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

• Sponsor: University of Washington (Other)
• Overall Status: Terminated
• CT.gov ID: NCT03515226
• Collaborator: National Institute of Mental Health (NIMH) (NIH)
• Enrollment: 25
• Location: 1
• Arms: 2
• Actual Duration (Months): 26
• Patients Per Site Per Month: 1

Study Details

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	N/A

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
• Actual Enrollment: 25 participants
• Allocation: Randomized
• Intervention Model: Parallel Assignment
• Intervention Model Description: Randomized clinical trialRandomized 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: Jun 30, 2018
• Actual Primary Completion Date: Jun 30, 2020
• Actual Study Completion Date: Aug 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 [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 [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 [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 [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 [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 [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 [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 [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

Criteria

• Ages Eligible for Study: 18 Years and Older
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: Yes

Inclusion Criteria:

• BA level social work student

• Bilingual Spanish Speaking

Exclusion Criteria:

• none

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	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)

• Study Protocol and Statistical Analysis Plan - Jul 30, 2020
• Informed Consent Form - Sep 10, 2019

More Information

Publications

None provided.

• Responsible Party: Pat Arean, Professor, Department of Psychiatry & Behavioral Sciences, University of Washington
• ClinicalTrials.gov Identifier: NCT03515226
• Other Study ID Numbers: STUDY00004268; 1P50MH115837-01
• First Posted: May 3, 2018
• Last Update Posted: Jul 26, 2022
• Last Verified: Jul 1, 2022

• Individual Participant Data (IPD) Sharing Statement: Yes
• Plan to Share IPD: Yes
• Studies a U.S. FDA-regulated Drug Product: No
• Studies a U.S. FDA-regulated Device Product: No
• Keywords provided by Pat Arean, Professor, Department of Psychiatry & Behavioral Sciences, University of Washington: workforce development; intelligent tutoring systems
• Additional relevant MeSH terms: Depression

Study Results

Participant Flow

Arm/Group Title	Traditional Training	ITS Based Training
Arm/Group Description	25 hours of didactic and simulated case role play training in CBT principles, depression assessment and cultural competency. Traditional Training: Training using didactics and role plays	Traditional training plus the addition of an algorithmic based training computer program that trains clinicians in clinical micro-competencies. ITS based training: Training using computerized adaptive training in addition to role play
Period Title: Overall Study
STARTED	10	15
COMPLETED	8	11
NOT COMPLETED	2	4

Baseline Characteristics

Arm/Group Title	Traditional Training	ITS Based Training	Total
Arm/Group Description	24 hours of didactic and simulated case role play training in CBT principles, depression assessment and cultural competency. Traditional Training: Training using didactics and role plays	Traditional training plus the addition of an algorithmic based training computer program that trains clinicians in clinical micro-competencies. ITS based training: Training using computerized adaptive training in addition to role play	Total of all reporting groups
Overall Participants	8	11	19
Age (years) [Mean (Standard Deviation) ]
Mean (Standard Deviation) [years]	26.63 (9.61)	24.09 (8.63)	24.74 (8.82)
Sex: Female, Male (Count of Participants)
Female	8 100%	9 81.8%	17 89.5%
Male	0 0%	2 18.2%	2 10.5%
Ethnicity (NIH/OMB) (Count of Participants)
Hispanic or Latino	8 100%	4 36.4%	12 63.2%
Not Hispanic or Latino	0 0%	7 63.6%	7 36.8%
Unknown or Not Reported	0 0%	0 0%	0 0%
Race (NIH/OMB) (Count of Participants)
American Indian or Alaska Native	0 0%	0 0%	0 0%
Asian	0 0%	1 9.1%	1 5.3%
Native Hawaiian or Other Pacific Islander	0 0%	0 0%	0 0%
Black or African American	0 0%	1 9.1%	1 5.3%
White	8 100%	8 72.7%	16 84.2%
More than one race	0 0%	1 9.1%	1 5.3%
Unknown or Not Reported	0 0%	0 0%	0 0%

Outcome Measures

1. Primary Outcome

Title	Acceptability of Intervention Measure (AIM) - Goal Setting
Description	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.
Time Frame	This measure will be administered to participants in each training group after they complete the 25 hours of training.

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Traditional Training	ITS Based Training
Arm/Group Description	25 hours of didactic and simulated case role play training in CBT principles, depression assessment and cultural competency. Traditional Training: Training using didactics and role plays	Traditional training plus the addition of an algorithmic based training computer program that trains clinicians in clinical micro-competencies. ITS based training: Training using computerized adaptive training in addition to role play
Measure Participants	8	11
Pre-Training	17.88 (0.99)	17.64 (1.43)
Post-Training	17.63 (1.69)	18.27 (2.61)

2. Primary Outcome

Title	Acceptability of Intervention Measure (AIM) - Identifying Challenges
Description	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.
Time Frame	This measure will be administered to participants in each training group after they complete the 25 hours of training.

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Traditional Training	ITS Based Training
Arm/Group Description	24 hours of didactic and simulated case role play training in CBT principles, depression assessment and cultural competency. Traditional Training: Training using didactics and role plays	Traditional training plus the addition of an algorithmic based training computer program that trains clinicians in clinical micro-competencies. ITS based training: Training using computerized adaptive training in addition to role play
Measure Participants	8	11
Pre-Training	16.75 (1.39)	17.73 (3.44)
Post-Training	16.25 (1.28)	17.82 (1.72)

3. Primary Outcome

Title	Intervention Appropriateness Measure (IAM) - Goal Setting
Description	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.
Time Frame	This measure will be administered to participants in each training group after they complete the 25 hours of training.

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Traditional Training	ITS Based Training
Arm/Group Description	24 hours of didactic and simulated case role play training in CBT principles, depression assessment and cultural competency. Traditional Training: Training using didactics and role plays	Traditional training plus the addition of an algorithmic based training computer program that trains clinicians in clinical micro-competencies. ITS based training: Training using computerized adaptive training in addition to role play
Measure Participants	8	11
Pre-Training	18.25 (1.75)	18.55 (1.63)
Post-Training	17.88 (2.23)	18.82 (1.54)

4. Primary Outcome

Title	Intervention Appropriateness Measure (IAM) - Identifying Challenges
Description	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.
Time Frame	This measure will be administered to participants in each training group after they complete the 25 hours of training.

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Traditional Training	ITS Based Training
Arm/Group Description	24 hours of didactic and simulated case role play training in CBT principles, depression assessment and cultural competency. Traditional Training: Training using didactics and role plays	Traditional training plus the addition of an algorithmic based training computer program that trains clinicians in clinical micro-competencies. ITS based training: Training using computerized adaptive training in addition to role play
Measure Participants	8	11
Pre-Training	16.38 (1.19)	18.82 (2.27)
Post-Training	17.13 (1.81)	18.27 (1.90)

5. Primary Outcome

Title	Feasibility of Intervention Measure (FIM) - Goal Setting
Description	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.
Time Frame	This measure will be administered to participants in each training group after they complete the 25 hours of training.

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Traditional Training	ITS Based Training
Arm/Group Description	24 hours of didactic and simulated case role play training in CBT principles, depression assessment and cultural competency. Traditional Training: Training using didactics and role plays	Traditional training plus the addition of an algorithmic based training computer program that trains clinicians in clinical micro-competencies. ITS based training: Training using computerized adaptive training in addition to role play
Measure Participants	8	11
Pre-Training	16.88 (2.23)	17.09 (2.17)
Post-Training	17.13 (1.46)	18.91 (1.64)

6. Primary Outcome

Title	Feasibility of Intervention Measure - Identifying Challenges
Description	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.
Time Frame	This measure will be administered to participants in each training group after they complete the 25 hours of training.

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Traditional Training	ITS Based Training
Arm/Group Description	25 hours of didactic and simulated case role play training in CBT principles, depression assessment and cultural competency. Traditional Training: Training using didactics and role plays	Traditional training plus the addition of an algorithmic based training computer program that trains clinicians in clinical micro-competencies. ITS based training: Training using computerized adaptive training in addition to role play
Measure Participants	8	11
Pre-Training	15.88 (2.30)	17.73 (2.45)
Post-Training	15.63 (1.69)	18.27 (1.68)

7. Primary Outcome

Title	Intervention Usability Scale (IUS) - Goal Setting
Description	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.
Time Frame	This measure will be administered to participants in each training group after they complete the 25 hours of training.

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Traditional Training	ITS Based Training
Arm/Group Description	24 hours of didactic and simulated case role play training in CBT principles, depression assessment and cultural competency. Traditional Training: Training using didactics and role plays	Traditional training plus the addition of an algorithmic based training computer program that trains clinicians in clinical micro-competencies. ITS based training: Training using computerized adaptive training in addition to role play
Measure Participants	8	11
Pre-Training	28.25 (3.85)	28.27 (3.61)
Post-Training	30.13 (5.03)	30.82 (4.02)

8. Primary Outcome

Title	Intervention Usability Scale (IUS) - Identifying Challenges
Description	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.
Time Frame	This measure will be administered to participants in each training group after they complete the 25 hours of training.

Outcome Measure Data

Analysis Population Description

[Not Specified]

Arm/Group Title	Traditional Training	ITS Based Training
Arm/Group Description	25 hours of didactic and simulated case role play training in CBT principles, depression assessment and cultural competency. Traditional Training: Training using didactics and role plays	Traditional training plus the addition of an algorithmic based training computer program that trains clinicians in clinical micro-competencies. ITS based training: Training using computerized adaptive training in addition to role play
Measure Participants	8	11
Pre-Training	26.75 (4.30)	27.91 (4.55)
Post-Training	28.88 (4.09)	29.27 (5.10)

Adverse Events

Time Frame	9 months
Arm/Group Title	Traditional Training		ITS Based Training
Arm/Group Description	24 hours of didactic and simulated case role play training in CBT principles, depression assessment and cultural competency. Traditional Training: Training using didactics and role plays		Traditional training plus the addition of an algorithmic based training computer program that trains clinicians in clinical micro-competencies. ITS based training: Training using computerized adaptive training in addition to role play
All Cause Mortality
	Traditional Training		ITS Based Training
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	0/8 (0%)		0/11 (0%)
Serious Adverse Events
	Traditional Training		ITS Based Training
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	0/8 (0%)		0/11 (0%)
Other (Not Including Serious) Adverse Events
	Traditional Training		ITS Based Training
	Affected / at Risk (%)	# Events	Affected / at Risk (%)	# Events
Total	0/8 (0%)		0/11 (0%)

Limitations/Caveats

[Not Specified]

More Information

Certain Agreements

All Principal Investigators ARE employed by the organization sponsoring the study.

There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.