(PS9-51) CBIT Adoption Across Practice Settings: How Therapist Location Influences Training Outcomes and Implementation

Abstract Text: Tic disorders (TDs) are neurodevelopmental disorders characterized by involuntary motor and vocal tics. These disorders affect approximately 1%-3% of the population, with onset typically occurring in childhood and, for many individuals, symptoms persisting into adulthood. A recent survey conducted by the Tourette Association of America (TAA) found that individuals with TDs experience high rates of occupational and educational challenges (~80%), significant financial burden (43%), and overall dissatisfaction with current treatment options (44%). Comprehensive Behavioral Intervention for Tics (CBIT) is the gold-standard behavioral treatment for TDs and has been empirically validated through large, randomized controlled trials. Access to CBIT remains limited due to a shortage of trained providers, particularly in underserved and rural areas. The Behavior Therapy Training Institute (BTTI), an in-person training program led by the Tourette Association of America, is the only available training option for CBIT. However, this training method is limited by high costs, time commitments, and travel requirements, which may disproportionately affect providers in rural and under-resourced communities. To address this gap, CBIT-Trainer, an interactive, online CBIT training program, has been developed to increase accessibility and expand the number of CBIT trained therapists. A randomized controlled trial is currently being conducted to compare CBIT-Trainer to the BTTI. This study aims to identify barriers and facilitators to CBIT adoption in different practice settings, providing insight into how therapist location may impact CBIT implementation, sustainability, and accessibility for patients in underserved areas. Data collection is ongoing. To date, 283 therapists have been recruited and randomly assigned to either online training (CBIT-Trainer) or in-person training (BTTI). Therapists will complete surveys pre-training, post-training, 10 weeks post-training, and 6 months post-training, with questions about their overall knowledge of tics, their motivation for seeking training, likelihood of implementing CBIT, frequency of CBIT use in practice, and number of tic patients seen. Therapists who work in counties that are HPSAs (Health Professional Shortage Areas) or counties having a 4 or higher RUCC (Rural-Urban Continuum Code) score will be considered as rural or underserved providers. We plan to use descriptive statistics, t-tests, chi-square analyses, and mixed-effects models to examine differences in training outcomes, CBIT use over time, and therapist-reported barriers to CBIT implementation for rural or underserved therapists compared to other therapists based on practice location. This study aims to identify potential barriers and facilitators to CBIT adoption in rural and underserved non-rural communities, providing insights into how location influences long-term CBIT implementation. In addition, these findings could help inform other efforts to increase therapist access to specialty trainings, especially considering the needs of providers in rural or underserved areas.