Low Cost Scaffolded Clinician Training in an Evidence-Supported Treatment

Background and Purpose. Research on clinical training has consistently shown that one-shot training doesn’t work. Multi-faceted training is needed, but is expensive and presents barriers to scalability. This study attempts to determine what kinds of no-cost clinical training activities mental health clinicians will participate in to learn an evidence-supported treatment (EST). Based on scaffolded learning theory, we developed a training package for an evidence-supported treatment that included no in-person training, but included seven other components (e-learning, manual, webinars, toolkit, discussion board,  e-mailed tips, and role plays with assigned training “buddies”).  The research questions were: (1) Can the PBRN be used as a recruitment platform for clinical training trials? (2) What activities will clinicians complete? (3) What drives their participation or lack of participation in certain activities? (4) Will modest payments boost participation?

Methods.Clinicians from the Missouri Therapy Network were invited to participate in a training program for a trauma treatment for children. From previous data, 614 Network clinicians appeared eligible for the training; 303 responded via email that they had interest in the training; 157 completed the pre-training survey on-line and were randomized into a training now or training later condition and further randomized to receive $10 payments for completing certain training components. A mixed methods evaluation of the trainees was conducted with post and follow-up surveys emailed to trainees and phone qualitative interviews with 30 trainees, 10 each purposively recruited from three categories: participants who completed most, some and no training activities.

Results. Clinicians from initial and delayed training groups combined reported completing or mostly completing the initial online training (72%), online webinars (56%-77% for the four webinars), reading the weekly emailed tips (67%), reading the toolkit (47%), and reading the treatment manual (40%). Few reported using the online discussion board (4%) or doing the role plays with other trainees (14%). In qualitative interviews, trainees reported appreciating the high quality of the training content and the flexibility of the training, especially the ability to do training activities at home and at off peak hours. Many trainees, however, thought this flexibility was their downfall, concluding they needed more accountability mechanisms such as due dates for CEUs to “force them” to complete training. Clinicians were reluctant to role play with other clinicians, for fear of not appearing competent. Many clinicians said using a discussion board was not their style. Several clinicians thought the training package needed at least one in-person training activity. The modest training investments were related to completion of only one learning activity, the last of four webinars (67%  incentivized v. 42% not incentivized, χ²=4.46, p=.035).

Conclusions. PBRNs may be useful platforms for clinical training trials. Clinicians wishing to learn ESTs will likely participate in some low-cost distance training activities, but not others. Additional accountability mechanisms are needed to ensure that clinicians do everything needed to acquire necessary skills to use ESTs.