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Designing an Intelligent Tutoring System as a Tool to Support the Training of Mental Health Providers in Core Psychotherapy Competencies
Event Type
Oral Presentations
TimeWednesday, April 141:10pm - 1:30pm EDT
LocationEducation and Simulation
DescriptionEach year millions of people with mental illness struggle with access to mental health care. According to National Alliance on Mental Illness (NAMI) half of the 60 million adults and children living with mental health conditions in the United States go without any treatment . Globally this “mental health treatment gap” is even greater, with more than 70% of people who need mental health services lacking access to care. While there are many barriers to treatment, a fundamental one, particularly in rural areas, is the shortage of well-trained mental health professionals. Increasing the number of clinicians trained to deliver high quality care is essential to closing this gap, and the ability to train large numbers of clinicians efficiently and economically is critical.

A major obstacle in increasing the number of clinicians, especially in remote areas, is the difficulty of teaching core therapeutic skills without intensive one on one teacher-student interaction. This interaction is both logistically and economically limiting. Our goal in this “Building Capacity” project was to address this issue by creating a tool, an intelligent tutoring system, that would supplement in-person learning and improve competency in essential skills while being cost-effective and scalable. Intelligent tutoring systems (ITS) are computerized programs used as classroom adjuncts or replacements that support learning by giving personalized instruction without requiring the presence of a teacher. Our ITS guides users through simulated cases, decision dilemmas and other cognitive tasks by providing immediate and customized instruction and feedback.

The UW ALACRITY Center, based out of the University of Washington, is funded by the National Institute of Mental Health (NIMH) as an incubator to improve the delivery of mental healthcare for underserved communities. All funded projects look at the design and delivery of quality mental health treatments and, using an approach based in human centered design and implementation science, uncover and overcome obstacles that prevent their use. Our development team in this project included user experience researchers and designers, psychologists and computer scientists and developers tasked with designing a tool that could be used by university social work or psychology students or in training medical professionals. The tool will allow users to practice core therapeutic concepts such as empathy and redirection at their own pace, wherever they are. Typically, these skills are practiced through therapist/teacher and student simulations, however this requires the on-site presence of trained professionals and incurs the cost of their time to roll-play, evaluate and provide feedback on what they observe.

We interviewed experts in training beginning-mental health students and other non-medical clinicians to identify common challenges and errors made while teaching evidence based psychosocial interventions: what areas they found the most challenging for their students to master and what information they thought would help them gauge their students’ mastery of the subject matter. These discussions, coupled with Bloom’s revised taxonomy and the educational competencies established by the Council on Social Work Education , informed the content of the ITS. For each competency module we developed a series of question types that progress in difficultly from multiple choice to case scenarios where the user is asked to play the role of therapist, choose appropriate responses and explain his/her reasoning.

The user interface of the ITS offered many challenges which we tackled through an iterative design process including many rounds of user testing and a co-design session with undergraduate psychology students. Examples of questions:
• What is the best way to gauge users’ knowledge while keeping them motivated?
• How to distinguish the experience of using the ITS from that of taking a test?
• How to provide feedback and additional explanations when a user is struggling to master a skill?
• What information do the instructors need about their students’ performance?
• How can instructors use the ITS to inform their lesson plans, and what the best way is to visualize that in a dashboard?

This case study will show the development and steps of the design process leading to the pilot testing of an intelligent tutoring system to teach core clinical skills. It will show how the ITS can provide opportunities for students to practice and acquire skills critical to the delivery of effective evidence based psychosocial interventions (EBPIs). We will also discuss the pilot of the ITS and its results. Next steps include developing more content as well as wider testing of the tool and its potential to build clinician capacity rapidly to improve access to mental health care.