Using the Web to Improve Substance Abuse Treatment Training

In 2006, Chestnut Health Systems, a non-profit behavioral healthcare organization that provides direct services to individuals as well as technical assistance to support initiatives funded by the federal government, developed a secure role-based website (https://www.ebtx.org) now in use by 125 substance abuse therapists and clinical supervisors across the U.S. The purpose of this application is to assist these professionals in learning how to better treat adolescents who have alcohol and drug problems.

The website (known as EBTx, or “evidence-based treatment”) was designed for uploading audio recordings of clinical sessions and supervision sessions, along with key data describing each session, following training workshops in the approach. Experts in the treatment could then listen to the recordings, rate them, and provide feedback to help the therapists improve their ability to provide the treatment. In behavioral health, there are increasing calls for the implementation of evidence-based treatments, but training large numbers of therapists in multiple locations to reliably implement an intervention has been difficult. This approach uses available technology to link clinicians and trainers successfully. Additionally, an important aspect of the site is the data that is gathered about what happens during each session, which can be summed by client, site, etc. and used in combination with outcome data to assess what are the important mechanisms of change.

Since sites and raters are located all over the United States, the certification process relies on the website that allows: (a) uploading of digitally recorded sessions; (b) streaming of session audio for review by raters; and (c) posting of numeric ratings and narrative comments for review by clinicians and supervisors, as well as by “coaches” in preparation for telephone coaching sessions.

The project has been very successful. Therapists can quickly learn to use it with some telephone coaching. Since the project went on-line, over 90 individuals have attained clinician or supervisor certification across 33 sites that are located all over the United States. Follow-up data on adolescent outcomes also suggests that this program has better outcomes (larger decreases in alcohol and drug use) than other programs for similar adolescents.

Microsoft solutions acquired via TechSoup were used throughout the course of this development project. Microsoft SQL Server 2005 was used as the back-end database platform, which was hosted on a server running Microsoft Windows Server 2003 and Internet Information Server (IIS) 6. The website and application were developed by in-house programmers on the Microsoft .NET 2.0 platform.