Delivering an Online Cognitive Behavioral Therapy Program to Address Mental Health Challenges Faced by Correctional Workers and Other Public Safety Personnel: Protocol for a Mixed Methods Study

Abstract

Background Public safety personnel have regular and often intense exposure to potentially traumatic events at work, especially workplace violence in the case of correctional workers. Subsequently, correctional workers are at higher risk of developing mental health problems such as posttraumatic stress disorder. Public safety personnel are up to 4 times more likely to experience suicidal ideation, suicidal attempts, and death by suicide compared to the general population. Despite this high prevalence, help-seeking behaviors from public safety personnel are low due to stigma and irregular work hours limiting access to care. Innovative treatments are needed to address these challenges. Objective This study will investigate the efficacy of an electronically delivered cognitive behavioral therapy (e-CBT) program tailored to correctional workers’ mental health problems. Methods This study is composed of 4 phases. In phase 1, we will interview correctional workers individually and in focus groups to identify personal, social, and cultural factors affecting their mental health and barriers to care. Phase 2 will use the information gathered from the interviews to develop gender- and diagnosis-specific e-CBT modules. These will be presented to a new group of participants who will provide further feedback on their usability and accessibility. In phase 3, we will randomly assign participants to either an e-CBT or treatment as usual arm. The program will be evaluated with validated symptomatology questionnaires and interviews. Phase 4 will use this additional information to fine-tune the e-CBT modules for a larger-scale randomized controlled trial design comparing the e-CBT program to in-person CBT. All e-CBT modules will be delivered through a secure online platform. Results The study received ethics approval in December 2020, and participant recruitment began in March 2021. Participant recruitment has been conducted through targeted advertisements and physician referrals. To date, there have been 15 participants recruited for Phase 1, and it is expected to conclude in July 2021, with phase 2 beginning in September 2021. Complete data collection and analysis from all phases are expected to conclude by July 2023. Linear and binomial regression (for continuous and categorical outcomes, respectively) will be conducted along with interpretive qualitative methods. Conclusions If proven efficacious and feasible, this e-CBT program can provide a high-quality and clinically validated resource to address the mental health problems of correctional workers. Additionally, findings can contribute to the development of innovative treatments for other public safety professions. Trial Registration ClinicalTrials.gov NCT04666974; https://www.clinicaltrials.gov/ct2/show/NCT04666974 International Registered Report Identifier (IRRID) DERR1-10.2196/30845

Improving the Mental Health of Correctional Workers: Perspectives From the Field

“…The gap in effective and timely support can potentially exacerbate the effects of potentially psychologically traumatic and violent incidents on correctional workers. It may even contribute to the development of mental disorders such as posttraumatic stress disorder—a disorder and its comorbidities that is prevalent among correctional workers (Alavi et al, 2021; Finney et al, 2013; Genest et al, 2021; Norman & Ricciardelli, 2021; Regehr et al, 2019; Ricciardelli & Carleton, 2021; Ricciardelli et al, 2018).…”

“…Regarding mental health interventions, respondents' accounts of available treatment options point to the need for a special correctional mental health paradigm that reflects the characteristics and sources of stress among correctional workers. There is some recent recognition of this need in the extant literature as Alavi et al (2021) have identified some of the benefits of delivering an online cognitive behavioral therapy program to address the mental health challenges experienced by correctional workers and other public safety personnel. Our data, in tandem, speak to the need for a model that is responsive to correctional-specific work stressors, available easily and immediately (i.e., in the aftermath of an event), and comprehensive and continuous so as to adequately and sufficiently respond to the complexity of occupational stress injuries.…”

A qualitative exploration of the mental health challenges and therapeutic needs of Canadian correctional workers

“…The lived experiences of CWs can provide rich and detailed insights into the dynamics of the mental health and treatment-seeking challenges they face in their work environment. The current study is the first phase of a larger randomized controlled trial (RCT) that will investigate the efficacy of online psychotherapy in this population ( 11 ). The virtual platform (Online Psychotherapy Tool; OPTT) offers electronic cognitive behavioral therapy (e-CBT), the first-line psychotherapeutic treatment for many mental health disorders ( 12 – 14 ).…”

“…In-depth 1:1 interviews and focus groups focused on how CWs interacted with prisoners and colleagues, their work conditions and conflicts, mental health challenges they faced, perceptions of mental health resources and support, and their attitudes toward mental health care. Participants were also asked to provide feedback on previous modules for PTSD and depression available on OPTT ( 11 , 15 ). The findings of the current study will guide the development and evaluation of e-CBT programs for CWs in the subsequent phases.…”

Why Do Public Safety Personnel Seek Tailored Internet-Delivered Cognitive Behavioural Therapy? An Observational Study of Treatment-Seekers

“…PSPNET's ICBT has demonstrated promising initial outcomes for treating symptoms of several mental disorders among PSP [30]. At the time this article was written, at least two other Canadian research groups were also developing ICBT interventions for PSP [31,32].…”