2019 HSR&D/QUERI National Conference

1028 — Virtual Delivery of Competency-Based Training in Evidence-Based Psychotherapy: Comparison of Training Approaches

Lead/Presenter: Craig Rosen,  National Center for PTSD
All Authors: Eftkehari A (National Center for PTSD), Crowley JE (National Center for PTSD Dissemination & Training Division, Palo Alto), Martin, N (National Center for PTSD Dissemination & Training Division, Palo Alto) Simon, E (National Center for PTSD Dissemination & Training Division, Palo Alto) Rosen CS (National Center for PTSD Dissemination & Training Division AND Center for Innovation to Implementation, Palo Alto)

Since 2007, VA has trained mental health providers in Prolonged Exposure Therapy (PE) and other evidence-based psychotherapies through competency based trainings. In FY 2015, VA travel restrictions required that in-person workshops be replaced with virtual trainings. We compare outcomes from two virtual training approaches.

The original PE training model (FY 2007-2015) involved 4-day in-person experiential workshops combining didactics, role plays, viewing training videos, and other interactive exercises. In 2016, the program shifted to a ‘blended-learning' model in which trainees reviewed some online didactic material independently, and then participated in virtual workshops spread across several weeks. In FY 2017, the program shifted to a synchronous virtual workshop with minimal independent study and training concentrated during a 4-day block of time. This model included small group break-out sessions, role-plays, and viewing of videos. All models of didactic training were followed by completion of two or more training cases while receiving consultation from a PE expert who reviewed audio recordings and provided feedback. Our primary outcome was the proportion of participants who attained competence (as determined by their PE consultant) over the course of consultation.

With in-person training (FY 2007-15), 82% of participants went on to complete consultation and attain competence. With the blended-learning model (FY 2016), only 66% of participants attained competence: 2% did not complete the workshop and 32% failed to complete their training cases or did not attain competence. A major difficulty was having protected time for self-study. Many trainees required remedial help during case consultation for content they were supposed to have learned in the didactic training. With the synchronous virtual workshop (FY 2017), 78% went on to attain competence, similar to in-person training. Participant characteristics did not explain these differences in graduation rates.

Through iteration, the PE Training Program determined how to recreate many components of its successful in-person training in a virtual format. This included protected time for training, interactivity and accountability to encourage engagement, and small-group breakouts to practice skills.

Virtual delivery of competency-based training is possible, but requires careful design and interactivity to ensure engagement and mastery of content.