Web-Based Provider Training for Concurrent Treatment of PTSD and Substance Use Disorders using Prolonged Exposure (COPEWeb)

Background: PTSD is the most common mental health disorder among Veterans seeking treatment at Veterans Affairs (VA) hospitals, and more than half of Veterans with PTSD also meet criteria for a substance use disorder (SUD). VA/DoD Clinical Practice Guidelines recommend trauma-focused integrated treatment as a first-line treatment for Veterans with co-occurring PTSD/SUD. However, whereas most VA providers desire training in trauma-focused integrated treatment, most are untrained and therefore cannot adequately meet the needs of these Veterans. To address this critical need, we developed Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (COPE), an evidence-based, integrated, trauma-focused treatment that VA has identified as a gold standard of behavioral healthcare. Randomized controlled trials among Veterans demonstrate COPE’s efficacy in reducing PTSD and substance use. Most Veterans with PTSD/SUD prefer integrated treatment. Significance/Impact: There is a critical shortage of clinicians trained to deliver COPE. Traditional in-person workshops are inefficient and costly. A poll of VA PTSD/SUD Specialists found that 96.9% want COPE training and 99.1% would use a web-based training for COPE if available. A web-based resource for providers is ideal, as it can be rapidly disseminated, is easily accessible, and provides a significant amount of standardized information. The proposed project, conducted in close partnership and with funding provided by the National Center for PTSD, will directly address this critical gap in provider training to improve the care of Veterans with comorbid PTSD/SUD, enhance treatment delivery using innovative in-session provider assistance tools, and enhance knowledge of cost-benefit of technology-enhanced training. The new training program (COPEWeb) may be particularly useful for providers in rural clinic settings where mental health training is less accessible. This proposal has the potential for high military relevance and an immediate impact on dissemination and uptake of COPE, as well as a long-term impact on the overall health of the millions of Veterans suffering from co-occurring PTSD/SUD. Innovation: A new web-based provider training for COPE will be developed along with a highly innovative delivery aid system to guide clinicians during sessions to enhance delivery and fidelity to the protocol and reduce provider burden. A panel of national VA experts and dissemination leaders will develop a best practice VA dissemination guideline on disseminating web- based provider trainings. The proposed project has the potential to significantly enhance provider training and increase patient access to evidence-based care. Furthermore, COPEWeb has the potential to serve a novel role in disaster planning to ensure mental health care providers are equipped to address the anticipated post- pandemic needs of Veterans given the rise in post-traumatic stress and alcohol/drug use during the pandemic. Specific Aims: This project will (1) develop a new web-based training protocol and innovative delivery aid system to strengthen providers’ delivery of COPE to treat Veterans with PTSD/SUD with a high level of fidelity and competence, and (2) compare the COPEWeb training to in-person training on knowledge, satisfaction, and behavior (i.e., fidelity). A cost-effectiveness analysis will compare web-based to in-person training. Methodology: The proposed methods and timeline to develop COPEWeb are based on our team’s prior success developing other widely-used provider training protocols (e.g., PEWeb, CBTIWeb). COPEWeb will be built and refined over the course of three strategic phases: content development, alpha-testing, and beta-testing. Following beta testing, we will compare COPEWeb to in-person training among clinicians. Ongoing assessment will obtain qualitative and quantitative data on measures of provider satisfaction, knowledge, and behavior. Implementation/Next Steps: In collaboration with our operations partners, VA leadership, and EBP Coordinators, COPEWeb will be rapidly disseminated to mental health providers to increase adoption of evidence-based treatment for PTSD/SUD and improve the quality of mental health care for Veterans and the nation.