SMART Therapist Training: A Hybrid Factorial-SMART Design
NCT ID: NCT07010770
Last Updated: 2025-09-02
Study Results
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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RECRUITING
NA
240 participants
INTERVENTIONAL
2025-08-15
2030-08-30
Brief Summary
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The overall objective of this application is to empirically optimize an adaptive model for CPT training. The rationale is that developing an adaptive training model will improve efficiency and personalization, yield higher fidelity, and ultimately improve Veteran outcomes. We expect that completion of this project will produce an adaptive CPT training program that yields high therapist fidelity. Improving CPT fidelity in VHA will have a positive impact on the health and wellbeing of Veterans with PTSD.
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Detailed Description
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Significance: The number of VHA patients with a diagnosis of PTSD has steadily increased for the past 10 years, therefore improving VHA's capacity to deliver PTSD treatment is of utmost importance. This project aligns with the 2024 VHA priorities to connect Veterans to the best care and improve VHA workforce retention.
Innovation \& Impact: Upon successful completion of this project, we expect to contribute an empirically-based, adaptive training model for CPT. This contribution will improve therapist fidelity to CPT and ultimately yield superior clinical outcomes for Veterans with PTSD. The research is innovative because it will use a novel, highly efficient experimental design to shift the current CPT training paradigm from fixed, hard-to-scale strategies to a dynamic and accessible approach, composed of empirically-based components. Our specific aims are:
* Specific Aim 1: Identify which of two low-intensity training components contribute meaningfully to therapist fidelity. We will test the effectiveness of each component and their interaction, as measured by therapist fidelity ratings across 12 months.
* Specific Aim 2: For those with "fidelity in progress," determine whether stepping up to high-intensity consultation improves fidelity. We hypothesize that stepping up will lead to greater fidelity.
* Exploratory Aims: A) For those with "early fidelity," assess the impact of stepping down to self-monitoring versus continuing in standard consultation. B) Compare standard training and consultation to the embedded adaptive training strategies. C) Identify moderators. D) Conduct cost analysis and refine the program through process evaluation.
Methodology: This Hybrid Factorial-SMART will determine which of two low-intensity components (Web-based Training or Consultation Work-Sample Review) is most effective during the initial phase of CPT training. Those who have reached fidelity benchmarks at Month 4 ("early fidelity") will be re-randomized to Continue with standard consultation or Step Down to fidelity self-monitoring. Those not reaching fidelity at Month 4 ("fidelity in progress") will be re- randomized to Continue or Step Up to high-intensity consultation. Fidelity will be assessed by trained evaluators at baseline, 6, 9, \& 12 months via standardized patient exercise.
Conditions
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Study Design
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RANDOMIZED
FACTORIAL
1. Web-Based Training (WBT) + Consultation with Work-Sample Review (WR)
2. Web-Based Training (WBT) + Standard Consultation
3. Standard Training + Consultation with Work-Sample Review (WR)
4. Standard Training + Standard Consultation
After four months/one completed case, CPT fidelity will be assessed, and therapists who demonstrate inadequate fidelity/cannot be reached for assessment will be classified as demonstrating "fidelity in progress" and will be re-randomized to one of two second-stage tactics for the next two months:
1. Continue in standard consultation
2. Step up to high intensity consultation with biweekly session review.
Therapists who have achieved fidelity benchmarks will be classified as demonstrating "early fidelity" and will be re-randomized to one of two second-stage tactics for the next two months:
3. Continue in standard consultation
4. Step down to fidelity self-monitoring
OTHER
SINGLE
Study Groups
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Condition 1-A
Web-Based Training (WBT) + Work-Sample Review (WR) + early fidelity + step down to fidelity self-monitoring.
Web-Based Training (WBT)
A self-paced online training course that includes video demonstrations, self-guided modules, and clinical materials/resources.
Work Sample Review (WR)
Four months of weekly hour-long consultation that will include trainer-led reviews of work samples, focusing on the Impact Statement and Stuck Point Log.
Step down to fidelity self-monitoring
After four months, and for participants who are classified as meeting "early fidelity", for the next two months, therapists in self-monitored fidelity will no longer attend group consultation. Instead, they will assess their own fidelity through self-report surveys.
Condition 1-B
Web-Based Training (WBT) + Work-Sample Review (WR) + early fidelity + continue in Standard Consultation.
Web-Based Training (WBT)
A self-paced online training course that includes video demonstrations, self-guided modules, and clinical materials/resources.
Work Sample Review (WR)
Four months of weekly hour-long consultation that will include trainer-led reviews of work samples, focusing on the Impact Statement and Stuck Point Log.
Condition 1-C
Web-Based Training (WBT) + Work-Sample Review (WR) + fidelity in progress + step up to session audio review.
Web-Based Training (WBT)
A self-paced online training course that includes video demonstrations, self-guided modules, and clinical materials/resources.
Work Sample Review (WR)
Four months of weekly hour-long consultation that will include trainer-led reviews of work samples, focusing on the Impact Statement and Stuck Point Log.
Step up to session audio review
After four months, and for participants who are classified as meeting "fidelity in progress", for the next two months, therapists will have their session audio recordings reviewed and rated for fidelity.
Condition 1-D
Web-Based Training (WBT) + Work-Sample Review (WR)+ fidelity in progress + continue in Standard Consultation.
Web-Based Training (WBT)
A self-paced online training course that includes video demonstrations, self-guided modules, and clinical materials/resources.
Work Sample Review (WR)
Four months of weekly hour-long consultation that will include trainer-led reviews of work samples, focusing on the Impact Statement and Stuck Point Log.
Continue in Standard Consultation
After four months, therapists will continue to attend weekly hour-long group consultation for another two months.
Condition 2-A
Web-Based Training (WBT) + Standard Consultation (SC) + early fidelity + step down to fidelity self-monitoring.
Web-Based Training (WBT)
A self-paced online training course that includes video demonstrations, self-guided modules, and clinical materials/resources.
Step down to fidelity self-monitoring
After four months, and for participants who are classified as meeting "early fidelity", for the next two months, therapists in self-monitored fidelity will no longer attend group consultation. Instead, they will assess their own fidelity through self-report surveys.
Standard Consultation (SC)
Four months of weekly hour-long group consultation
Condition 2-B
Web-Based Training (WBT) + Standard Consultation (SC) + early fidelity + continue in Standard Consultation.
Web-Based Training (WBT)
A self-paced online training course that includes video demonstrations, self-guided modules, and clinical materials/resources.
Standard Consultation (SC)
Four months of weekly hour-long group consultation
Condition 2-C
Web-Based Training (WBT) + Standard Consultation (SC) + fidelity in progress + step up to session audio review.
Web-Based Training (WBT)
A self-paced online training course that includes video demonstrations, self-guided modules, and clinical materials/resources.
Step up to session audio review
After four months, and for participants who are classified as meeting "fidelity in progress", for the next two months, therapists will have their session audio recordings reviewed and rated for fidelity.
Standard Consultation (SC)
Four months of weekly hour-long group consultation
Condition 2-D
Web-Based Training (WBT) + Standard Consultation (SC) + fidelity in progress + continue in Standard Consultation.
Web-Based Training (WBT)
A self-paced online training course that includes video demonstrations, self-guided modules, and clinical materials/resources.
Standard Consultation (SC)
Four months of weekly hour-long group consultation
Continue in Standard Consultation
After four months, therapists will continue to attend weekly hour-long group consultation for another two months.
Condition 3-A
Standard Training (ST) + Work-Sample Review (WR) + early fidelity + step down to fidelity self-monitoring.
Work Sample Review (WR)
Four months of weekly hour-long consultation that will include trainer-led reviews of work samples, focusing on the Impact Statement and Stuck Point Log.
Step down to fidelity self-monitoring
After four months, and for participants who are classified as meeting "early fidelity", for the next two months, therapists in self-monitored fidelity will no longer attend group consultation. Instead, they will assess their own fidelity through self-report surveys.
Standard Training (ST)
2-day instructor-led CPT workshop.
Condition 3-B
Standard Training (ST) + Work-Sample Review (WR) + early fidelity + continue in Standard Consultation.
Work Sample Review (WR)
Four months of weekly hour-long consultation that will include trainer-led reviews of work samples, focusing on the Impact Statement and Stuck Point Log.
Standard Training (ST)
2-day instructor-led CPT workshop.
Condition 3-C
Standard Training (ST) + Work-Sample Review (WR) + fidelity in progress + step up to session audio review.
Work Sample Review (WR)
Four months of weekly hour-long consultation that will include trainer-led reviews of work samples, focusing on the Impact Statement and Stuck Point Log.
Step up to session audio review
After four months, and for participants who are classified as meeting "fidelity in progress", for the next two months, therapists will have their session audio recordings reviewed and rated for fidelity.
Standard Training (ST)
2-day instructor-led CPT workshop.
Condition 3-D
Standard Training (ST) + Work-Sample Review (WR)+ fidelity in progress + continue in Standard Consultation.
Work Sample Review (WR)
Four months of weekly hour-long consultation that will include trainer-led reviews of work samples, focusing on the Impact Statement and Stuck Point Log.
Standard Training (ST)
2-day instructor-led CPT workshop.
Continue in Standard Consultation
After four months, therapists will continue to attend weekly hour-long group consultation for another two months.
Condition 4-A
Standard Training (ST) + Standard Consultation (SC) + early fidelity + step down to fidelity self-monitoring.
Step down to fidelity self-monitoring
After four months, and for participants who are classified as meeting "early fidelity", for the next two months, therapists in self-monitored fidelity will no longer attend group consultation. Instead, they will assess their own fidelity through self-report surveys.
Standard Consultation (SC)
Four months of weekly hour-long group consultation
Standard Training (ST)
2-day instructor-led CPT workshop.
Condition 4-B
Standard Training (ST) + Standard Consultation (SC) + early fidelity + continue in Standard Consultation.
Standard Consultation (SC)
Four months of weekly hour-long group consultation
Standard Training (ST)
2-day instructor-led CPT workshop.
Continue in Standard Consultation
After four months, therapists will continue to attend weekly hour-long group consultation for another two months.
Condition 4-C
Standard Training (ST) + Standard Consultation (SC) + fidelity in progress + step up to session audio review.
Step up to session audio review
After four months, and for participants who are classified as meeting "fidelity in progress", for the next two months, therapists will have their session audio recordings reviewed and rated for fidelity.
Standard Consultation (SC)
Four months of weekly hour-long group consultation
Standard Training (ST)
2-day instructor-led CPT workshop.
Condition 4-D
Standard Training (ST) + Standard Consultation (SC) + fidelity in progress + continue in Standard Consultation.
Standard Consultation (SC)
Four months of weekly hour-long group consultation
Standard Training (ST)
2-day instructor-led CPT workshop.
Continue in Standard Consultation
After four months, therapists will continue to attend weekly hour-long group consultation for another two months.
Interventions
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Web-Based Training (WBT)
A self-paced online training course that includes video demonstrations, self-guided modules, and clinical materials/resources.
Work Sample Review (WR)
Four months of weekly hour-long consultation that will include trainer-led reviews of work samples, focusing on the Impact Statement and Stuck Point Log.
Step down to fidelity self-monitoring
After four months, and for participants who are classified as meeting "early fidelity", for the next two months, therapists in self-monitored fidelity will no longer attend group consultation. Instead, they will assess their own fidelity through self-report surveys.
Step up to session audio review
After four months, and for participants who are classified as meeting "fidelity in progress", for the next two months, therapists will have their session audio recordings reviewed and rated for fidelity.
Standard Consultation (SC)
Four months of weekly hour-long group consultation
Standard Training (ST)
2-day instructor-led CPT workshop.
Continue in Standard Consultation
After four months, therapists will continue to attend weekly hour-long group consultation for another two months.
Eligibility Criteria
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Inclusion Criteria
* Participants must be licensed mental health clinicians or a mental health trainee in VA service (e.g., practicum students, psychology interns, postdoctoral fellows) whose formal job responsibilities include the provision of psychotherapy services to Veterans on a regular basis
* Participants must be able to participate for 9 months.
* Participants must work in a setting where CPT may be implemented (12 weekly 60-minute individual sessions or 90-minute group sessions).
* Participants must have local/supervisor support to implement CPT and fully participate in all training and consultation activities.
* Participating trainees (e.g. psychology interns) on a 6-month training rotation must have permission from their supervisors to continue the study into their next rotation.
Exclusion Criteria
* Participant is already certified in CPT
18 Years
ALL
No
Sponsors
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VA Office of Research and Development
FED
Responsible Party
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Principal Investigators
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Rebecca Kaufman Sripada, PhD MS
Role: PRINCIPAL_INVESTIGATOR
VA Ann Arbor Healthcare System, Ann Arbor, MI
Locations
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VA Palo Alto Health Care System, Palo Alto, CA
Palo Alto, California, United States
VA Ann Arbor Healthcare System, Ann Arbor, MI
Ann Arbor, Michigan, United States
Minneapolis VA Health Care System, Minneapolis, MN
Minneapolis, Minnesota, United States
Cincinnati VA Medical Center, Cincinnati, OH
Cincinnati, Ohio, United States
Countries
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Central Contacts
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Isabel Gracy, BS
Role: CONTACT
Facility Contacts
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Other Identifiers
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HX003943-01
Identifier Type: OTHER_GRANT
Identifier Source: secondary_id
IIR 24-069
Identifier Type: -
Identifier Source: org_study_id
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