Improving Quality of Care in Child Mental Health Service Settings
Condition: Post Traumatic Stress Disorder; Technology; Child Abuse
MeSH terms: Stress Disorders, Traumatic; Stress Disorders, Post-Traumatic
Study type: Interventional

Summary: 
      The investigators recently completed an NIMH R34 in which they piloted a patient- and
      provider-informed tablet-based toolkit designed to facilitate delivery of Trauma-Focused
      Cognitive Behavioral Therapy (TF-CBT) - a treatment that was selected because it addresses a
      wide range of symptoms using techniques shared by other treatments for emotional and
      behavioral disorders. The tablet-based toolkit consists of numerous components (e.g., videos,
      interactive games, drawing applications) that are designed to facilitate provider-patient
      interactions in a way that enhances children's engagement and supports adherence to the
      treatment model. The tablet-based toolkit was very well received by children, caregivers, and
      providers in the pilot evaluation. Moreover, all benchmarks for feasibility were met or
      exceeded. This study proposes to conduct a hybrid effectiveness-implementation trial to
      examine the extent to which the tablet intervention may improve fidelity, engagement, and
      children's mental health outcomes. The investigators will conduct a randomized controlled
      trial with 120 mental health providers and 360 families in partnership with dozens of clinics
      in the Carolinas and Florida. Providers will be assigned randomly to tablet-facilitated vs.
      standard TF-CBT. Youth aged 8-16 years with clinically elevated symptoms of PTSD will be
      recruited. Baseline and 3-, 6-, 9-, and 12-month post-baseline assessments will be conducted
      by independent, blind evaluators. Sessions will be videorecorded for observational coding of
      engagement and fidelity by independent raters blind to study hypotheses. The investigators
      will also examine costs and conduct semi-structured interviews with families, providers,
      supervisors, and agency leaders to inform future dissemination and implementation
      initiatives. Technology-based resources that are scalable, easy to use, and designed for
      efficient integration into everyday practice may have sustained national impact.
    

Detailed description: 
      Assuring children access to the highest quality mental health care is a top national
      priority. Yet, quality of care continues to be highly variable in traditional service
      settings. Novel, scalable solutions are needed to address modifiable quality-of-care
      indicators in sustainable ways. To this end, provider fidelity and children's engagement are
      key correlates of clinical outcome and practical targets for intervention. There is
      tremendous opportunity to address both through technology. Studies in child education show
      that interactive games, touch-screen learning, and demonstration videos enhance engagement,
      knowledge, motivation, and learning. These benefits also may extend to the therapeutic
      context, where strategic integration of technology-based activities may enhance children's
      learning, strengthen the therapeutic alliance, and keep providers on protocol. The
      investigators recently completed an NIMH R34 in which they piloted a patient- and
      provider-informed tablet-based toolkit designed to facilitate delivery of Trauma-Focused
      Cognitive Behavioral Therapy (TF-CBT) - a treatment that was selected because it addresses a
      wide range of symptoms using techniques shared by other treatments for emotional and
      behavioral disorders. The tablet-based toolkit consists of numerous components (e.g., videos,
      interactive games, drawing applications) that are designed to facilitate provider-patient
      interactions in a way that enhances children's engagement and supports adherence to the
      treatment model. The tablet-based toolkit was very well received by children, caregivers, and
      providers in the picot evaluation and all benchmarks for feasibility were met or exceeded.
      The investigators propose to conduct a hybrid effectiveness-implementation trial to examine
      the extent to which the tablet intervention may improve fidelity, engagement, and children's
      mental health outcomes. The investigators will conduct a randomized controlled trial with 120
      mental health providers and 360 families in partnership with dozens of clinics in the
      Carolinas and Florida. Providers will be assigned randomly to tablet-facilitated vs. standard
      TF-CBT. Youth aged 8-16 years with clinically elevated symptoms of PTSD will be recruited.
      Baseline and 3-, 6-, 9-, and 12-month post-baseline assessments will be conducted by
      independent, blind evaluators. Sessions will be videorecorded for observational coding of
      engagement and fidelity by independent raters blind to study hypotheses. The investigators
      will also examine costs and conduct semi-structured interviews with families, providers,
      supervisors, and agency leaders to inform future dissemination and implementation
      initiatives. Technology-based resources that are scalable, easy to use, and designed for
      efficient integration into everyday practice may have sustained national impact.
    

Intervention name(s): TFCBT; eTFCBT
Intervention type(s): Behavioral; Behavioral
Intervention description(s): treatment as usual; tablet-facilitated Trauma Focused Cognitive Behavioral Therapy (eTFCBT)
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment