, accessible training programs, and broadly applicable interventions relevant for diverse populations. Notably, participants emphasized the clinical advantages and increased accessibility of a virtual training programs focused on psychoeducational treatment interventions, particularly within community-based healthcare settings. This study highlights the potential of a virtual psychoeducational training programs for HCPs to address this critical gap in healthcare provision for individual with CIT. It also underscores the need to move beyond training program development and focus on implementation and sustainability of interventions in clinical practice.

Challenges and facilitators in treating unaccompanied young refugees with posttraumatic stress disorder in a dissemination trial: a qualitative study with psychotherapists

BACKGROUND

Unaccompanied young refugees (UYRs) report high rates of post-traumatic stress, depression and anxiety, and low mental health service utilization. Studies have examined the experiences of psychotherapists and refugees in psychotherapy, focusing on barriers. Our stepped-care approach aims to reduce barriers through comprehensive support, such as training and case consultation for psychotherapists and interpreters, and treatment recommendations for UYRs.

METHODS

A qualitative design with semi-structured interviews was employed, with 20 psychotherapists, of whom 13 were females. All psychotherapists participated in the 'BETTER CARE' project, which included trauma-focused cognitive-behavioral therapy training and case consultations. We analyzed psychotherapists' initial worries, challenges, and facilitators in treating UYRs with posttraumatic stress disorder, and compared the responses of completers' and non-completers' psychotherapists, following a mix of deductive and inductive coding.

RESULTS

Psychotherapists expressed worries similar to those documented in the literature on barriers (such as organizational challenges, emotional stress, and uncertainty about working with interpreters) prior to participating in the project. Major facilitators were the components offered by the project, such as online training, workshop and case consultations. In addition, support from the facility and caregivers and the provision of skilled interpreters who translated accurately and transparently, as well as patients' treatment readiness and language proficiency, were seen as facilitators or, when lacking, as challenges. Completers' psychotherapists were more likely to emphasize the positive aspects of the project, a positive therapeutic alliance and patients' trusting relationship with the interpreters as facilitators. In contrast, non-completers' psychotherapists were more likely to encounter structural difficulties, such as the lack of primary caregivers, greater distances, and grief symptoms among patients.

CONCLUSIONS

Our findings indicate that enhancing the knowledge of psychotherapists, caregivers, and interpreters through specialized training is important for effective trauma treatment with UYRs. This training should result in increased patient readiness, caregiver support, and fostering a cooperative treatment environment, while also building a trusting relationship between patient, psychotherapist, and interpreter. As initial worries were largely unconfirmed, and completers' psychotherapists benefited more from the projects' offers, we recommend similar approaches.

TRIAL REGISTRATION

German Clinical Trials Register DRKS00017453. Registered on 11 December 2019.

Implementation of a Multi-Site Digitally-Enhanced School Clinician Training and ADHD/ODD Intervention Program in Mexico: Randomized Controlled Trial of CLS-R-FUERTE

Childhood conditions of inattention and disruptive behavior, such as Attention-Deficit/Hyperactivity Disorder (ADHD) and Oppositional Defiant Disorder (ODD), are prevalent but undertreated worldwide. One promising solution is harnessing digital technology to enhance school clinician training and ADHD/ODD intervention programs. We conducted a school-clustered randomized controlled trial of CLS-R-FUERTE: a program featuring training/consultation for school clinicians to deliver a six-week intervention comprised of weekly parent and student skills groups, as well as support teachers' classroom management in the form of a Daily Report Card, all facilitated by electronic program manuals/materials and videoconferencing. A total of N = 163 (n = 6-8 students/school [ages 6-12] and their parents, teachers, and school clinicians) participated across eight public schools in Sinaloa, Mexico. We randomly assigned four schools to receive CLS-R-FUERTE immediately and four schools to receive school services as usual. We compared groups post-treatment on parent- and teacher-rated ADHD/ODD and impairment. We observed the program implementation in vivo, tracking trainer and school clinician program fidelity, as well as participant attendance and adherence, to evaluate feasibility. We also collected participant ratings of satisfaction and usability on the System Usability Scale to evaluate acceptability. Our CLS-R-FUERTE trial demonstrated high rates of program feasibility and acceptability comparable to prior in-person program trial findings. Students receiving CLS-R-FUERTE showed greater improvement in parent- and teacher-rated ADHD, as well as parent-rated ODD and impairment, compared to students receiving school services as usual. Results support the utility of global digital mental health programs training school clinicians to implement ADHD/ODD interventions, which have the potential to increase evidence-based treatment access and uptake across worldwide contexts.

Large-Scale Evaluation of Satisfaction, Intent to Use, and Confidence with an Online Learning Course for a Well-Established, Evidence-Based Trauma Treatment: TFCBTWeb2.0

Web-courses for learning evidence-based treatments (EBTs) are increasingly used to improve the dissemination and implementation of evidence-based practice in psychology. Most research on web-courses has focused on engagement and knowledge acquisition, and limited research has evaluated learner satisfaction with training and intent to use EBTs. Further, even when aspects of satisfaction and learner intentions are examined, factors that may contribute to these variables are often overlooked. The current study sought to address these limitations by examining individual, training, and system level factors related to web-course satisfaction, intent to use EBTs, and confidence working with trauma-exposed families following completion of TFCBTWeb2.0, a publicly available web-course for trauma-focused cognitive-behavioral therapy (TF-CBT). Data from 80,749 learners who completed TFCBTWeb2.0 and who represented a wide range of professionals were examined. Most learners (> 90%) were satisfied with the course, intended to use the material, and had high confidence about working with trauma-exposed families. Moreover, those learners who completed the course more slowly (vs. faster completion time) and had more knowledge gain, as well as those who enrolled during the COVID-19 pandemic (vs. pre-pandemic), reported higher satisfaction with the course. Collectively, these results highlight the need to examine both individual and system level factors when considering web-course satisfaction, intent to use EBTs, and confidence working with client populations. Suggestions for TF-CBT trainers and supervisors are provided for how to improve training and learners' willingness to use TF-CBT.

Comparing In-Person and Synchronous Online Training for an Evidence-Based Treatment

Online trainings in evidence-based treatments (EBT) can be effective platforms and may provide better access to community providers as compared with traditional in-person trainings. However, questions remain as to whether online trainings can achieve similar rates of training engagement and model application to traditional in-person trainings. We compared training engagement and model application (e.g., extent of use, fidelity) between participants attending in-person (n = 127) and synchronous online (n = 277) trainings for an EBT (Alternatives for Families: a Cognitive Behavioral Therapy; AF-CBT). Data were collected through pre- and post-training questionnaires and trainers' records. Chi-square analyses and t-tests were used to test for differences between groups. Engagement regarding attendance at workshops and consultation calls was high for both groups, with no significant differences. A total of 81% and 76% presented at least one case and submitted at least one audio recording of an actual AF-CBT session, respectively. Participants rated the training workshop as high quality (M > 4.5/5), and the consultation calls as medium-to-high quality (M > 4/5) across both modalities, indicating good training engagement. In-person training participants were significantly more likely to submit two or more audio recorded sessions than online training participants. This was the only training requirement outcome that differed between the two groups. In examining model application, there were no significant differences between in-person and online training participants in self-reported delivery of AF-CBT, the number of clients with whom it was implemented, the extent they used the model, or the fidelity with which they delivered it. Both groups reported similar improvements in comfort when working with aggressive families, being directive, and using learning techniques like role plays. Online evidence-based treatment skills training appears to be feasible, efficient, and beneficial, with engagement and performance comparable to in-person training. We discuss potential advantages of online training (e.g., fewer costs, greater flexibility for staff from independent practices) and disadvantages (e.g., less satisfaction).

Longitudinal changes in mental health professionals' perceived trauma care competencies after participation in a brief online training programme

BACKGROUND

Further developments in trauma care training for mental health staff are needed to ensure that trauma survivors are recognised and get the most effective care. The evaluation of the effects of trauma care training programs would enable the untangling of the most efficient ways of building the competence of clinicians who encounter trauma-exposed patients in their routine clinical practice.

OBJECTIVE

We aimed to analyse longitudinal changes in mental health professionals' perceived trauma care competencies after a brief online trauma care training, and to examine associations between these changes and specific work-related characteristics.

METHOD

In total, 223 mental health professionals, 96.4% women, 42 years on average, and 51.6% with more than 10 years of clinical practice, participated in a brief online trauma care training programme. The Readiness to Work with Trauma-Exposed Patients Scale (RTEPS) was used to measure perceived trauma care competencies at the pre-training, post-training, and at a 3-month follow-up.

RESULTS

Training had a significant effect on all measured perceived trauma care competencies of assessment, treatment and affect tolerance at post-training and 3-month follow-up. We also found that many years of unspecific clinical practice did not contribute to perceived trauma care competencies, and the training was perceived equally beneficial by professionals with more or less clinical practice.

CONCLUSIONS

Our study indicates that brief training can have lasting effects on clinicians' self-confidence in trauma care. Further investigation of factors associated with the effects of training might help to increase the effectiveness of the training programs.