Web Based Therapist Training on Complicated Grief Therapy

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Complicated Grief (CG) is a prevalent and debilitating disorder associated with significant distress and impairment. It differs from major depression in its treatment and symptomatology. CG is listed in DSM5 as a subtype of Trauma and Greif Disorder. The World Health Organization will include CG as a stand-alone disorder in ICD11, and it is expected that the DSM 5.1 subcommittee will follow suit. Traditional forms of therapy have not been successful in the treatment of CG. However a short-term, manualized Complicated Grief Treatment (CGT) has been developed and found efficacious in three large NIMH sponsored randomized controlled trials. As with other evidence based treatments (EBTs), lack of dissemination and implementation is a major issue, due in large part to a shortage of trained clinicians. Facilitating access to training in EBTs has been identified as a national priority by both mental health professional organizations and NIMH. One way to help disseminate therapist training on EBT of CG is through the use of new technologies. In prior NIMH-funded studies, we have shown that internet-based technologies can successfully train clinicians in EBTs, improving both didactic knowledge, clinical skills, and patient treatment outcomes. In the current application, we will use new technologies to develop a comprehensive on-line therapist training protocol for CGT consisting of three components: 1) An interactive on-line tutorial covering the didactic material; 2) Live, web-based videoconference group supervision following didactic training to practice and reinforce skills; 3) A patient app to help facilitate implementation of CGT including automated text-messaging system to provide messages of encouragement and support to patients between sessions, and improve homework compliance. Thirty clinician-trainees will be recruited. Trainees will take the on-line tutorial at their own pace, followed by 3 live group videoconference supervision sessions. Pre- and post-training measures of didactic knowledge and clinical skill, and evaluations of user-satisfaction will be obtained. The patient app will be developed in parallel to the training package, and follow a parallel but separate evaluation process. Evaluation of the patient app will be done through focus groups with 16 patients recruited from the practices of therapists who are currently providing CGT. Patients will be provided access to the patient app and will explore the app for two weeks, after which they will attend a focus group to obtain their feedback. A focus group of CGT therapists will also be used to evaluate the app. In phase I, we will evaluate feasibility, user satisfaction, and generate pilot data on the effectiveness of these components in improving knowledge and skill. We will also have ongoing meetings with the Director of the NYS Division of Behavioral Health Services in order to recruit phase I patients and lay the groundwork for phase II, where we will integrate and test the training protocol in the NYS mental health system as part of a randomized pragmatic trial. Meetings will help identify the barriers and facilitators to phase II implementation. Our aim is to develop a viable public health-relevant product. 1