TIA’s National Institute of Mental Health Small Business Innovation Research Program Phase II study will investigate whether our family training and implementation platform (FTTIP) is “not inferior” to traditional face-to-face training on all key domains, including trainee competencies, agency readiness, and client outcomes.

The Aims of the Phase II study are to:

• Complete learning, practice and competency-testing paths that provide the learner multiple learning options and increase the dynamic nature of the platform.
• Demonstrate that 75 FTTIP trainees show improvement in all core family therapy competencies that are not inferior to 75 providers receiving traditional in-person family therapy training as tested using pre and post training measures within a randomized clinical trial.
• Demonstrate that 150 client families (child-caregiver dyads) receiving CIFFTA family therapy show adequate retention in treatment, therapeutic alliance, and significant pre-post treatment improvements on family environment and presenting problems.
• Establish the process (e.g., initiation and delays in training new staff) and cost associated with training in each of the two training conditions.
• Demonstrate that 15 agency leaders receiving FTTIP agency readiness consultations show more pre and post change in agency readiness and knowledge than 15 leaders receiving agency engagement as usual.

FTTIP’s commercial application is that national, state, and local treatment services funders and providers will find FTTIP to be a highly cost effective, flexible, and engaging way to improve the quality of their evidence-based treatments. TIA’s experience in providing training in Spanish will also allow the product to impact Latin America and other countries such as Spain.

Outcome:
The study achieved most of its aims by: 1) enhancing the dynamic nature of the platform with practice and competency testing paths that provided the learner with multiple learning options; 2) demonstrating that FTTIP trainees showed improvement in all core family therapy competencies that were “not inferior” to trainees receiving traditional in-person family therapy training; 3) demonstrating that agency leaders receiving FTTIP agency readiness consultations showed overall stability, with leaders consistently endorsing high agreement on key areas such as the cultural and racial diversity of clients, the appropriateness of a family orientation within the agency’s mission, and clinician agreement with the intervention. Recognition of external mandates from funders and state systems and acknowledgment of difficulties sustaining other evidence-based practices increased post-implementation, suggesting heightened awareness of both the external pressures driving adoption and the internal challenges of sustainability; 4) establishing the cost-benefit advantages of FTTIP in the process (e.g., initiation and delays in training new staff) and cost associated with training when compared with the traditional in-person training. The study also faced major obstacles that reflected the reality of front-line practice when trying to implement a highly demanding dissemination model that may not fit a workforce that is unable to allocate the considerable effort required. These lessons have led to changes to our business model, placing greater emphasis on a more targeted approach that reduces the effort needed to incorporate new evidence-based interventions, as opposed to a full new model of treatment. A qualitative supplement study with counselors documented the successful integration of CIFFTA skills into practice and emphasized the value of coaching, while also identifying ongoing challenges in balancing family engagement with crisis management and complex dynamics. Agency leaders strongly endorsed the importance of family therapy but highlighted barriers at both the family and organizational levels, including parent resistance, scheduling difficulties, and systemic barriers (e.g., staff turnover, billing restrictions, program restructuring). These constraints prevented several agencies from implementing CIFFTA, despite interest. Where adoption was possible, leaders reported positive outcomes for families. The study also documented FTTIP’s commercial viability as national, state, and local treatment services funders and providers will find FTTIP to be a highly cost effective, flexible, and engaging way to improve the quality of their evidence-based treatments (EBTs). By better preparing the nation’s workforce on EBTs, and providing the support and coaching they need to reach full mastery, our FTTIP product has the potential to significantly improve the wellbeing and mental health in our nation and internationally.