SBIR-STTR Award

Family therapy has emerged as one of the most efficacious interventions for child and adolescent behavioral and psychiatric issues such a Conduct Disorder and Substance Use Disorders and for chronic health conditions such as cancer and Alzheimer's. However, widespread implementation of family therapy is often hampered by high training costs, re-training needs following staff turnover, low agency readiness to support new practices, and training strategies that lack ongoing implementation support or do so in ways that are prohibitively expensive. To address this need our company will utilize a web-based Family Therapy Training and Implementation Platform (FTTIP). FTTIP's innovation is that it: 1) is guided by the Simpson Program Change Model focusing on organizational readiness to inform the readiness consultation and online supervisor and agency leader coaching/consultation; 2) uses adaptive training and consultation processes that provide a dynamic and data- driven procedure in which a competency is taught, measured, and the success or failure of the learning informs the next step of training in real time; and 3) uses technology and an online platform that provides the capabilities to fully benefit from an adaptive training and consultation process, a reverse classroom strategy with more options for active learning, and long-distance work that reduces cost. Phase I research objectives will focus on customization of the platform, user interface, and adaptation of training and consultation content; on increasing the agency's readiness for family therapy training and implementation; showing significant improvement in counselor family therapy competencies; and documenting feasibility and acceptability. The Phase I study will also include a small-scale Training as Usual (TAU) comparison condition that will allow us to generate a preliminary estimate of effect size within each of the conditions (FTTIP and TAU). These effect sizes can be used in the power analysis needed for the Phase II study and will allow us to estimate delivery cost differences as well. The Phase I outcomes set the stage for a fully-powered multisite Phase II Randomized Controlled Trial that can investigate whether FTTIP is superior to "Traditional Face-to-Face Training" on all key domains, including trainee, supervisor, agency and client outcomes. FTTIP will be attractive to healthcare delivery systems because it will be more effective than traditional (face-to-face) training methods, better address the service providers' readiness barriers that often are not identified or addressed, and will provide ongoing consultation and counselor support during the difficult implementation phase.

Public Health Relevance Statement:


Project narrative:
The proposed family training and implementation platform will help to close the gap between research-tested interventions and their widespread use by incorporating recent advances in implementation science, adaptive training methods, and technology that facilitates the use of innovative strategies. This innovation is especially significant given that family therapy is considered one of the most efficacious interventions for child and adolescent behavioral and mental health problems such as Conduct Disorder and Substance Use Disorders, and for families with serious health conditions such as cancer and Alzheimer's. If successful the platform can significantly impact public health by making family therapy training and high-quality implementation less costly and more effective.

Project Terms:
Acculturation; Cultural Assimilation; Alzheimer's Disease; senile dementia of the Alzheimer type; primary degenerative dementia; dementia of the Alzheimer type; Primary Senile Degenerative Dementia; Alzheimers disease; Alzheimers Dementia; Alzheimer's; Alzheimer syndrome; Alzheimer sclerosis; Alzheimer disease; Alzheimer Type Dementia; Alzheimer; Malignant Neoplasms; neoplasm/cancer; malignancy; Malignant Tumor; Cancers; Child; youngster; childrens'; children; Children (0-21); Child Youth; 0-11 years old; Client; Communities; Conflict (Psychology); Conflict; Consultations; Professional counselor; Counselor; health care delivery; health services delivery; Healthcare Delivery; Mental Depression; depression; Diffusion; Family; Family Characteristics; Family psychotherapy; Family Therapy; Geographic Locations; geographic site; Geographical Location; Geographic Region; Geographic Area; Health; Learning; Mental Health; Psychological Health; Mental Hygiene; Methods; National Institute of Mental Health; NIMH; Online Systems; web based; online computer; On-Line Systems; Public Health; Research; Research Personnel; Researchers; Investigators; Substance Use Disorder; Technology; Testing; Time; United States; Work; Measures; Competence; Conduct Disorder; disorders of conduct; disorder of conduct; Custom; base; Procedures; Chronic; Clinical; Phase; juvenile human; juvenile; Adolescent Youth; Adolescent; Training; Failure; satisfaction; Experiential Learning; Cooperative Learning; Active Learning; randomized controlled study; Randomized Controlled Trials; Exposure to; programs; Complex; Event; System; Benchmarking; Best Practice Analysis; success; technology development; tech development; Participant; cultural competence; Modeling; behavioral health; Intervention; interventional strategy; Intervention Strategies; Readiness; Preparedness; Address; Data; Process; developmental; Development; Behavioral; traditional therapy; cost; Outcome; cost-effective; cost effective; Step retraining; Step training; innovative; innovate; innovation; user-friendly; implementation science; treatment development; intervention development; develop therapy; therapy development; research into practice; research to practice; therapeutic agent development; therapeutic development; evidence base; flexible; flexibility; Phase I Study; phase 1 study; phase II study; phase 2 study; unique treatment; tailored treatment; tailored therapy; tailored medical treatment; individualized treatment; individualized therapy; individualized patient treatment; customized treatment; customized therapy; individualized medicine; power analysis; web-based tool; service providers; Child Health; implementation strategy

Family therapy has emerged as one of the most efficacious interventions for child and adolescent behavioral and psychiatric issues and for chronic health conditions. However, widespread implementation of family therapy is often hampered by high training costs, re-training needs following staff turnover, low agency readiness to support new practices, and training strategies that lack ongoing implementation support and are prohibitively expensive. To better address the treatment needs of children and families, and to address long standing training and implementation challenges, we developed an innovative Family Therapy Training and Implementation Platform (FTTIP). FTTIP: 1) is guided by advances in implementation science, agency readiness, and knowledge of what it takes to sustain an evidence-based treatment; 2) uses adaptive training and consultation processes that provide a dynamic and data-driven procedure in which a competency is taught, measured, and the success or failure of the learning informs the next step of training in real time; 3) provides interactive practice of skills in which the trainee records interventions in response to simulation and receives personalized feedback; and 4) provides optional learning paths that allow the learner to explore additional ways to master the skills. Our Phase I study demonstrated the feasibility of FTTIP and set the stage for a fully-powered multisite Phase II Randomized Controlled Trial that will investigate whether FTTIP is "not inferior" to traditional face-to-face training on all key domains, including trainee competencies, agency readiness, and client outcomes. The Phase II study aims to: 1) Complete learning, practice and competency- testing paths that provide the learner multiple learning options and to increase the dynamic nature of the platform; 2) Demonstrate that 75 FTTIP trainees show improvement in all core family therapy competencies that are not inferior to 75 providers receiving traditional in-person family therapy training as tested using pre and post training measures in a clinical trial; 3) Demonstrate that 150 families (child/parent dyad) receiving CIFFTA family therapy show adequate retention in treatment, therapeutic alliance, and significant pre-post treatment improvements on family environment and presenting problems; 4) Establish the process (e.g., initiation and delays in training new staff) and cost associated with training in each of the two conditions; 5) Demonstrate that 15 agency leaders receiving FTTIP agency readiness consultations show more pre and post change in agency readiness and knowledge than 15 leaders receiving agency engagement as usual. FTTIP's commercial application is that national, state, and local treatment services funders and providers will find FTTIP to be a highly cost effective, flexible, and engaging way to improve the quality of their evidence-based treatments (EBTs). By better preparing the nation's workforce on EBTs, and providing the support and coaching they need to reach full mastery, our FTTIP product has the potential to significantly improve the wellbeing and mental health in our nation and internationally.

Public Health Relevance Statement:
Project Narrative Our family training and implementation platform (FTTIP) addresses challenges that maintain the research to practice gap, including the inability of most evidence-based treatments to utilize technological advances to build provider mastery; provides coaching and support; addresses agency readiness factors that can contribute to success or failure of EBT implementation; and focuses on sustainability by addressing such issues as costs (e.g., retraining needs, onboarding new staff). FTTIP's commercial application is that national, state, and local treatment services funders and providers will find FTTIP to be a highly cost effective, flexible, and engaging way to improve the quality of their EBTs. By better preparing the nation's workforce and providing the support and coaching they need to reach full mastery, our FTTIP product has the potential to significantly disrupt the traditional costly and inflexible training strategies and improve the wellbeing and mental health in our nation and internationally.

Project Terms:
Aftercare; After Care; After-Treatment; post treatment; Behavior; Mental disorders; Mental health disorders; Psychiatric Disease; Psychiatric Disorder; mental illness; psychiatric illness; psychological disorder; Centers for Disease Control and Prevention (U.S.); CDC; Centers for Disease Control; Centers for Disease Control and Prevention; United States Centers for Disease Control; United States Centers for Disease Control and Prevention; Child; 0-11 years old; Child Youth; Children (0-21); youngster; Client; Clinical Trials; Consultations; Environment; Extended Family; Family; Family psychotherapy; Family Therapy; Feedback; Goals; Health; Institutes; Latin America; Learning; Mental Health; Mental Hygiene; Psychological Health; Persons; NIH; National Institutes of Health; United States National Institutes of Health; On-Line Systems; online computer; web based; Online Systems; Parents; well-being; wellbeing; Personal Satisfaction; Records; Research; Spain; Students; Substance Use Disorder; Testing; Time; Measures; Self-Injurious Behavior; Deliberate Self-Harm; deliberate self harm; intentional self harm; intentional self injury; self harm; self injury; Caregivers; Care Givers; Competence; Conduct Disorder; disorder of conduct; disorders of conduct; base; improved; Procedures; Chronic; Clinical; Phase; Adolescent; Adolescent Youth; juvenile; juvenile human; Randomized Clinical Trials; Training; Failure; Fostering; behavioral problem; Problem behavior; Collaborations; randomized control trial; Randomized Controlled Trials; Therapeutic; Exposure to; Shapes; Nature; Knowledge; Country; meetings; experience; success; skills; simulation; Modeling; response; Intervention Strategies; interventional strategy; Intervention; Provider; Preparedness; Readiness; Address; Data; Grant Proposals; Applications Grants; International; Small Business Innovation Research Grant; SBIR; Small Business Innovation Research; Process; Behavioral; Evidence based treatment; cost; design; designing; Outcome; cost effective; Step training; Step retraining; innovation; innovate; innovative; implementation science; commercial application; research to practice; research into practice; evidence base; flexibility; flexible; phase 1 study; Phase I Study; phase 2 study; phase II study; individualized medicine; customized therapy; customized treatment; individualized patient treatment; individualized therapeutic strategy; individualized therapy; individualized treatment; patient specific therapies; patient specific treatment; tailored medical treatment; tailored therapy; tailored treatment; unique treatment; web-based tool; treatment services; health goals; Dissemination and Implementation; organizational readiness; implementation barriers; barriers to implementation; implementation challenges; efficacious intervention