Remote Mental Health Training for Mental Illness

Overseen By Jessica Goldstein, MPH

Age: Any Age

Sex: Any

Trial Phase: Academic

Sponsor: Children's Hospital of Philadelphia

Disqualifiers: Intellectual disability, Developmental delays, Psychotic disorders, Autistic spectrum, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 1

408 Participants Needed

Trial Summary

What is the purpose of this trial?

An increasing number of schools in rural settings are employing the multi-tier positive behavioral interventions and supports (PBIS) framework to improve school-climate. PBIS can also be used as a framework for the adoption and integration of evidence-based practices (EBPs) for children's mental health concerns. A key challenge is that school personnel need technical assistance (training plus ongoing consultation) in order to implement EBPs with fidelity. In urban and suburban schools, this support can be provided to school staff on site. However, providing ongoing on-site support is not feasible or sustainable in the majority of rural schools, due to their remote physical location. For this reason, video technology has been recommended for the training of behavioral health staff (BHS) in under-served rural communities.

Will I have to stop taking my current medications?

The trial information does not specify whether participants need to stop taking their current medications.

What data supports the effectiveness of the treatment Remote Mental Health Training for Mental Illness?

Research shows that cognitive behavioral therapy (CBT), which is part of the treatment, is effective for anxiety and depression. The English IAPT service, which uses CBT, reports symptom improvement in 98% of patients. Additionally, internet-delivered CBT has been shown to improve access to mental health care for students. ^{1 2 3 4 5}

Is remote mental health training generally safe for humans?

The research on computerized cognitive behavioral therapy (cCBT) suggests it is generally acceptable and effective, especially for youth, but specific safety data is limited. No significant safety concerns have been reported in the studies available. ^{2 4 6 7 8}

How is the Remote Mental Health Training for Mental Illness treatment unique for anxiety?

This treatment is unique because it combines various components like CBT for Anxiety Treatment in Schools (CATS) and Coping Power Program (CPP) with remote training methods, making it accessible for those in rural or remote areas where traditional therapy is hard to access. It also includes innovative elements like video and coaching to enhance the initial training, which can improve engagement and outcomes. ^{2 3 9 10 11}

Research Team

Ricardo Eiraldi, PhD

Principal Investigator

Children's Hospital of Philadelphia

Eligibility Criteria

This trial is for counselors, social workers, or teachers from schools using PBIS with students in grades 4-8. Principals and assistant principals can also participate. Students eligible are those attending these schools who need extra support after Tier 1 intervention and score high on the SDQ for emotional or conduct issues.

Inclusion Criteria

I am a student in grades 4-8, not helped by initial school support, and scored high on a behavior or emotional test.

Behavioral Health Staff: Any counselor, social worker, or teacher from participating schools implementing PBIS who work with students in grades 4-8

Administrator: Any school principal or assistant principal from participating schools implementing PBIS

Exclusion Criteria

Students: Students who do not meet screening or group participation criteria, students with a history of intellectual disability or serious developmental delays according to school records, students with a history of psychotic or autistic spectrum disorders as reported by parents

Administrator: School staff who are not principals or assistant principals

Behavioral Health Staff: School staff who are not part of the PBIS team and who do not work with students in grades 4-8

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Initial Training

School personnel participate in an initial live remote training to learn about implementing the three EBPs

2 weeks

1 visit (virtual)

Remote Video Training

School personnel receive access to asynchronous video training modules about the EBPs

4 weeks

Ongoing access (virtual)

Remote Video Training plus Coaching

School personnel receive coaching support by study staff regarding the implementation of EBPs

4 weeks

Weekly sessions (virtual)

Follow-up

Participants are monitored for fidelity and effectiveness of the interventions

Up to 3 years

Treatment Details

Interventions

• CBT for Anxiety Treatment in Schools (CATS)
• Check-in/Check-out (CI/CO)
• Coping Power Program (CPP)
• Initial Training (CC)
• Initial Training plus Video plus Coaching (RV+)
• Initial Training plus Video (RV)

Trial Overview The study tests a remote training strategy to help school staff implement mental health practices effectively. It compares initial training alone (CC), with added video (RV), and both plus coaching (RV+). Interventions include CPP, CATS, and CI/CO within a PBIS framework.

Participant Groups

Group I: Initial training plus video, plus coaching Experimental Treatment 4 Interventions

School personnel will implement CATS or CPP and CICO with students in the school setting. They will participate in an initial live remote training, receive access to asynchronous video training modules about the EBPs, and receive coaching support by study staff (RV+). The coaching will be from a study consultant regarding the implementation of EBPs.

Group II: Initial training plus video Experimental Treatment 4 Interventions

School personnel will implement CATS or CPP and CICO with students in the school setting. They will participate in an initial live remote training and receive access to asynchronous video training modules about the EBPs (RV).

Group III: Initial training Active Control 4 Interventions

School personnel will implement CATS or CPP and CICO with students in the school setting. They will participate in an initial live remote training to learn about implementing the three EBPs (CC).

Who Is Running the Clinical Trial?

Children's Hospital of Philadelphia

Lead Sponsor

Trials

749

Recruited

11,400,000+

Devereux Center for Effective Schools

Collaborator

Trials

3

Recruited

1,200+

Agency for Healthcare Research and Quality (AHRQ)

Collaborator

Trials

415

Recruited

6,777,000+

Findings from Research

The Improving Access to Psychological Therapies (IAPT) service in the UK effectively monitors and reports clinical outcomes for over 537,000 patients annually, revealing that specific organizational factors, such as the number of treatment sessions and timely access to care, significantly predict better mental health outcomes.

Improvements in service organization could enhance clinical outcomes by 11-42%, indicating that how psychological therapies are delivered is as crucial as the treatments themselves, and this model could be beneficial for mental health services globally.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Transparency about the outcomes of mental health services (IAPT approach): an analysis of public data. Clark, DM., Canvin, L., Green, J., et al.[2023]

In a study involving 308 postsecondary students undergoing internet-delivered cognitive behavioral therapy (ICBT), 54% completed the treatment, showing significant improvements in depression and anxiety symptoms that were sustained at 1 and 3 months post-treatment.

While motivational interviewing (MI) before treatment did not enhance completion rates, students who accessed self-guided booster lessons after treatment experienced greater reductions in depressive symptoms, suggesting that timing and support for boosters may be crucial for effectiveness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Internet-Delivered Cognitive Behavioral Therapy for Postsecondary Students: Randomized Factorial Trial for Examining Motivational Interviewing and Booster Lessons. Peynenburg, V., Hadjistavropoulos, H., Thiessen, D., et al.[2022]

A large-scale controlled trial involving 2,745 children demonstrated that the 'Journey of the Brave' cognitive behavioural therapy (CBT)-based program significantly reduced anxiety symptoms in the intervention group compared to the control group.

The intervention group showed a mean reduction in anxiety scores of -4.91, while the control group had a reduction of -2.53, indicating that the program was effective in lowering anxiety levels among children.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Classroom-based cognitive behavioural therapy: a large-scale non-randomised controlled trial of the 'Journey of the Brave'. Urao, Y., Ohira, I., Koshiba, T., et al.[2021]

Cognitive Behavioral Therapy (CBT) is an effective treatment for youth anxiety, but there is a significant gap in access to this therapy, highlighting the need for flexible delivery methods.

The paper reviews various adaptations of CBT for youth anxiety, including delivery in schools, community settings, telehealth, online programs, and by caregivers, providing strategies to maintain treatment effectiveness while increasing accessibility.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Adapting CBT for youth anxiety: Flexibility, within fidelity, in different settings. Kendall, PC., Ney, JS., Maxwell, CA., et al.[2023]

Internet-based cognitive-behavioral therapy (CBT) is an effective self-help program that allows patients to receive psychological support via the Internet, making therapy more accessible, especially for those unable to attend traditional sessions.

This form of therapy has shown particular effectiveness in treating conditions like panic disorder, social phobia, and depression, indicating its potential to reach and help a wider range of individuals in need of mental health support.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Internet-based cognitive-behavioral therapy in the treatment of psychiatric disorders]. Holmberg, N., Kähkönen, S.[2022]

References

1. England pubmed.ncbi.nlm.nih.gov

Transparency about the outcomes of mental health services (IAPT approach): an analysis of public data. [2023]

2. United States pubmed.ncbi.nlm.nih.gov

Consumers' and providers' perceptions of utilizing a computer-assisted cognitive behavioral therapy for childhood anxiety. [2018]

3. Canada pubmed.ncbi.nlm.nih.gov

Internet-Delivered Cognitive Behavioral Therapy for Postsecondary Students: Randomized Factorial Trial for Examining Motivational Interviewing and Booster Lessons. [2022]

4. England pubmed.ncbi.nlm.nih.gov

Classroom-based cognitive behavioural therapy: a large-scale non-randomised controlled trial of the 'Journey of the Brave'. [2021]

5. England pubmed.ncbi.nlm.nih.gov

Computerised cognitive-behavioural therapy for depression in adolescents: 12-month outcomes of a UK randomised controlled trial pilot study. [2021]

6. England pubmed.ncbi.nlm.nih.gov

Using Computerized Mental Health Programs in Alternative Education: Understanding the Requirements of Students and Staff. [2022]

7. England pubmed.ncbi.nlm.nih.gov

Universal and targeted computerised cognitive behavioural therapy (Think, Feel, Do) for emotional health in schools: results from two exploratory studies. [2020]

8. Switzerland pubmed.ncbi.nlm.nih.gov

Adapting CBT for youth anxiety: Flexibility, within fidelity, in different settings. [2023]

9. Canada pubmed.ncbi.nlm.nih.gov

Computerized Cognitive Behavior Therapy for Anxiety and Depression in Rural Areas: A Systematic Review. [2018]

10. England pubmed.ncbi.nlm.nih.gov

The promise of online cognitive behavioural therapy training for rural and remote mental health professionals. [2018]

11. Finland pubmed.ncbi.nlm.nih.gov

[Internet-based cognitive-behavioral therapy in the treatment of psychiatric disorders]. [2022]