4 - (SYM 9) Initial Development and Testing of Copeweb

Introduction: Posttraumatic stress disorder (PTSD) is the most common mental health disorder among Veterans seeking treatment at Veterans Affairs (VA) hospitals, and over 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 the first-line treatment for co-occurring PTSD/SUD, including Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (COPE). Whereas most VA providers desire training in trauma-focused integrated treatments, most are untrained and therefore cannot adequately meet the needs of these Veterans. A poll of national VA PTSD/SUD Specialists found that 96.9% want COPE training and 99.1% would use a web-based COPE training if available. To address this need, we are developing an online training program called COPEweb.

Methods: Experts in PTSD treatment, SUDs, and the COPE intervention met weekly for several months to determine the content and order of the training curriculum and develop pre- and post-tests to assess knowledge acquisition throughout the training. Once the initial build of COPEweb was developed, 65 mental health providers were recruited to engage with the course, including completing the 10-item System Usability Scale (SUS) and pre- and post-tests.

Results: Expert consensus resulted in development of 15 learning modules (5 Introduction/Background of comorbid PTSD/SUD treatment, 1 Assessment, 2 PTSD-focused, 4 SUD-focused, 1 Anger management, 2 Special considerations) and 168 test questions. Significant pre- to post-test improvement was demonstrated on 13 of 15 modules (ps < .05). A large proportion of pre- (40.5%) and post- (58.3%) test questions were answered correctly by all providers. IRT analyses of the remaining questions indicated they were low in difficulty (average b = -2.60 for pre-test and -2.97 for post-test). The average SUS score was 93.26, indicating “Excellent” usability of the web-based training course.

Discussion: Initial testing of COPEweb suggests the platform is highly promising as a scalable solution for training providers in evidence-based treatment for co-occurring PTSD/SUD. The observed low difficulty of test questions should be interpreted in the context of platform infrastructure and sample characteristics, as many providers already had substantial experience with PTSD or SUD treatment. Findings inform revision of test questions. The next stage of development will include a comparison of COPEweb with a synchronous workshop.