ABSTRACT
Recent years have seen an increase in demand for evidence-based practices (EBPs) in mental health care; however, there exists a dearth of accessible, low-cost trainings in EBPs. This has led national organizations, such as the Society of Clinical Child and Adolescent Psychology (SCCAP; Division 53 of the American Psychological Association), to undertake evidence-based dissemination initiatives. Whereas traditional efforts, such as publishing special issues about EBPs in academic journals and hosting conferences dedicated to child mental health, were well received, the reach of these efforts were limited. To disseminate EBPs more broadly, SCCAP partnered with the Center for Children and Families at Florida International University in 2011 to create a website designed to educate parents and professionals on child and adolescent mental health. The result is a not-for-profit website providing one of the largest caches of educational videos by leading experts in clinical child and adolescent psychology summarizing the state of the evidence for mental health treatment, in-depth workshops on specific treatment techniques and packages, and brief informational videos for parents. The online courses are being used by community mental health agencies, individual clinicians, and universities to facilitate training in EBPs and to inform parents about EBPs. Initial evaluations of the impact of the online courses indicate high rates of consumer satisfaction with the course content and materials, as well as broad reach in terms of user geography, theoretical orientation, and professional setting. Development of additional website content, mobile applications, and new presentation formats are under way.
Increasing recognition of the global burden of mental illness and related problems (Birnbaum et al., Citation2010; Comer et al., Citation2011; Greenberg et al., Citation1999; Kessler et al., Citation2006; Kessler, Chiu, Demler, & Walters, Citation2005; Merikangas et al., Citation2007) has led in recent years to an increased demand for evidence-based practices (EBPs) in mental health care (Barlow, Citation2000; Barlow, Bullis, Comer, & Armetaj, Citation2013; Kazdin & Blasé, Citation2011; McHugh & Barlow, Citation2010). In the United States, several states have created mandates for the use of EBPs, and some managed care companies now require evidence-based treatments for maximum reimbursement (Kazak et al., Citation2010; McHugh & Barlow, Citation2010; Patient Protection and Affordable Care Act, Citation2010). Recent years have also witnessed direct-to-consumer marketing strategies being used to directly inform mental health consumers of the considerable benefits of EBPs and to create a “bottom-up” demand for greater availability of EBPs (Gallo, Comer, & Barlow, Citation2013; Gallo, Comer, Barlow, Clarke, & Antony, Citation2015)
The push for evidence-based treatments may present a challenge for providers who have not had adequate training in EBPs. Several billion dollars have been allocated in the past decade for disseminating EBPs (McHugh & Barlow, Citation2010), but professionals wanting to update or further their training in EBPs through continuing education are confronted with a myriad of training opportunities. Many of these opportunities strategically advertise as operating from an “evidence base,” but there is considerable variability in the extent to which treatment programs covered are actually meeting scientific standards. Unfortunately, the term “evidence-based” has been operationalized so unreliably, and has been used so frequently with varying degrees of legitimacy, that by itself it cannot be considered an indication of training quality. Even when trainings are accredited by a national association, the quality of the training content is not guaranteed, because associations vary considerably in their approval standards for continuing education. Moreover, the increasing demand for evidence-based treatments brings an expectation for professionals to stay current in their scientific knowledge, which is perhaps more challenging now than ever due to the rapid expansion of specialized research (Neimeyer, Taylor, & Rozensky, Citation2012) and proliferation of outlets publishing high-quality scientific reports.
The challenge to finding appropriate training opportunities in EBPs is not unique to psychologists. Professionals who provide services to children and adolescents with behavioral and emotional problems typically vary widely in their training background due to the diverse, yet disconnected, systems that are all related to youth mental health (Hoagwood, Olin, & Cleek, Citation2013; Kazak et al., Citation2010). For example, in treating a child with attention-deficit/hyperactivity disorder, a pediatrician or psychiatrist is trained to prescribe stimulant medications, a teacher is trained in classroom interventions, and a psychologist is trained to provide parent training. In fact, recent trends in treatment utilization show that multimodal treatments divided across distinct professional workforces are common for those receiving therapeutic services (Olfson & Marcus, Citation2010). However, multidisciplinary conferences and journals are not the norm. Therefore, in the modern health care landscape, practitioners must find ways to be informed about complementary treatments outside of their discipline and to provide adequate recommendations regarding multimodal treatment options.
The Center for Children and Families (CCF) at Florida International University (FIU) has taken on the challenge to increase the availability of accessible, palatable, effective, low-cost trainings in EBPs that have met rigorous scientific standards. Initiated with the Society of Clinical Child and Adolescent Psychology (SCCAP; Division 53 of the American Psychological Association), the CCF at FIU has developed a comprehensive online education website to meet the ongoing training needs of all types of youth-serving professionals, the FIU/CCF Internet Dissemination Initiative for Children’s Evidence-based Services (INDICES; formerly named effectivechildtherapy.fiu.edu). The website http://www.indices4kids.com offers video-based continuing education opportunities for mental health professionals that have met rigorous scientific standards for establishing “evidence,” as explained in detail next. Other organizations have launched online training programs dedicated to educating professionals and public audiences about evidence-based treatments. For example, the American Psychological Association (APA), the Association for Behavioral and Cognitive Therapies, and psychotherapy.net have developed online dissemination programs. However, FIU/CCF INDICES differs from other available resources in several ways that may be important to consumers. Many key distinguishing features of the website are listed in , with examples. Although individual distinguishing features are not necessarily unique to FIU/CCF INDICES, it is their combination that makes FIU/CCF INDICES a unique resource. Unlike for-profit commercial continuing education programs, the sole purpose of FIU/CCF INDICES is to provide information and trainings on child and adolescent treatments that are high quality and research based. Roughly half of the content on the website is available for free. The remaining content is available at a very low cost, which supports the maintenance of the website and the ability to provide continuing education credits for a variety of professionals, including clinical psychologists, school psychologists, teachers, mental health counselors, nurses, and social workers. Moreover, the content on FIU/CCF INDICES is not restricted to didactic presentations and workshops on investigator-specific/commercial treatment protocols (e.g., Parent–Child Interaction Therapy, Coping Power) but also includes didactic presentations and workshops on generic evidence-based treatment principles and practices (e.g., time-out procedures, parent training).
Table 1. Distinguishing features of the Florida International University/Center for Children and Families Internet Dissemination Initiative for Children’s Evidence-Based Services website.
This article provides practical recommendations that will facilitate a diverse array of youth-serving professionals to reap maximum benefits from the resulting web-based resources. In addition, we offer a brief historical account of the developments that have yielded FIU/CCF INDICES, including consensus processes for selecting treatment workshop topics and presenters, and a list of topics and presentations currently available.
The development of FIU/CCF INDICES
As mentioned previously, one of the primary goals of FIU/CCF INDICES is to provide training in therapeutic practices that have been designated as evidence-based by legitimate sources. Over the past 20 years, numerous professional organizations have worked hard to evaluate the research evidence for specific therapeutic practices. The resulting guidelines, lists, or recommendations have informed the content of FIU/CCF INDICES. APA’s Division 12 Task Force on the Promotion and Dissemination of Psychological Procedures was the first to generate a widely recognized rubric for categorizing treatments, and consequently a list of qualifying treatments at different designations of evidence was published in 1995 (American Psychological Association, Division of Clinical Psychology, Task Force on Promotion and Dissemination of Psychological Procedures, Citation1995). Treatments were assigned a level of evidence (e.g., “well-established,” “probably efficacious,” “possibly efficacious,” “experimental,” and “not effective”) according to the quantity and quality of studies conducted and in accordance with clear and objective criteria for each designation of support. The goal was to provide an accessible compendium of the state of science on psychological treatments and, by doing so, promote awareness of the importance of using evidence to inform practice (Chambless & Ollendick, Citation2001). The list generated at that time by Division 12’s Task Force mainly focused on treatments for adults. Consequently, Section 1 (Clinical Child) of APA’s Division 12 (Clinical Psychology) formed the Task Force on Effective Psychosocial Interventions: A Lifespan Perspective to identify treatments with empirical support for the most common child and adolescent mental health problems. The Task Force on Effective Psychosocial Interventions: A Lifespan Perspective, now known as SCCAP, published its list for child-focused treatments in the Journal of Clinical Child Psychology as a special issue (Lonigan, Elbert, & Johnson, Citation1998). It was hoped that the list could become a resource for practitioners who needed to justify their services for payment and who wanted to know which treatments had the most support for a particular problem (Lonigan et al., Citation1998). A more detailed history of the creation and progress of the task force can be found in the 1998 special issue of the Journal of Clinical Child Psychology (Lonigan et al., Citation1998) and in a review by Chambless and Ollendick (Citation2001). The resources published by Division 12, SCCAP, and other professional organizations have been directly used to inform content developed for FIU/CCF INDICES.
The Niagara Conference
FIU/CCF INDICES grew out of another important dissemination effort initiated by SCCAP and executed by the CCF, the Niagara Conference. In the years immediately following the turn of the century, there was a considerable expansion in the number of high-quality clinical trials evaluating treatments specifically for children and adolescents. The increase in the amount of information resulting from clinical psychology research led professional associations to provide more frequent updates and training to its consumers. Although there was a proliferation in journal publications regarding evidence-based treatment, it was apparent that information in academic outlets would likely not be adequately received by the majority of frontline practicing clinicians. As a result, in 1999 the Niagara Conference was established as a conference primarily for clinicians in order to disseminate leading scientific information into community settings. The Niagara Conference was greatly expanded upon by the CCF at the State University of New York Buffalo (SUNY Buffalo) and McMaster University to include innovative presentation formats and the latest topics presented by leading experts in clinical child and adolescent psychology and related fields. In addition, prior to the development of FIU/CCF INDICES, the CCF at SUNY Buffalo had provided free webcasts of the Niagara Conference presentations beginning in 2007 (along with many other presentations at the CCF). Temporarily named the “Niagara in Miami” conference for two cycles to reflect its move to South Florida in 2011, the conference continues to be run under the name the Miami International Child and Adolescent Mental Health (MICAMH) Conference. MICAMH is run by the CCF (at Florida International University since 2010) on a biennial basis with support from SCCAP and The Children’s Trust (a Miami-Dade county-wide taxpayer initiative supporting programs that benefit children).
The format for FIU/CCF INDICES has been heavily modeled after the Niagara/MICAMH Conference, the goals of which have been twofold: (a) to present information on the state of the science for topics related to youth mental health, and (b) to provide a venue for hands-on skills-based clinical training in the latest evidence-based treatments. The first goal of the conference is accomplished with a series of 60-min plenary presentations (i.e., keynotes), during which a leading expert in the field provides a comprehensive review of the literature to date for a specific topic area (e.g., a review of evidence-based treatments for child abuse). To address the second goal of the conference, developers of EBPs lead interactive workshops designed to train practicing clinicians in specific interventions. One important aspect of the CCF’s involvement has been the creation of generic (nonbranded) treatment tools (e.g., daily report card templates) and generic workshops (e.g., parent-training manual) where participants are able to download or photocopy tools needed for sessions free of charge. Many of the keynote and workshop presentations filmed during 2011, 2013, and 2015 Niagara Conferences are available as online resources on the FIU/CCF INDICES website (www.indices4kids.com).
Another aspect of FIU/CCF INDICES that has been modeled from the conference is its intent to be relevant to the diverse array practitioners, in field of study and level of experience, that serve child mental health. The Niagara/MICAMH Conference has always been interdisciplinary, with invited presenters from fields such as clinical psychology, social work, psychiatry, social psychology, education, and school psychology. To date the conference has typically drawn 250–350 attendees per year, who are mostly local clinicians, representing a variety of fields such as social work, mental health counseling, foster care, school psychology, and clinical psychology. Satisfaction ratings indicate that the conferences are well received by attendees and there have been a large number of repeat attendees over the years. A more recent and systematic evaluation of the conference found that the majority of attendees identified with cognitive, behavioral, or cognitive-behavioral orientations and chose to attend because they were interested in the updated information (Pelham & Kuriyan, Citation2012). At a 3-month postconference follow-up assessment, the majority of attendees reported using the skills that they had learned at the conference with about half of their relevant clients (Kuriyan & Pelham, Citation2012). Although this has been encouraging, many attendees also report feeling that they did not have enough time to implement techniques learned at the conference in their daily practice (Pelham & Kuriyan, Citation2012). In conclusion, the conference has appeared to be a highly useful way to update practitioners who are already familiar with the set of therapies that are presented in the workshops and are already somewhat motivated to use evidence-based treatments.
Like journals, conferences also have limitations in their ability to spread information and facilitate change. Although hands-on skills-based workshops are provided at the Niagara/MICAMH Conference, variability in implementation has been apparent (Kuriyan & Pelham, Citation2012). Due to the self-report nature of the data gathered from the conference, the quality of implementation following the conference remains unknown. Moreover, although follow-up training was offered to conference attendees free of charge, no attendees elected to take advantage of this opportunity. A follow-up survey found that the two most cited reasons for not pursing follow-up training were lack of time and the feeling that they had enough training during the conference (Kuriyan & Pelham, Citation2012). Barriers such as the expense of attending a conference and the travel required for out-of-region attendees led SCCAP and the CCF to add Internet-based methods in its multimethod approach to dissemination of information about evidence-based therapies.
Description of FIU/CCF INDICES
In 2010, SCCAP and the Children’s Trust provided the CCF at FIU funds to develop a web-based video project, now known as FIU/CCF INDICES (www.indices4kids.com). In 2014, SCCAP elected to completely turn over the website’s future development and continued maintenance to the CCF at FIU.
Like the Niagara/MICAMH Conferences, the website videos have been designed to provide information and training on a variety of evidence-based treatments for child and adolescent mental health problems (see ). Important to note, FIU/CCF INDICES is not affiliated with one particular type of therapy but rather lets the evidence determine which programs are featured. This selection process allows for a diverse array of professionals to learn from different practice areas. For example, the section on treatment for depression includes two forms of evidence-based treatments: cognitive-behavioral therapy and interpersonal psychotherapy. In addition, the website contains information from a variety of disciplines (e.g., medicine, social work, and psychology) so that professionals from different disciplines treating the same children can use the same website to educate themselves on combined medication and psychosocial treatment options, fostering more fruitful collaborations among treating professionals. The website also describes evidence-based treatment options for a variety of settings such as school, in a professional’s office, at home, and in recreational settings.
Table 2. Videos currently available on the continually updated Florida International University/Center for Children and Families Internet Dissemination Initiative for Children’s Evidence-Based Services website.
The intent of FIU/CCF INDICES was to create videos at multiple levels of complexity such that the site would be useful to a wide audience (e.g., parents, clinicians, educators, paraprofessionals, university-based professionals, clinical trainees, and students). Multiple resources were used to review the quality of treatments for child and adolescent mental health problems, including the aforementioned Division 12 and Division 53 guidelines, to compile a list of treatments to be highlighted on the website and the foremost experts to present these treatments. Therefore, treatments that are included in FIU/CCF INDICES were carefully selected based on a peer review of the available research evidence and consensus decision processes. Additional resources used included review articles from the 2008 Journal of Clinical Child and Adolescent Psychology special issue on updates in EBPs and guidelines from the Association of Behavioral and Cognitive Therapy, Journal of Clinical Child and Adolescent Psychology Evidence Base Updates published in more recent years, National Registry of Evidence-based Programs and Practices, Substance Abuse and Mental Health Services Administration, and California Clearinghouse. A treatment was considered to have sufficient evidence if, at the time of consideration, it had multiple controlled trials (published or soon to be published in peer-reviewed journals), and/or a large body of single-case studies demonstrating treatment effectiveness. Accordingly, the research support of treatments presented on FIU/CCF INDICES roughly corresponds to Southam-Gerow and Prinstein’s (Citation2013) definitions of Level 1 (“Well-Established”), Level 2 (“Probably Efficacious”), and Level 3 (“Possibly Efficacious”) programs. Treatments at research support Level 4 (“Experimental Treatments,” “Unknown/Untested”) and Level 5 (“Tested but Did Not Work”) are not included on FIU/CCF INDICES. After identifying treatments that had sufficient scientific evidence, corresponding treatment developers and expert treatment evaluators were invited to volunteer their time to film videos at the CCF at FIU. To ensure high quality for the actual presentation, presenters were given guidelines for developing the online workshop content and were asked to submit all materials prior to the filming to allow revision. All content and materials were thoroughly reviewed prior to the filming and scrutinized for accordance with scientific standards and a rigorous evidence base. Videos on a variety of mental health issues were covered, such as attention-deficit/hyperactivity disorder, suicide, autism, dealing with divorce, eating disorders, and many more. Three types of videos were created: parent videos, keynote overviews, and clinical workshops.
Informational videos for parents each consist of a brief interview with a leading expert on a particular topic that covers a description of the disorder/problem, how to decide if a child needs treatment, and a description of evidence-based treatment options. These videos are typically only 10 min or less in length, include links to additional resources, and are available with Spanish-language subtitles. To date, more than 20 interviews with the experts have been filmed and cover topics such as suicide, divorce, anxiety, and bipolar disorder. All of the videos for parents are available free of charge.
The keynote videos are for anyone seeking more of an overview of information about the evidence base for different treatment options for a particular disorder or mental health issue. In a 1-hr video, experts describe the research base for interventions for a particular mental health problem, identify and describe the components of EBPs for the problem, and discuss future directions for research. For example, a keynote on child abuse reviews basic information about child abuse, describes four family-focused interventions, and describes the research basis for each intervention. The keynote videos on the FIU/CCF INDICES website are all free and accessible to the general public. Keynote videos cover specific disorders as well as other special topics, such as the effectiveness of school mental health programs, theoretical underpinnings of cognitive-behavioral therapy for anxiety, bullying, how to get fathers involved in treatment, and many others. At the end of each keynote video, additional resources are provided, such as links to helpful websites, a list of relevant journal articles, and a full reference list from the presentation. These videos are also available on YouTube as INDICES 4 KIDS (https://www.youtube.com/c/INCIDES4KIDSFIUCCF).
Finally, the website also contains in-depth videos of intensive skills-based workshops geared toward professionals that vary in length from 2 to 10 hr. Workshops are provided at a low cost (exact cost varies by length) to support website maintenance and the ability to offer continuing education credit. In these workshops, treatment developers or related experts demonstrate how to use and implement particular treatment techniques. Workshops were filmed with a live audience. Audience members consisted of graduate students, psychologists of varying levels of expertise, social workers, counselors, school mental health professionals, and many others in related mental health fields. All workshop courses contain a downloadable version of the slides used by the presenter and links to additional resources. Some workshop courses even contain downloadable treatment materials such as a therapy manual, patient handouts, and worksheets to be used in session. The additional resource links provided within the workshop course include links to related websites, relevant journal articles, and links to available manuals. The courses are self-paced and contain generic (e.g., general parent training) as well as commercial (e.g., Parent–Child Interaction Therapy) treatment modules. Without the cost of travel or the cost of hiring a professional presenter, these videos reduce expenses for mental health agencies and related constituencies (e.g., schools and hospitals) to obtain training from the foremost experts in the field of clinical child and adolescent psychology.
Projects examining the impact of FIU/CCF INDICES have yielded some basic information about the usability of the website for online training. Chu, Carpenter, Wyszynski, Conklin, and Comer (Citation2015) utilized an online workshop in a study that examined the effects of the workshop plus three different options for extended contact: peer consultation, Internet-streaming videos of expert-led supervision, and fact sheets. Following the online workshop, participants indicated satisfaction with the workshop, but there were no changes in CBT knowledge (Chu et al., Citation2015). Following the extended contact, all three study conditions produced similar results for self-reported use of skills. Fenley and colleagues (Fenley et al., Citation2015; Fenley et al., Citation2016) examined self-reported skill use and satisfaction immediately after watching a workshop and at a 3-month follow-up with an ethnically and professionally diverse range of individuals who self-enrolled in an online workshop. Consistent with Chu and colleagues, Fenley and colleagues (Fenley et al., Citation2015; Fenley et al., Citation2016) found that users were highly satisfied with the workshops and rated the treatments described in the workshops as highly acceptable. Ninety-six participants responded to the survey immediately following the workshop, with the majority indicating that they learned new skills and felt that the courses should be maintained online, which held true across theoretical orientations, professional practice settings, and levels of education (Fenley et al., Citation2015). Furthermore, 3 months later, professionals’ positive attitudes were maintained, but to a slightly lesser degree (Fenley et al., Citation2016). In addition, Google Analytics data demonstrate that users from nearly 5,000 different cities around the world have visited the website. Both the website and the YouTube channel average more than 1,000 views per month.
To date, the studies conducted using INDICES suggest that the online courses are not sufficient to engender change in therapeutic practices. However, the online courses are a palatable training option for a broad audience of youth-serving professionals and have the ability to influence provider attitudes over the long term. Therefore, the online courses have the potential to contribute to training in EBPs for many professionals both locally and internationally and reach a truly global professional audience.
Website applications
The FIU/CCF INDICES keynote videos, parent videos, and workshops can be used in many ways to improve clinical practice and enhance training and teaching in children’s mental health. In the next section, specific suggestions for maximizing the utility of the website are provided for those in training, supervision, and/or teaching roles, as well as those in clinical practice.
Training
In academic settings, the videos on the website can easily be utilized in both undergraduate and graduate courses. No longer are psychology departments restricted by the specific expertise found in their own universities; the online education website allows everyone “access” to the field’s leading experts. Training programs can refer their students to the videos, particularly when their department does not have an expert in a specific area of child psychology. Furthermore, instructors can utilize the accompanying reference lists to build syllabi or recommend readings to students. Professors may find that the videos are useful as multimedia content to enhance didactic lectures. The keynote videos that cover general topics in mental health, such as the importance of evidence-based treatments or the effects of bullying, may incite discussion and enhance a didactic lecture in either undergraduate- or graduate-level classes. Those in charge of clinical training or supervision will find the keynote videos on the specific disorders an efficient way to provide a comprehensive literature review. Students who have difficulty sifting through meta-analyses or lengthy review journal articles may find that keynote videos facilitate their understanding of the material. For example, an instructor could assign the most recent evidence base update on eating disorder treatment (Lock, Citation2015) and refer students to the keynote video on eating disorders, thereby accommodating different learning styles.
Most graduate, internship, and postdoctoral residency/fellowship programs include some type of educational colloquium series, which often includes invited speakers. However, programs vary considerably in the funds available to invite out-of-town speakers. Keynote and workshop videos can contribute rich content for programs that do not have easy access to professionals who are willing to present regularly, or do not have access to someone with expertise in an area of interest. With the aid of a discussion facilitator, the workshop and keynote videos may create an opportunity to encourage trainees to reflect on different treatment techniques and expand their knowledge of the literature.
Workshop videos can also be useful for demonstrating therapeutic techniques during practicum or supervision experiences. Workshop videos include role-plays, case illustrations, and examples of therapeutic games and activities to use in group and individual sessions. For example, the workshop on cognitive-behavioral strategies for adolescent depression contains a full downloadable treatment manual with handouts and worksheets to be used in-session. Supervisors can follow the workshop video as a guide and actually have their trainees complete the workshop activities (e.g., role-plays) during supervision and provide feedback. In fact, a blended supervision model that uses videos and live-practice would enable students to engage in didactic training via the videos, allowing more time for active skill building in supervision sessions. Last, trainees may also find the parent video interviews with experts useful, as these interviews represent an excellent model for trainees to learn how to explain mental health topics in lay language.
One example of successful integration of the online courses into graduate training is the Professional Counseling Psychology Masters Program at FIU. Since 2013, the Professional Counseling Psychology program has purchased site licenses for all 1st-year students, providing more than 70 students with access to more than 160 hr of online training in EBPs. Instructors have incorporated keynotes and workshops into coursework by assigning students specific courses for homework and holding class discussions. To encourage students to explore individual interests, students can also receive credit for completing online courses of their choice. In addition, practicum supervisors have used the online workshops to train students in particular therapeutic techniques and protocols to be implemented during their practicum experience. For example, one supervisor who oversees student implementation of the Coping Power Program (Lochman, Wells, & Lenhart, Citation2008) at a local elementary school has used the corresponding online workshop to train students. In addition to the online workshop, the supervisor has used keynote addresses on externalizing behavior problems to provide practicum students with an overview of the state of the literature and introduction to the interventions.
Clinical practice
Clinicians may find the online education website most useful for obtaining continuing education credits in exchange for watching the keynote and workshop videos. To date, nearly 600 mental health professionals have sought continuing education credit from the online workshops. In addition, the Children’s Trust of Miami-Dade County has purchased a collection of bulk workshop packages and all-access passes with the goal of making the materials and training available to the large number of agencies that it funds. To date, these materials have been made available to more than 200 mental health professionals, and ratings of the training experience have been quite positive. On the postworkshop survey, 90% of attendees reported that they learned new information, 76% indicated that the course exceeded their expectations, and 74% endorsed that the course should be offered again. However, there are other ways that the videos can be integrated into clinical practice. Mental health professionals, advocacy groups, and community resource centers could easily use these videos as an engaging educational tool for the families they support. Clinicians can refer parents to the parent videos for those who want additional resources or want to share information with others. Keynote videos can be useful for parents who are interested in more in-depth information about a particular mental health topic.
The workshop videos offer up to 10 hr of continuing education for viewing one workshop. The convenience of not having to travel to a workshop may be appealing, especially for professionals who have to use their own resources to attend workshops. Clinicians who are looking for further training may find that watching the online workshops is a useful way to sample different treatment approaches before deciding to commit additional resources to training. It can be especially challenging to treat patients who have less prevalent disorders (e.g., bipolar disorder in children and Tourette’s syndrome), and the workshop videos may be a convenient way to become reacquainted with less frequently used treatment techniques. Depending on the professional’s previous training experiences, additional training/consultation may be necessary to fully implement the treatment with fidelity. Even though all workshops typically contain a didactic element, research on the effectiveness of didactic workshops show that workshops have a limited effect on changing behavior (Comer & Barlow, Citation2014; McHugh & Barlow, Citation2010). However, by making the didactic and most likely least effective portion of the implementation process available online, and therefore cheaper than a live workshop, the entire process of dissemination may become more efficient in that resources can instead be allocated to follow-up consultation and supervision. For example, a local community mental health agency received funding from the Children’s Trust to watch the online workshop on treating obsessive-compulsive disorder. The In-Service Training Director reported that watching the workshop stimulated interest among agency clinicians to learn more about evidence-based strategies for obsessive-compulsive disorder, prompting the director to bring in local CBT experts to lead a hands-on training as a follow-up to the online workshop. For those without access to local experts, each online workshop presenter provided contact information for further training, consultation, supervision, or general questions. All of the participating presenters indicated enthusiasm for providing follow-up services to interested individuals.
Concluding thoughts: The potential impact of online education
The Internet offers a highly promising avenue for the broad dissemination of knowledge about evidence-based children’s mental health practices to both professionals and the general public. Moreover, in contrast to published books, Internet techniques enable a more agile approach to dissemination, in which new information and breaking advances can be rapidly updated and incorporated into online materials with minimal disruption. Indeed, FIU/CCF INDICES is designed to be dynamic and updated frequently. Currently, roughly 10 new keynotes and workshops are in final stages of production to be added to the website, with additional keynotes, workshops, and parent videos scheduled for filming in the near future. In contrast to a desk reference or physical handbook on a shelf, when professionals and trainees access FIU/CCF INDICES, they can be assured that they are accessing the absolute latest evidence the field has to offer.
In addition to updating the FIU/CCF INDICES content, the development of innovative formats for presenting evidence-based mental health information is under way. In the future, shorter training modules modeled after the MATCH-ADTC protocol (Chorpita & Weisz, Citation2009) offering targeted training in specific techniques (e.g., praise, creating a fear hierarchy) will be available on the website. In addition, FIU/CCF INDICES is working with collaborators to develop user-friendly mobile applications that will make the information even more accessible and convenient. The continued web-based dissemination efforts of FIU/CCF INDICES aim to increase accessibility of high-quality, low-cost mental health materials to parents and to a broad range of youth-serving professionals.
Although online training in therapeutic techniques is a relatively new concept, there has been highly encouraging recent evidence supporting its utility in training therapists, particularly when coupled with additional training components that extend trainee contact with the material over continued periods. There have been several randomized controlled trials examining the utility of online training courses for clinicians. Collectively, the results indicate that online trainings can result in meaningfully increased knowledge, therapist self-efficacy, therapist readiness to change, and in some cases better use of skills (e.g., Dimeff et al., Citation2015; Dimeff et al., Citation2009; Harned, Dimeff, Woodcock, & Skutch, Citation2011; Sholomskas et al., Citation2005; Weingardt, Cucciare, Bellotti, & Lai, Citation2009). In addition, a recent review about online trainings for cognitive-behavioral therapy highlights the many advantages of online training and describes several existing training programs that have shown positive training effects (Khanna & Kendall, Citation2015). Although increasing access to high-quality resources may not always lead to improved practices, it may lead to increased awareness, knowledge, curiosity, and motivation to understand EBPs. There are a number training strategies (e.g., consultation, supervision, active learning activities, didactics, etc.) along with training formats (e.g., online, in-person, phone based) that could be combined to design tailored training programs. Future research should examine methods to create the most efficient, economical, effective, and satisfactory training experience for a given population.
FIU/CCF plans to develop online training modules that are more directly in line with evidence-based training strategies. Broadly, research indicates that strategies that involve active learning and allow for extended contact with the material over time may be critical to extending and maintaining behavior change (Herschell, Kolko, Baumann, & Davis, Citation2010; Lyon, Stirman, Kerns, & Bruns, Citation2011). However, it may be difficult to engage mental health professionals in lengthy training programs due to cost and time commitment (McMillen, Hawley, & Proctor, Citation2016). Furthermore, despite the potential benefits of online training, participating in an online course may not be for everyone. As noted by Khanna and Kendall (Citation2015), challenges to participating in online trainings such as low computer/Internet fluency, poor Internet connection, and low motivation to engage in self-study impact the effectiveness of an online training program. Therefore, simply providing access to low-cost, high-quality online training programs may not alone be sufficient to effect change in behavior. Other changes, such as including accountability procedures for completing training in EBPs, creating a system that allows mental health professionals to take part in nonbillable activities, and changing attitudes toward active-learning strategies may need to take place (McMillen et al., Citation2016). Moreover, we plan to incorporate more user-centered designs and incorporate feedback from nonpsychology stakeholders to optimally inform future iterations of the FIU/CCF INDICES program and enhance user engagement.
The present article provided practical recommendations for the use of FIU/CCF INDICES along with a summary of the development of the online education website on child and adolescent mental health. Perhaps the most important aspect of the FIU/CCF INDICES resource is that people who use the website can feel confident that they are accessing a legitimate resource with research-based information free from commercial interests. The online education website is already being used by community mental health agencies, individual clinicians, and universities for training purposes. Future plans for the website include creating workshops based on a modular approach and developing mobile applications. It is the hope that the online education website as a purely research-based, nonprofit, multidisciplinary resource will facilitate lifelong learning for the highly diverse array of professionals collectively working to improve children’s mental health.
References
- American Psychological Association, Division of Clinical Psychology, Task Force on Promotion and Dissemination of Psychological Procedures. (1995). Training in and dissemination of empirically-validated psychological treatments: Report and recommendations. The Clinical Psychologist, 48, 3–23.
- Barlow, D. H. (2000). Evidence-based practice: A world view. Clinical Psychology: Science and Practice, 7, 241–242.
- Barlow, D. H., Bullis, J. R., Comer, J. S., & Armetaj, A. A. (2013). Evidence-based psychological treatments: An update and the way forward. Annual Review of Clinical Psychology, 9, 1–27.
- Birnbaum, H. G., Kessler, R. C., Kelley, D., Ben-Hamadi, R., Joish, V. N., & Greenberg, P. E. (2010). Employer burden of mild, moderate, and severe major depressive disorder: Mental health services utilization and costs, and work performance. Depression and Anxiety, 27, 78–89.
- Chambless, D. L., & Ollendick, T. H. (2001). Empirically supported psychological interventions: Controversies and evidence. Annual Review of Psychology, 52, 685–716.
- Chorpita, B. F., & Weisz, J. R. (2009). MATCH-ADTC: Modular approach to therapy for children with anxiety, trauma, or conduct problems. Satellite Beach, FL: PracticeWise, LLC.
- Chu, B. C., Carpenter, A. L., Wyszynski, C., Conklin, P., & Comer, J. S. (2015). Scalable options for extended skill building following didactic training in cognitive-behavioral therapy for anxious youth: A pilot randomized trial. Journal of Clinical Child and Adolescent Psychology. Advance online publication. doi:10.1080/15374416.2015.1038825
- Comer, J. S., & Barlow, D. H. (2014). The occasional case against broad dissemination and implementation: Retaining a role for specialty care in the delivery of psychological treatments. American Psychologist, 69, 1–18.
- Comer, J. S., Blanco, C., Grant, B., Hasin, D., Liu, S. M., Turner, J. B., & Olfson, M. (2011). Health-related quality of life across the anxiety disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry, 72, 43–50.
- Dimeff, L. A., Harned, M. S., Woodcock, E. A. & Skutch, J. M. (2015). Investigating bang for your training buck: A randomized controlled trial comparing three methods of training clinicians in two core strategies of dialectical behavior therapy. Behavior Therapy, 46, 283–295.
- Dimeff, L. A., Koerner, K., Woodcock, E. A., Beadnell, B., Brown, M. Z., Skutch, J. M., … Harned, M. S. (2009). Which training method works best? A randomized controlled trial comparing three methods of training clinicians in dialectical behavior therapy skills. Behaviour Research and Therapy, 47, 921–930.
- Fenley, A., Wyszynski, C. M., Toffey, K. L., Comer, J. S., Kuriyan, A., Altszuler, A. R., … Chu, B.C. (2015, November). Professional profiles and satisfaction results from a large Internet-based continuing education dissemination effort. Poster presented at the annual convention of the Association for Behavioral and Cognitive Therapies, Chicago, IL.
- Fenley, A., Wyszynski, C., Toffey, K., Comer, J., Kuriyan, A., Altszuler, A., … Chu, B. (2016, October). Long-term satisfaction and impact of web-based training: 3-month and 1-year follow-up of a large Internet-based continuing education dissemination effort. Poster presented at the annual convention of the Association for Behavioral and Cognitive Therapies, New York, NY.
- Gallo, K. P., & Barlow, D. H. (2012). Factors involved in clinician adoption and nonadoption of evidence-based interventions in mental health. Clinical Psychology: Science and Practice, 19, 93–106.
- Gallo, K. P., Comer, J. S., & Barlow, D. H. (2013). Direct-to-consumer marketing of psychological treatments for anxiety disorders. Journal of Anxiety Disorders, 27, 793–801.
- Gallo, K. P., Comer, J. S., Barlow, D. H., Clarke, R. N., & Antony, M. N. (2015). Direct-to-consumer marketing of psychological treatments: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 83, 994–998.
- Greenberg, P. E., Sisitsky, T., Kessler, R. C., Finkelstein, S. N., Berndt, E. R., Davidson, J. R., … Fyer, A. J. (1999). The economic burden of anxiety disorders in the 1990s. Journal of Clinical Psychiatry, 60, 427–435. doi:10.4088/JCP.v60n0702
- Harned, M. S., Dimeff, L. A.,Woodcock, E. A., & Skutch, J. M. (2011). Overcoming barriers to disseminating exposure therapies for anxiety disorders: A pilot randomized controlled trial of training methods. Journal of Anxiety Disorders, 25, 155–163.
- Herschell, A. D., Kolko, D. J., Baumann, B. K., & Davis, A. C. (2010). The role of therapist training in the implementation of psychosocial treatments: A review and critique with recommendations. Clinical Psychology Review, 20, 448–466.
- Hoagwood, K., Olin, S., & Cleek, A. (2013). Beyond context to the skyline: Thinking in 3D. Administration and Policy in Mental Health and Mental Health Services Research, 40, 23–28.
- Kazak, A. E., Hoagwood, K., Weisz, J. R., Hood, K., Kratochwill, T. R., Vargas, L. A., & Banez, G. A. (2010). A meta-systems approach to evidence-based practice for children and adolescents. American Psychologist, 65, 85–97.
- Kazdin, A. E., & Blasé, S. L. (2011). Rebooting psychotherapy research and practice to reduce the burden of mental illness. Perspectives on Psychological Science, 6, 21–37. doi:10.1177/1745691610393527
- Kessler, R. C., Akiskal, H. S., Ames, M., Birnbaum, H., Greenberg, P., Hirschfeld, R. A., … Wang, P. S. (2006). Prevalence and effects of mood disorders on work performance in a nationally representative sample of U.S. workers. American Journal of Psychiatry, 163, 1561–1568.
- Kessler, R. C., Chiu, W., Demler, O., & Walters, E. E. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 617–627.
- Khanna, M. S., & Kendall, P. C. (2015). Bringing technology to training: Web-based therapist training to promote the development of competent cognitive-behavioral therapists. Cognitive and Behavioral Practice, 22, 291–301.
- Kuriyan, A., & Pelham, W.E. (2012, November). Motivation and implementation of skills after a conference on evidence-based treatments for youth mental health. Poster presented at the annual meeting of the Association for Cognitive and Behavioral Therapies, Washington, DC.
- Lochman, J. E., Wells, K., & Lenhart, L. (2008). Coping power: Child group facilitator’s guide. New York, NY: Oxford University Press.
- Lock, J. (2015). An update on evidence-based psychosocial treatments for eating disorders in children and adolescents. Journal of Clinical Child and Adolescent Psychology, 44, 707–721.
- Lonigan, C. J., Elbert, J. C., & Johnson, S. B. (1998). Empirically supported psychosocial interventions for children: An overview. Journal of Clinical Child Psychology, 27, 138–145.
- Lyon, A. R., Stirman, S. W., Kerns, S. E., & Bruns, E. J. (2011). Developing the mental health workforce: Review and application of training approaches from multiple disciplines. Administration and Policy in Mental Health and Mental Health Services Research, 38, 238–253.
- McHugh, R. K., & Barlow, D. H. (2010). The dissemination and implementation of evidence-based psychological treatments. American Psychologist, 65, 73–84.
- McMillen, J. C., Hawley, K. M., & Proctor, E. K. (2016). Mental health clinicians’ participation in web-based training for an evidence supported intervention: Signs of encouragement and trouble ahead. Administration and Policy in Mental Health and Mental Health Services Research, 43, 592–603.
- Merikangas, K. R., Ames, M., Cui, L., Stang, P. E., Ustun, T., Von Korff, M., & Kessler, R. C. (2007). The impact of comorbidity of mental and physical conditions on role disability in the US adult household population. Archives of General Psychiatry, 64, 1180–1188.
- Neimeyer, G. J., Taylor, J. M., & Rozensky, R. H. (2012). The diminishing durability of knowledge in professional psychology: A Delphi Poll of specialties and proficiencies. Professional Psychology: Research and Practice, 43, 364–371.
- Olfson, M., & Marcus, S. C. (2010). National trends in outpatient psychotherapy. The American Journal of Psychiatry, 167, 1456–1463. doi:10.1176/appi.ajp.2010.10040570
- Patient Protection and Affordable Care Act, 42 U.S.C. § 18001 (2010).
- Pelham, W. E., & Kuriyan, A. B. (2012, August). Disseminating EBPs for child and adolescent mental health: A web-based initiative. Symposium presented at the annual meeting of the American Psychological Association, Orlando, FL.
- Sholomskas, D. E., Syracuse-Siewert, G., Rounsaville, B. J., Ball, S. A., Nuro, K. F., & Carroll, K. M. (2005). We don’t train in vain: A dissemination trial of three strategies of training clinicians in cognitive-behavioral therapy. Journal of Consulting and Clinical Psychology, 73, 106–115.
- Southam-Gerow, M. A., & Prinstein, M. J. (2013). Evidence base updates: The evolution of the evaluation of psychological treatments for children and adolescents. Journal of Clinical Child and Adolescent Psychology, 43, 1–6.
- Weingardt, K. R., Cucciare, M. A., Bellotti, C., & Lai, W. P. (2009). A randomized trial comparing two models of web-based training in cognitive-behavioral therapy for substance abuse counselors. Journal of Substance Abuse Treatment, 37, 219–227.