Improving practice in community-based settings: a randomized trial of supervision - study protocol
Improving practice in community-based settings: a randomized trial of supervision - study protocol
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DOI：
10.1186/1748-5908-8-89
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发表时间：
2013-08-10
影响因子：
7.2
通讯作者：
Garland, Ann F.
中科院分区：
文献类型：
--
作者：
Dorsey, Shannon;Pullmann, Michael D.;Garland, Ann F.
背景：儿童心理健康问题的循证治疗在公共心理健康环境中并不是始终如一的。扩大可获得性需要劳动力培训。然而，研究表明，仅靠培训不足以改变提供者的行为，这表明需要持续的干预具体监督或咨询。特别是在公共精神卫生方面，对监管的调查明显不足。这一背景下的监督在多大程度上包括疗效试验的“黄金标准”监督要素(例如，会议审查、模型保真度、结果监测、技能建设)尚不清楚。目前由联邦政府资助的调查利用华盛顿州以创伤为重点的认知行为治疗倡议来描述通常的监督做法，并测试系统地实施黄金标准监督策略对治疗保真度和临床结果的影响。方法/设计：研究分为两个阶段。我们将对华盛顿州公共精神卫生领域的监督实践进行初步描述性研究(第一阶段)，然后进行黄金标准监督策略的随机对照试验(第二阶段)，在临床医生层面进行随机化(即监督者提供两种条件)。研究参与者将是社区精神卫生中心的35名监督员和130名临床医生。我们将在第一阶段为每位临床医生招收一名儿童(N=130)，在第二阶段为每位临床医生招收三名儿童(N=390)。我们采用多层次混合的受试者内部和受试者之间的纵向设计。监督和治疗过程的录音将在这两个阶段收集和编码。儿童结局数据将在治疗开始时以及治疗后三个月和六个月收集。讨论：这项研究将为监督者如何以最佳方式支持临床医生提供循证治疗提供洞察。第一阶段将提供目前文献中没有的描述性信息，关于社区心理健康中常用的监督策略。据我们所知，黄金标准监管策略的第二阶段随机对照试验是黄金标准监管策略在社区心理健康方面的第一次实验性研究，将产生关于如何利用监管来提高临床医生忠诚度和客户结果的必要信息。
Background: Evidence-based treatments for child mental health problems are not consistently available in public mental health settings. Expanding availability requires workforce training. However, research has demonstrated that training alone is not sufficient for changing provider behavior, suggesting that ongoing intervention-specific supervision or consultation is required. Supervision is notably under-investigated, particularly as provided in public mental health. The degree to which supervision in this setting includes 'gold standard' supervision elements from efficacy trials (e.g., session review, model fidelity, outcome monitoring, skill-building) is unknown. The current federally-funded investigation leverages the Washington State Trauma-focused Cognitive Behavioral Therapy Initiative to describe usual supervision practices and test the impact of systematic implementation of gold standard supervision strategies on treatment fidelity and clinical outcomes.Methods/Design: The study has two phases. We will conduct an initial descriptive study (Phase I) of supervision practices within public mental health in Washington State followed by a randomized controlled trial of gold standard supervision strategies (Phase II), with randomization at the clinician level (i.e., supervisors provide both conditions). Study participants will be 35 supervisors and 130 clinicians in community mental health centers. We will enroll one child per clinician in Phase I (N = 130) and three children per clinician in Phase II (N = 390). We use a multi-level mixed within- and between-subjects longitudinal design. Audio recordings of supervision and therapy sessions will be collected and coded throughout both phases. Child outcome data will be collected at the beginning of treatment and at three and six months into treatment.Discussion: This study will provide insight into how supervisors can optimally support clinicians delivering evidence-based treatments. Phase I will provide descriptive information, currently unavailable in the literature, about commonly used supervision strategies in community mental health. The Phase II randomized controlled trial of gold standard supervision strategies is, to our knowledge, the first experimental study of gold standard supervision strategies in community mental health and will yield needed information about how to leverage supervision to improve clinician fidelity and client outcomes.