Training of Cross-cultural Competencies in Psychotherapists

Study Overview
=================
Brief Summary
-----------------
The purpose of this study is to determine whether a web-based training program with text-based information as well as practical exercises can improve cross-cultural competencies in therapists.

Detailed Description
-----------------
As the number of patients from diverse cultures increases in psychotherapeutic care, cross-cultural competencies of therapists become increasingly important. In particular, mental health care of patients with immigration background needs to be improved as studies show that these patients drop out of treatment more often and benefit less from therapy. In addition, patients with immigration background and refugees show higher prevalences in mental illnesses. Nevertheless, evaluated training programs to improve cross-cultural competencies in psychotherapists are lacking. In particular, web-based training programs, which allow therapists to work time-flexible and at their own pace on a training, are, to date, missing completely. For the current study, a web-based training program to improve therapists' cross-cultural competencies was developed. It is based on existing conceptions of cross-cultural competencies. The developed program consists of six modules with the following contents: definitions and conceptions of culture, the role of cross-cultural competencies in psychotherapy, the influence of prejudices and discrimination as well as the role of migration and acculturation, and culturally sensitive diagnostics. The modules contain PDF-files with text-based information, video files, case studies with associated questions as well as practical exercises. The main focus of the training is the participants' self-reflection concerning their conceptions of (their own) culture and their beliefs about culturally diverse patients. The training group will be compared to two other groups, i.e. an education only and a waitlist control group. Whereas the waitlist control group will not receive any training materials, the education only group will receive a slimmed down version of the training consisting only of text-based information files.

Official Title
-----------------
Evaluation of an Internet-based Training Program to Improve Cross-cultural Competencies in Psychotherapists

Conditions
-----------------
Healthy Volunteers

Intervention / Treatment
-----------------
* Behavioral: Training
* Behavioral: Education only


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: current psychotherapeutic work Internet access sufficient German language skills ongoing or completed training in Psychotherapy Exclusion Criteria: too much previous knowledge about cross-cultural competencies (> 10h training)
Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

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: Training<br>In the training group, participants work six weeks on the training program, one module per week. The modules contain PDF-files with text-based information, video files, case studies with associated questions as well as practical exercises that participants perform independently. The main purpose of this intervention is the improvement of cross-cultural competencies in psychotherapists | Behavioral: Training<br>* Six modules containing PDF-files with text-based information, video files, case studies with associated questions and practical exercises. Participants can download the modules and associated materials from an online platform they need to register for. They receive access to modules and associated exercises once a week. After six weeks the training is completed.<br>|
| Active Comparator: Education only<br>In the education only group, participants work six weeks on a slimmed down version of the training program. The modules only contain text-based information without any exercises. After completion, participants receive access to the practical exercises, case studies and video files as well. Main purpose of the education only group is to determine whether the practical part of the training program can offer additional benefit. | Behavioral: Education only<br>* Six modules containing only PDF-files with text-based information. Participants can download the modules and associated materials from an online platform they need to register for. They receive access to modules once a week. After six weeks the education is completed.<br>|
| No Intervention: Waiting control<br>Initially, participants do not receive any training contents. After a six week waiting period, they can participate in the training program as well. Modules are equivalent to those of the training group. Purpose of this group is to determine whether the training program is effective. | |

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Transcultural Competencies of Psychotherapists Questionnaire (TKKP; Reichardt et. al., in prep.) | Change in cross-cultural psychotherapeutic competencies | pre-training, post-training (6 weeks after the start of the training); follow up (6 month after training completion) | 
| Multicultural Counseling Inventory (MCI; Sodowsky, 1994) | Change in cross-cultural psychotherapeutic competencies | pre-training, post-training (6 weeks after the start of the training); follow-up (6 month after training completion) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cultural sensitivity in actual psychotherapeutic work I | Percentage of culturally diverse patients currently in treatment in own actual psychotherapeutic work | pre-training, post-training (6 weeks after the start of the training), follow-up (6 month after training completion) | 
| Cultural sensitivity in actual psychotherapeutic work II | Willingness to treat culturally diverse patients in own actual psychotherapeutic work (rating scale) | pre-training, post-training (6 weeks after the start of the training), follow-up (6 month after training completion) | 
| Cultural sensitivity in actual psychotherapeutic work III | Satisfaction with cross-cultural therapies provided in actual psychotherapeutic work (rating scale) | pre-training, post-training (6 weeks after the start of the training), follow-up (6 month after training completion) | 
| Cultural sensitivity in actual psychotherapeutic work IV | Perceived competence in the currently provided cross-cultural therapies (rating scale) | pre-training, post-training (6 weeks after the start of the training), follow-up (6 month after training completion) | 
| Knowledge regarding the provision of cross-cultural psychotherapy | Test of specific knowledge gained during the training (knowledge test in multiple choice answer format) | post-training (6 weeks after the start of the training) | 
| Training satisfaction scale | Satisfaction with the training (rating scale; items assessing satisfaction with contents and structure of the developed training) | post-training (6 weeks after the start of the training); follow-up (6 month after training completion) | 
| Learning success scale | Rating of competencies achieved through the training for the treatment of culturally diverse patients (rating scale, rating of the degree to which certain competencies have been achieved) | post-training (6 weeks after the start of the training); follow-up (6 month after training completion) | 
| Cultural sensitivity in psychotherapeutic work (Behavioural change measure) | Rating of different case examples with focus on expected difficulty and effectiveness of psychotherapy (given different cases with different disorders, severity levels, and cultural backgrounds) | post-training (6 weeks after the start of the training), 2 months after training completion; follow-up (6 month after training completion) | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
cross-cultural competencies, internet-based training, cognitive-behavioural therapy (CBT), psychotherapy training, competence training