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A Web-based Platform to Support the Implementation of an Evidence-based Mental Health Intervention: Lessons from the CBITS Website
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Manuscript ID: Manuscript Type:
APPI-PS-2013-00512.R1 Brief Report Childhood trauma - PS0403, Community mental health services - PS0066, Continuing education - PS0073, Telecommunications - PS0421, Social work/psychiatric - PS0260
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RUNNING HEAD: WEB-BASED PLATFORMS AND BEHAVIORAL HEALTH A Web-based Platform to Support the Implementation of an Evidence-based Mental Health Intervention: Lessons from the CBITS Website
Pamela Vona , MA UCLA Center for Health Services and Society 10920 Wilshire Blvd. Suite 300 Los Angeles California 90024
[email protected] Pete Wilmoth , MSW, MPA RAND Corporation Pittsburgh, Pennsylvania
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Lisa H Jaycox , PhD RAND Corporation - Behavioral and Policy Sciences Arlington, Virginia
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Janey Sturtz McMillen , PhD 3C Institute Cary, North Carolina
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Sheryl H Kataoka, MD, MSHS UCLA - Department of Psychiatry and Biobehavioral Sciences Los Angeles, California Marleen Wong, PhD University of Southern California - School of Social Work Los Angeles, California
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Melissa DeRosier, 3-C Institute for Social Development Cary, North Carolina Audra K Langley, PhD UCLA - Department of Psychiatry and Biobehavioral Sciences Los Angeles, California Joshua Kaufman, LCSW Los Angeles Unified School District Los Angeles, California Lingqi Tang, UCLA - Psychiaatry Los Angeles, California Bradley D. Stein, M.D., Ph.D. For Review Only
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RUNNING HEAD: WEB-BASED PLATFORMS AND BEHAVIORAL HEALTH University of Pittsburgh - Dept. of Psychiatry One Chatham Center 112 Washington Place, Suite 700 USE RAND E-MAIL ONLY, Pittsburgh, Pennsylvania 15219
Acknowledgements: Support for this study was provided by the Substance Abuse and Mental Health Administration SM061270 and the National Institute for Mental Health P30MH082760.
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All authors confirm that they have no conflicts of interests to disclose.
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RUNNING HEAD: WEB-BASED PLATFORMS AND BEHAVIORAL HEALTH ABSTRACT: Objective: To better understand the role of web-based platforms in behavioral health, we examine the use of a website designed to support training and implementation of an evidence-based intervention. Methods: Using data from the online registration survey and Google Analytics, we examined user characteristics and website utilization. Results: Engagement was substantial across all user groups. Visit duration differed by registrants’ characteristics, with less experienced clinicians spending more time on the website. The training section accounted for the majority of page views across user groups. Individuals previously trained in CBITS viewed
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more pages in the implementation assistance and online community sections. Conclusions: Web-based platforms may have the potential to support training and implementation of evidence-
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based interventions for clinicians of varying levels of experience and subsequently may facilitate more rapid dissemination. Web-based platforms may be promising for trauma-related interventions, since training and
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implementation support should be available rapidly following a traumatic event.
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RUNNING HEAD: WEB-BASED PLATFORMS AND BEHAVIORAL HEALTH INTRODUCTION The tremendous progress made developing evidence-based practices to improve mental health care quality has not been matched by successful implementation of such interventions in community settings.(1) Few clinicians enter the workforce trained to implement evidence-based practices (2) and training the current workforce is challenged by limited infrastructure, funding, and support.(3) Moreover, the “train and hope”(4) approach (i.e., training clinicians without continued implementation support) has resulted in low use of evidence-based practices among community clinicians.(3, 5) The demand for effective mental health services will likely increase substantially due to recent policies such as the Affordable Care Act (ACA). However, the
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existing mental health workforce and training infrastructure is unlikely to meet this increased demand, requiring new mechanisms to expand and enhance successful training in and implementation of evidence-based practices.(1)
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Many clinical fields have increased the use of distance learning via websites to enhance workforce
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skills.(6) Recently, there has been a comparable increase in behavioral health, with web-based trainings for
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substance abuse treatment,(7) dialectical behavior therapy,(8) and cognitive-behavioral therapy.(9) Such efforts have been demonstrated to be as effective as in-person trainings in improving professionals’ knowledge and
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skills.(7, 8, 10) However, little is known about who uses such websites or how users interact with them. To contribute to our understanding of the rapidly growing area of distance learning in behavioral health,
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this paper describes user characteristics and usage of a website that supports training and implementation of an evidence-based intervention for traumatized youth. Such information may inform future efforts to enhance training and implementation support through such websites and may begin to inform how web-based platforms can be used to rapidly disseminate knowledge following traumatic events.
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RUNNING HEAD: WEB-BASED PLATFORMS AND BEHAVIORAL HEALTH METHODS The Cognitive Behavioral Intervention for Trauma in Schools (CBITS) website (cbitsprogram.org) is an online training and implementation support website for CBITS, a widely recognized, (11) effective treatment for trauma-exposed children.(12) The website was developed in response to high demand for CBITS trainings and requests for ongoing implementation support. The website is comprised of a “public” side that contains general information about CBITS, biographies of the intervention developers, and answers to frequently asked questions; and a “private” side that provides registrants with a training course, implementation assistance resources, and a community forum.
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To better understand use of the CBITS website, we used Google Analytics to examine website utilization among all registrants between July 1, 2011 and June 30, 2012 (n =1406). Average visit duration, the
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average length of time a user spends on the website per visit, was used to evaluate website engagement. Page views, the total number of pages a registrant viewed across visits, was used to examine usage of the three
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website sections. Website user characteristics, including demographic information, training background, clinical
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experience, purpose for visiting the website, and prior participation in a CBITS training, were obtained from the website registration survey.
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Using SPSS version 21.0, we described registrants' characteristics and calculated overall website engagement and website section usage. We conducted bivariate analyses, using t-tests and one-way analysis of
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variance (ANOVA) as appropriate, to examine the relationship between user characteristics, website engagement, and content usage. The research was exempted from IRB review by the RAND Corporation IRB.
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RUNNING HEAD: WEB-BASED PLATFORMS AND BEHAVIORAL HEALTH RESULTS Registrants were predominantly female (86%; n=1186), Caucasian (68%; n=959), had a master’s degree (68%, n=939), and had not been previously trained in CBITS (79%; n=1085). (Further information about user characteristics is available online.) Registrants averaged 13:59 minutes per visit, with registrants not previously trained in CBITS spending significantly longer on the website each visit than previously trained registrants (15:11 vs. 10:08 minutes, p
