Psychosis resulting from schizophrenia spectrum disorders and major mood disorders is one of the most disabling health concerns worldwide. Evidence-based psychotherapeutic interventions are recommended as standard of care by national psychosis treatment guidelines but are rarely accessible. Cognitive Behavioral Therapy for psychosis (CBTp) is the most well-researched psychotherapy for psychotic disorders, yet fewer than 1% of American mental health providers are trained in this intervention. To date, there has been no scalable way to offer high-quality and sustainable CBTp training to mental health providers. The primary objective of this Small Business Technology Transfer (STTR) proposal is to develop and evaluate a spoken language technology tool - CBTpro -- to support high-quality skills training in CBTp. CBTpro will provide a rapid means of scaling and sustaining CBTp in routine care settings across the US, resulting in more clinicians across the country providing higher quality CBTp to individuals with psychosis. This fast-track STTR proposal has two phases. The objective of Phase I is to develop a CBTpro prototype, which requires three core activities: Aim 1: understand community stakeholder needs to inform software design and functionality; Aim 2: develop CBTpro digital content; and Aim 3: train and validate machine learning algorithms to automatically score CBTp fidelity. The objective of Phase II is to optimize and test the CBTpro tool in real world practice settings. Accordingly, in Phase II, we will Aim 1: conduct a lab usability study (Aim 1a) followed by field testing of the CBTpro prototype (Aim 1b) with 20 trainees; Aim 2: conduct a randomized controlled trial of CBTpro training vs. training as usual (N= 100 providers / N=300 clients), using a nested mixed model analysis to determine the effect of CBTpro on client symptoms, functioning, and recovery; and Aim 3: adopting an NIMH experimental therapeutics approach, assess the hypothesized mechanism by which CBTpro affects clinical outcomes through increased provider fidelity to CBTp (mediation), and test whether the strength of the relationship between these variables is affected by client skill acquisition (moderation). This proposal directly addresses the National Institute of Mental Health's strategic objectives to improve dissemination, implementation, and continuous improvement of evidence-based mental health services (Objective 4.2) and develop innovative models to dramatically improve the outcomes of mental health services received (Objective 4.3), particularly through the use of novel technology. CBTpro has the potential to reduce the high personal and societal costs associated with serious mental illness, redress the challenges of training amidst high rates of mental health system turnover, support supervisors in quality assurance and improvement efforts, and reduce health disparities associated with mental health workforce shortage areas.
Public Health Relevance Statement: Evidence based psychotherapeutic interventions are recommended by national psychosis treatment guidelines, but are inaccessible in routine practice. The objective of this proposal is to systematically develop, pilot, and rigorously test CBTpro, a novel clinician support tool designed to train community mental health workers to provide cognitive behavioral therapy for psychosis skills to their clients. CBTpro merges cutting- edge technology with best psychotherapeutic practices for serious mental illness to enable a rapid research, development, and testing pipeline.
Project Terms: Adult; 21+ years old; Adult Human; adulthood; Affect; Client; Cognitive Therapy; Cognition Therapy; Cognitive Psychotherapy; cognitive behavior intervention; cognitive behavior modification; cognitive behavior therapy; cognitive behavioral intervention; cognitive behavioral modification; cognitive behavioral therapy; cognitive behavioral treatment; Communities; Disease; Disorder; Elements; Feedback; Future; Health; Health Personnel; Health Care Providers; Healthcare Providers; Healthcare worker; health care personnel; health care worker; health provider; health workforce; healthcare personnel; medical personnel; treatment provider; Human; Modern Man; Language; Learning; Mental Health; Mental Hygiene; Psychological Health; Mental Health Services; Mental Hygiene Services; Persons; National Institute of Mental Health; NIMH; Patient Education; Patient Instruction; Patient Training; Patients; Psychotherapy; Psychotic Disorders; Psychoses; psychotic illness; Records; Research; research and development; Development and Research; R & D; R&D; Resources; Research Resources; Schizophrenia; Schizophrenic Disorders; dementia praecox; schizophrenic; Software Design; Designing computer software; Speech; Technology; Testing; Time; Training Programs; Universities; Businesses; Caring; Comprehension; Practice Guidelines; base; quality assurance; improved; Area; Clinical; Phase; Medical; Training; disability; Individual; Recovery; Interdisciplinary Research; Multidisciplinary Collaboration; Multidisciplinary Research; Interdisciplinary Study; Technology Transfer; Collaborations; Randomized Controlled Trials; tool; machine learned; Machine Learning; Adopted; Clinic; System; Country; Affective Disorders; Mood Disorders; psychosocial; Needs Assessment; skills training; American; experience; field based data; field learning; field test; field study; Performance; rehearsal; skills; novel; member; Negotiating; Negotiation; Mediation; novel technologies; new technology; Modeling; response; depository; repository; Intervention Strategies; interventional strategy; Intervention; Experimental Therapies; Investigational Treatments; experimental therapeutic agents; experimental therapeutics; Investigational Therapies; Provider; disparity in health; health disparity; Effectiveness; Address; Health system; Symptoms; Economic Burden; developmental; Development; Behavioral; Evidence based treatment; website; web site; Instruction; cost; virtual; digital; computerized; designing; design; chronic mental illness; persistent mental illness; serious mental disorder; serious mental illness; severe mental disorder; severe mental illness; Outcome; scale up; cost effective; innovate; innovative; innovation; skill development; skill acquisition; usability; prototype; multi-modality; multimodality; effective intervention; evidence base; standard of care; routine care; routine practice; arm; m-Health; mobile health; mHealth; support tools; Workforce Development; improved outcome; health care outcomes; healthcare outcomes; care outcomes; practice setting; societal costs; cognitive benefits; treatment guidelines; machine learned algorithm; machine learning algorithm; evaluate effectiveness; effectiveness evaluation
