Assessing Mental Health Providers' Clinical Knowledge and Skills Via an Online Training on LGBTQ-affirmative Cognitive-behavioral Therapy

Study Overview
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Brief Summary
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The purpose of the proposed study is to train mental health providers (MHPs) at lesbian, gay, bisexual, transgender, and queer (LGBTQ) community centers across the United States in evidence-based, LGBTQ-affirmative cognitive-behavioral therapy (CBT).

Detailed Description
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The purpose of the proposed study is to train mental health providers (MHPs) at LGBTQ community centers across the United States in evidence-based, LGBTQ-affirmative cognitive-behavioral therapy (CBT). The primary objective of this study is to determine whether the LGBTQ-affirmative CBT training increases LGBTQ and CBT knowledge, clinical skills, and cultural humility among a sample of MHPs from LGBTQ community centers in the U.S. The proposed prospective study will follow a 2-arm waitlist randomized-controlled trial design where one group of MHPs will be randomized to receive the intervention training (i.e., the immediate training group) in LGBTQ-affirmative CBT, and the second group of MHPs will be randomized to a waitlist control group. The proposed mixed-methods study will consist of predominantly quantitative self-report measures, as well as a qualitative self-assessment of participants' LGBTQ-affirmative CBT clinical skills. All study measures will be administered online at three time points-- baseline, 4-months post-baseline, and 8-months post-baseline (changed prior to randomization from 3-months and 6-months, respectively)-- via the secure Yale Qualtrics survey software.

Official Title
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Assessing Mental Health Providers' Clinical Knowledge and Skills Via an Online Training on LGBTQ-affirmative Cognitive-behavioral Therapy

Conditions
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LGBTQ

Intervention / Treatment
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* Behavioral: LGBTQ-affirmative CBT training


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 18+ years old Fluent in English Mental health provider (including, but not limited to licensed practicing counselors, licensed clinical social workers, licensed marital and family therapists, clinical/counseling psychologists, pre-doctoral psychology interns, third-year or greater graduate practicum students/externs) Currently practicing in an LGBTQ community center that is coordinated by CenterLink, the coordinating hub for LGBTQ community centers in the U.S. Exclusion Criteria: • Individuals unwilling or unable to give informed consent at the time of participation and/or not fitting the eligibility criteria outlined above

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: immediate training group<br>Participants will take part in 11-week LGBTQ-affirmative CBT training via Zoom for 1-hour per week. The participants in the immediate training group will take part in the first 11-week course. | Behavioral: LGBTQ-affirmative CBT training<br>* Participants will take part in 11-week LGBTQ-affirmative CBT training via Zoom for 1-hour per week.<br>|
| Experimental: waitlist control group<br>Participants will take part in 11-week LGBTQ-affirmative CBT training via Zoom for 1-hour per week. The participants in the waitlist control group will take part in the second 11-week course. | Behavioral: LGBTQ-affirmative CBT training<br>* Participants will take part in 11-week LGBTQ-affirmative CBT training via Zoom for 1-hour per week.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Familiarity With LGBTQ-Affirmative CBT Skills | Familiarity with LGBTQ-affirmative CBT skills will be measured using a self-developed questionnaire by the researchers for the purpose of this study. This questionnaire consists of 7 items rated on a 5-point Likert scale for each item. An overall score of 35 (sum of all items) would be the highest possible score on the questionnaire and would indicate a high level of familiarity with LGBTQ-affirmative CBT skills. | Four-month Pre-intervention, Immediate Pre-intervention, Immediate Post-intervention, Four-month Post-intervention | 
| Use of LGBTQ-Affirmative CBT Skills | Use LGBTQ-affirmative CBT skills will be measured using a self-developed questionnaire by the researchers for the purpose of this study. This questionnaire consists of 7 items rated on a 5-point Likert scale for each item. An overall score of 35 (sum of all items) would be the highest possible score on the questionnaire and would indicate a high level of use of LGBTQ-affirmative CBT skills. | Four-month Pre-intervention, Immediate Pre-intervention, Immediate Post-intervention, Four-month Post-intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Self-Reported LGBTQ Clinical Skills Competency | Competency in LGBTQ clinical skills will be measured using the Sexual Orientation Counselor Competency Scale (SOCCS) - Clinical Skills subscale. This subscale consists of 11-items from a psychometrically validated measure, based on a 7-point Likert scale assessing the extent to which respondents endorse clinical competence as related to their skills in working with clients of diverse sexual identities. For the present study, items have been adapted to specifically assess competence in clinical skills based on an LGBTQ-affirmative CBT framework. An overall score of 7 (arithmetic mean of all 11 items) would be the highest possible score and would indicate a high level of competence in LGBTQ clinical skills. | Four-month Pre-intervention, Immediate Pre-intervention, Immediate Post-intervention, Four-month Post-intervention | 
| Applied LGBTQ Clinical Skills Competency | Competency in LGBTQ clinical skills will be measured by asking participants to provide responses to videos of fictional LGBTQ clients. Participants will watch 2 brief video clips (90 seconds each) of fictional clients presenting concerns they would like to address in psychotherapy. Participants will then be asked to write a brief paragraph describing what clinical approaches they would use in clinical treatment in order to address the challenges discussed by the fictional client. These written responses will be rated based on 22 items on a 2-point scale of 0 (did not mention at all), 1 (briefly discussed), and 2 (discussed in detail) to determine participants' LGBTQ-affirmative and general CBT skills. Items coded related to LGBTQ-affirmative CBT skills will not be double coded in the comparable items related to general CBT skills. Average scores will be taken such that 2 would be the highest possible score and would indicate a high level of competence in LGBTQ clinical skills. | Four-month Pre-intervention, Immediate Pre-intervention, Immediate Post-intervention, Four-month Post-intervention | 
| Applied CBT Clinical Skills Competency | Competency in general CBT clinical skills will be measured by asking participants to provide responses to videos of fictional LGBTQ clients. Participants will watch 2 brief video clips (90 seconds each) of fictional clients presenting concerns they would like to address in psychotherapy. Participants will then be asked to write a brief paragraph describing what clinical approaches they would use in clinical treatment in order to address the challenges discussed by the fictional client. These written responses will be rated based on 22 items on a 2-point scale of 0 (did not mention at all), 1 (briefly discussed), and 2 (discussed in detail) to determine participants' LGBTQ-affirmative and general CBT skills. Items coded related to LGBTQ-affirmative CBT skills will not be double coded in the comparable items related to general CBT skills. Average scores will be taken such that 2 would be the highest possible score and would indicate a high level of competence in CBT clinical skills. | Four-month Pre-intervention, Immediate Pre-intervention, Immediate Post-intervention, Four-month Post-intervention | 
| LGBTQ Cultural Humility | LGBTQ cultural humility will be measured using the Multidimensional Cultural Humility Scale (MCHS). This questionnaire is a 15-item self-report psychometrically validated measure assessing the extent to which respondents endorse an ability to maintain an other-oriented, interpersonal stance in relation to cultural identities most salient to clients. For the present study, items were adapted to specifically assess cultural humility as related to working with LGBTQ clients. An overall score of 90 (sum of all items) would be the highest possible score on the questionnaire and would indicate a high level of LGBTQ cultural humility. | Four-month Pre-intervention, Immediate Pre-intervention, Immediate Post-intervention, Four-month Post-intervention | 
| Content Knowledge of Minority Stress | Content knowledge of minority stress will be measured using a self-developed, 10-item multiple-choice measure by the researchers for the purpose of this study and based on past minority stress research. An overall score of 10 (i.e., answering all 10-items correctly) would be the highest possible score on the measure and would indicate a high level of content knowledge of minority stress. | Four-month Pre-intervention, Immediate Pre-intervention, Immediate Post-intervention, Four-month Post-Intervention | 
| Content Knowledge of CBT/LGBTQ-Affirmative CBT | Content knowledge of CBT/LGBTQ-affirmative CBT will be measured using a self-developed, 10-item multiple-choice measure by the researchers for the purpose of this study based on past interventional studies of LGBTQ-affirmative CBT. An overall score of 10 (i.e., answering all 10-items correctly) would be the highest possible score on the measure and would indicate a high level of content knowledge of CBT/LGBTQ-affirmative CBT. | Four-month Pre-intervention, Immediate Pre-intervention, Immediate Post-intervention, Four-month Post-intervention | 
| Acceptability of LGBTQ-affirmative CBT Training | Acceptability of LGBTQ-affirmative CBT will measured using a self-developed questionnaire by the researchers based on past research on training acceptability. Participants will be asked to report how many of the 11 training sessions they attended. Participants will then be asked 2 qualitative questions in regard to which of the 11 training sessions they found most and least helpful. Participants will also be asked 7 questions based on a 5-point Likert scale regarding their interest and perceived benefit from the training. An overall score of 35 (sum of all items) on the Likert scale items would be the highest possible score on the measure and would indicate a high level of perceived acceptability of the LGBTQ-affirmative CBT training. | Immediate Post-intervention |