Daniel W. Smith, Benjamin E. Saunders, Leticia L. Duvivier Department of Psychiatry and Behavioral Sciences Medical University of South Carolina Nicholas C. Heck Department of Psychology, Marquette University, Milwaukee

1. Daniel W. Smith1, Benjamin E. Saunders1, Nicholas C.
Heck2, & Leticia L. Duvivier1
1Department of Psychiatry and Behavioral Sciences
Medical University of South Carolina
Charleston, SC
2Department of Psychology, Marquette University
Milwaukee, WI
Presented at the BASPCAN Annual Congress, April 14, 2015, Edinburgh, Scotland UK
Online Training in Evidence-Based
Trauma Treatments: Lessons from
TFCBTWeb and CTGWeb

2. Disseminating Evidence Supported
Mental Health Interventions
 Limited by a lack of training resources.
 Availability
 Accessibility
 Cost (actual costs, time, lost productivity)
 Effectiveness
 Spread and reach of ESIs constrained by training
capacity.
 Online training is a promising mechanism for building
training capability.
 Asynchronous
 Stand alone
 Unmonitored

3. Online Advantages
 Virtually universal access worldwide
 Flexibility, training can fit into therapists’ schedules
 Time efficient, less lost productivity
 Multi-media, interactive
 Immediate access to clinical tools and resources
 Can be accessed repeatedly

4. Online Disadvantages
 Static in presentation
 No interactivity with expert faculty
 Not all learners can engage with unmonitored online
learning.
 Expensive to construct
 Must be maintained
 Need for customer service

5. Questions
 Will target trainees (therapists) engage with online
training?
 How effective are online training resources in…
 helping learners acquire knowledge of the treatment?
 helping learners develop clinical skills?
 promoting implementation with fidelity
 encouraging regular use of the treatment with appropriate
patients?
 promoting sustained use of the treatment over time?
 Are online training tools cost effective?

6. TF-CBTWeb is a
web-based,
distance education
training course for
learning Trauma-
Focused Cognitive-
Behavioral Therapy
(TF-CBT).
TF-CBTWeb
www.musc.edu/tfcbt
Launched on
October 1, 2005

7. Each module has:
•Concise explanations
•Video demonstrations
•Clinical scripts
•Cultural considerations
•Clinical Challenges
•4-item pre/post
knowledge tests
TF-CBTWeb
www.musc.edu/tfcbt
TF-CBTWeb was developed through grant No. 1-UD1-SM56070 from
the Substance Abuse and Mental Health Services Administration of the
U.S. Department of Health and Human Services.

8. CTGWeb is a follow-
up course that
teaches how to
apply TF-CBT to
cases of child
traumatic grief
CTGWeb
www.musc.edu/ctg
CTGWeb is
offered free
of charge.
CTGWeb was launched on September 1, 2008.
6 hours of CE

9. What do we know about how these
things work?
Our basic questions:
If we build it, will they come?
If they come, will they:
 Learn it?
 Like it?

10. TF-CBTWeb Learners
From October 1, 2005 to September 30, 2012:
 TF-CBTWeb had 123,848 unique registered
learners.
 About 40 learners registered for TF-CBTWeb each
day.
 10,197 (8.9%) learners lived outside the U.S.
and its territories
 130 countries represented, Albania to Zimbabwe.
 Most learners were from countries where English is
prevalent.
Heck, N., Saunders, B. E., & Smith, D. W. (in press). Web-based training for an evidence-supported
treatment: Training completion and knowledge acquisition in a global sample of learners. Child
Maltreatment.

11. TF-CBTWeb
Academic Degrees of Learners
Graduate
Student
15.6%
Masters
74.1%
Ph.D.
8.5%
MD
1.8%
N = 123,848

12. TF-CBTWeb
Learners’ Professions
17.5%
41.0%
26.4%
9.0%
0.9%
1.8%
3.4%
Psychology
Social Work
Counseling
M/F Therapy
Nursing
Psychiatry
Other
N=123,848

13. 62.7% 19.6% 12.1% 5.6%
<5 years
5-10 years
10-20 years
>20 years
TF-CBTWeb
Experience with Traumatized Children
N=123,848

14. TF-CBTWeb
Registration and Completion Results
Learners All U.S.1
Outside
U.S.
Registered 123,848 113,651 10,197
Completed2
(by 12/31/12)
67,208
(54.3%)
64,427
(56.7%)
2,781
(27.3%)
1Includes learners living in the U.S. and U.S. military and Department
of Defense employed personnel living outside the U.S.
2We are modifying the way we calculate completion rates.

15. TF-CBTWeb
Days to Complete Course
71.8 (188) Mean (SD) days to complete course
2,545 days
Longest number of days to complete
course
1 day
Shortest number of days to complete
course (mode)
11 days 50% of completers finish within
43 days 75% of completers finish within
N=67,208

16. TF-CBTWeb
Mean Pre- and Post-test Scores by Module
0
10
20
30
40
50
60
70
80
90
100
MeanScore
Course Module
Post-test
Pre-test
N = 67,208; All differences p<.001. Cohen’s d range: .54 – 1.22

17. Learner Evaluation of TF-CBTWeb
63.0%
55.2% 51.1%
57.8% 50.9% 55.4%
45.0%
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
Easy
Navigation
Easy to
Learn
Good Look &
Feel
Clear
Directions
Videos
Helped
Scripts
Practical
Clinical
Challenges
Str.Dis+Disagree Agree Strongly Agree
66,497 Evaluations
Heck, N., Saunders, B. E., & Smith, D. W. (2015). Satisfaction and usage patterns of a web-based
training course for an evidence-supported treatment. Manuscript in preparation.

18. Learner Evaluation of TF-CBTWeb
33.5% 55.6%
45.9% 49.5% 45.3% 48.3%
54.1%
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
Cultural
Helpful
Techniques
Helpful
Learn
PsychoEd
Learn Stress
Management
Learn Affect Cognitive
Coping
Trauma
Narrative
Str.Dis+Disagree Agree Strongly Agree
66,497 Evaluations

19. Learner Evaluation of TF-CBTWeb
49.4% 46.5% 47.9%
33.8%
39.9% 43.3%
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
Cognitive
Processing
Behavior
Management
Engage Parents Appropriate
Clients
Appropriate
Problems
Will Use TF-
CBT
Str.Dis+Disagree Agree Strongly Agree
66,497 Evaluations
Total Satisfaction Score: M = 3.43 (.51)

20. Learner Attrition : Modules 1-5
0
20000
40000
60000
80000
100000
120000
140000
-25,203
-8,783
n=123,848 n=75,754
Module Pre- Post-test Completion
-4,835

21. Learner Attrition: Modules 6-10
20000
40000
60000
80000
100000
120000
140000
n=74,252 n=67,208
68% retention from Pre-1
79% retention from Pre-2
91% retention from Pre-6
Module Pre- Post-test Completion

22. CTGWeb Learners
From January 1, 2009 to September 1, 2013:
 TF-CBTWeb had 11,871 unique registered
learners.
 About 7 learners registered for CTGWeb each day.
 713 (6.0%) learners lived outside the U.S. and
its territories
 74 countries represented
 Australia (81), Germany, Japan, UK, Israel, Kenya,
Sweden, Norway/Singapore (10)

23. CTGWeb
Academic Degrees of Learners
Graduate
Student
16.6%
Masters
76.4%
Ph.D.
6.0%
MD
1.0%
N = 11,871

24. TF-CBTWeb
Learners’ Professions
14.8%
40.6%
29.5%
10.2%
2.9%
0.9%
0.8%
Psychology
Social Work
Counseling
M/F Therapy
Nursing
Psychiatry
Other
N=11,871

25. 67.8% 18.0% 10.1% 3.9%
<5 years
5-10 years
10-20 years
>20 years
CTGWeb
Experience with Traumatized Children
N=11,871

26. CTGWeb
Registration and Completion Results
Learners All U.S.1
Outside
U.S.
Registered 11,871 11,158 713
Completed
8,825
(74.3%)
8,390
(75.2%)
435
(61.0%)
1Includes learners living in the U.S. and U.S. military and Department
of Defense employed personnel living outside the U.S.

27. CTGWeb
Mean Pre- and Post-test Scores by Module
40
50
60
70
80
90
100
MeanScore
Course Module
Post-test
Pre-test
N = 8,825; All differences p<.001. Cohen’s d range: .20 – .89

28. Conclusions
 Our basic questions:
 If we build it, will they come? – YES – and in much higher numbers than
we anticipated.
 If they come, will they:
 Like it? – Overwhelmingly they do
 Learn it?
 Knowledge: yes
 Skill: no idea yet
 Though costly to construct (we estimate $250K per course), per use
cost decreases over time, making online training a cost-effective
training mechanism.
 As of 2014, we had over 120K TFCBTWeb completers, so it’s ~$2 + change per
learner
 How does online learning compare to in-person? Is the combination
better than either alone?
 Under preliminary study (Cohen, Mannarino, & Deblinger)

29. Collaborator Acknowledgment
 TF-CBTWeb (2005)
 CTGWeb (2008)
Saunders Deblinger Cohen Mannarino
Saunders Deblinger Cohen Mannarino Goodman