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Delivery of best-practice care for posttraumatic stress disorder (PTSD) is a priority for clinicians working with active duty military personnel and veterans. The PTSD Clinicians Exchange, an Internet-based intervention, was designed to assist in disseminating clinically relevant information and resources that support delivery of key practices endorsed in the Veterans Administration (VA)-Department of Defense (DoD) Clinical Practice Guidelines (CPG) for the Management of Posttraumatic Stress. We conducted a randomized controlled trial to examine the effectiveness of the Clinicians Exchange intervention in increasing familiarity and perceived benefits of 26 CPG-related and emerging practices. The intervention consisted of ongoing access to an Internet resource featuring best-in-class resources for practices, self-management of burnout, and biweekly e-mail reminders highlighting selected practices. Mental health clinicians (N = 605) were recruited from three service sectors (VA, DoD, community); 32.7% of participants assigned to the Internet intervention accessed the site to view resources. Individuals who were offered the intervention increased their practice familiarity ratings significantly more than those assigned to a newsletter-only control condition, d = 0.27, p = .005. From baseline to 12-months, mean familiarity ratings of clinicians in the intervention group increased from 3.0 to 3.4 on scale of 1 (not at all) to 5 (extremely); mean ratings for the control group were 3.2 at both assessments. Clinicians generally viewed the CPG practices favorably, rating them as likely to benefit their clients. The results suggest that Internet-based resources may aid more comprehensive efforts to disseminate CPGs, but increasing clinician engagement will be important.

Introduction Web-based interventions hold great promise for the dissemination of best practices to clinicians, and investment in these resources has grown exponentially. Yet, little research exists to understand their impact on intended objectives. Materials & Methods The Post-Traumatic Stress Disorder (PTSD) Clinicians Exchange is a website to support clinicians treating veterans and active duty military personnel with PTSD, evaluated in a randomized controlled trial (N = 605). This manuscript explores how a subset of clinicians, those who utilized the intervention (N = 148), engaged with it by examining detailed individual-level web analytics and qualitative feedback. Stanford University and New England Research Institutes Institutional Review Boards approved this study. Results Only 32.7% of clinicians randomized to the intervention ever accessed the website. The number of pages viewed was positively associated with changes from baseline to 12 months in familiarity (P = 0.03) and perceived benefit of practices (P = 0.02). Thus, engagement with the website did predict an improvement in practice familiarity and benefit outcomes despite low rates of use. Conclusions This study demonstrates the importance of methodologically rigorous evaluations of participant engagement with web-based interventions. These approaches provide insight into who accesses these tools, when, how, and with what results, which can be translated into their strategic design, evaluation, and dissemination.

Purpose The purpose of this study was to evaluate the short-term effects of the Type 1 Teamwork program for parents of adolescents with type 1 diabetes mellitus (T1DM) on the primary outcome of psychosocial stress. Methods The study was a randomized wait-list control trial evaluating an eHealth program to reduce parenting stress around T1DM management during adolescence through interactive sessions on the safe transfer of responsibility, positive communication, and stress management. The primary outcome was psychosocial stress (parenting stress specific to child illness and general stress). Secondary outcomes included depressive and anxiety symptoms, parent support for adolescent autonomy, family conflict, and adolescent metabolic control (A1C). Data were collected at baseline, 3 months, and 6 months online. Mixed-model analyses were conducted, using intent-to-treat procedures. Results Parents (n = 162) had a mean age of 45.6 (±5.3) years, were 98% female, 91% white, 91% married/partnered, 51% of high income, and geographically dispersed around the United States. Parents reported that adolescents had a mean A1C of 7.9% (±1.2%) and T1DM duration of 5.08 (±3.62) years. At 6 months, parents in the Type 1 Teamwork group demonstrated less parenting stress compared with the control group. There were no differences between groups on general stress or secondary outcomes. Attrition at 6 months was 32% in the treatment group and 11% in the control group. Conclusions An eHealth program for parents of adolescents with T1DM improves parenting stress in a sample of parents from across the United States.

Introduction This study examined risk factors for secondary traumatic stress (STS) in behavioral health clinicians and whether access to the Post-Traumatic Stress Disorder (PTSD) Clinicians Exchange website mitigated STS risk. Methods A diverse sample of clinicians (N = 605) treating traumatized military populations in Department of Veterans Affairs (VA), Department of Defense, and community practice settings were randomized to a newsletter-only control group or the exchange group. The exchange website included resources for treating PTSD and promoting clinician well-being. Online surveys were administered at 0-, 6-, and 12-months postrandomization. Regression analyses were used to examine the link among risk factors, exchange access, and STS. Results Baseline clinician demographics, experience, total caseload, appeal of evidence-based practices (EBPs), and likelihood of adopting EBPs if required were not linked with STS at the 12-month assessment period. Providing care at the VA, more burnout, less compassion satisfaction, greater trauma caseload, less openness to new EBPs, and greater divergence from EBP procedures were linked with greater STS. Only burnout and divergence were associated with STS after accounting for other significant STS risk factors. Exchange and control group clinicians reported similar STS levels after accounting for burnout and divergence. Conclusions Given that burnout was linked with STS, future intervention may use techniques targeting burnout and STS (eg, emotion regulation strategies). Research exploring the link between divergence from EBPs and STS may inform EBP dissemination efforts and STS interventions. Finally, results highlight the need for research optimizing STS intervention efficacy among clinicians treating military populations.

Support for research involving children has a complicated history. Pediatricians and families have a unique opportunity to share perspectives about the relevance of pediatric clinical research. A national broadcast film on pediatric clinical research was developed to improve knowledge about and willingness to consider a clinical study. The film was delivered to a public audience employing a pre-post design comparing knowledge about clinical research before and after watching If Not for Me: Children and Clinical Studies. Change was measured by the difference in number of questions answered correctly prior to and after viewing the film. Engagement was measured by survey and a live feedback qualitative component. Adults viewing the program demonstrated a significant ( P < .0001) difference in knowledge about pediatric clinical research across all domains. This format appears to be a viable approach for improving public education and as a support tool for pediatricians and pediatric researchers about this topic.

Burnout is widespread among behavioral health clinicians treating posttraumatic stress disorder (PTSD) among military populations. Intervention-based strategies have shown some benefit in addressing clinician burnout. One Web-based tool, the PTSD Clinicians Exchange, was designed to disseminate clinical best practices for the treatment of PTSD and facilitate self-care to mitigate burnout. This study sought to determine whether this tool could reduce burnout among clinicians treating military populations.A total of 605 behavioral health clinicians from the U.S. Department of Veterans Affairs, the Department of Defense, and the community were enrolled in a randomized controlled trial to test the effectiveness of the PTSD Clinicians Exchange. Clinicians were assessed on demographic characteristics, practice patterns, and organizational support with an online survey at baseline and at 6 and 12 months. Burnout, secondary traumatic stress (STS), and compassion satisfaction were measured with the Professional Quality of Life Scale.At baseline, no differences were observed in mean±SD burnout scores for the intervention (19.9±5.1) and control groups (20.2±5.4). Participation in the Exchange had no effect on burnout score at 12 months; burnout scores remained stable across the study period. In a multivariable stepwise regression model, older age, lower burnout at baseline, and lower STS scores and higher compassion satisfaction scores at 12 months were significantly associated with lower burnout scores.The PTSD Clinicians Exchange did not mitigate burnout among clinicians, possibly because of the content provided, the dissemination mechanism, or participants' limited use of the Web site. These results can be used to inform and enhance future interventions.

Parents of teens with type 1 diabetes (T1D) report challenges in maintaining involvement with diabetes care while supporting teen autonomy. We developed a web-based tool to support parents in this transition—Type 1 Teamwork—that provides interactive content and video vignettes of real families on challenges and strategies to transition T1D care from parent to teen. The purpose of this study was to determine the reach (demographic characteristics), participation (web usage and engagement) and short-term effects (parenting stress, perceived stress, parental support for teen autonomy, family conflict, teen A1C) of Type 1 Teamwork. Parents of teens with T1D (11-16 years) were randomized to Type 1 Teamwork (n=81) or a control group (n=81). Parents were 45.6 (±5.3) years of age, 98% female, 91% white, 91% married/partnered, 51% high income, 36% with elevated depressive symptoms, and 40% with elevated anxiety symptoms. Teens had a mean A1C of 7.9 (±1.2), T1D duration of 5.(±3.62) years, with 75% using a pump, 69% using a CGM, and 39% reporting 20 or more episodes of hypoglycemia in the previous 3 months. There were no significant differences between groups on baseline characteristics. Eighty-two percent (n=133) of participants completed 3-month data collection. Parents in the Type 1 Teamwork group who did not access the tool (n=6) were excluded from the comparative analyses. Type 1 Teamwork was accessed a total of 453 times and had 6,614 total pages viewed, with an average of 15 pages and 11 minutes per visit. There was less frequent parenting emotional distress (p=.04) and trends for less family conflict (p=.14) in the Type 1 Teamwork group, with no short-term effect on perceived stress, parental support for autonomy, or teen A1C in change scores over 3 months. Ongoing usage of Type 1 Teamwork may further enhance outcomes in parents of teens with T1D, which we will evaluate at 6 months. More research is needed to engage lower income families in the use of websites to support parent-teen teamwork in T1D. Disclosure R. Whittemore: None. J.L. Coleman: None. R. Delvy: None. B. Kato: None. J.A. Ambrosoli: None. M.P. Maurao: None. R. Zincavage: None. L. Marceau: None.

Parents of teens with type 1 diabetes (T1D) are responsible for a labor-intensive and complicated daily regimen that has been described as overwhelming and requiring constant vigilance. Parents report high levels of stress, particularly during the adolescent transition. The primary aim of this study was to identify demographic (parent/child age, gender, race/ethnicity, income, marital status), clinical (T1D duration, pump use, CGM use, episodes of hypoglycemia, other health diagnoses) and psychosocial factors (depressive symptoms, family conflict, childhood-illness parenting stress, teen autonomy) associated with perceived stress in parents of teens with T1D. This was a secondary analysis of baseline data from parents (n=162) of teens with T1D (11-16 years) who were enrolled in a study to evaluate a web-based tool to help with the transition of diabetes care. Bivariate correlates of perceived stress were included in a multivariate model analysis. Parents were 45.6 (±5.3) years of age, 98% female, 91% white, 91% married/partnered, 51% high income, 36% with elevated depressive symptoms, and 40% with elevated anxiety symptoms. Teens had a mean A1C of 7.9 (±1.2), 5.(±3.62) years duration of diabetes, with 75% using an insulin pump, 69% using a CGM, and 39% reporting 20 or more episodes of hypoglycemia in the previous 3 months. Significant bivariate demographic, clinical, and psychosocial correlates were included in the model, in a stepwise procedure. Multivariate correlates of perceived stress were parent age, teen T1D duration, other teen health diagnosis (R2=0.13, p Disclosure R. Whittemore: None. R. Delvy: None. J.L. Coleman: None. B. Kato: None. J.A. Ambrosoli: None. M.P. Maurao: None. R. Zincavage: None. L. Marceau: None.

Background and Objective We developed a web-based continuing education course to assist clinicians to address issues related to communicating about developmental concerns and screening results with parents, and to better understand cultural considerations in this area of practice. Methods We conducted a randomized controlled trial which evaluated the web-based …