Assessing fidelity of cognitive behavioral therapy in rural VA clinics: design of a randomized implementation effectiveness (hybrid type III) trial.
Assessing fidelity of cognitive behavioral therapy in rural VA clinics: design of a randomized implementation effectiveness (hybrid type III) trial.
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DOI：
10.1186/s13012-016-0432-4
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发表时间：
2016-05-10
期刊：
影响因子：
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通讯作者：
Sullivan G
中科院分区：
文献类型：
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作者：
Cucciare MA;Curran GM;Craske MG;Abraham T;McCarthur MB;Marchant-Miros K;Lindsay JA;Kauth MR;Landes SJ;Sullivan G
广泛传播和实施具有高度保真度的循证心理疗法，特别是认知行为疗法（CBT），已被证明对许多卫生保健系统具有挑战性，包括退伍军人事务部，特别是在小型或偏远诊所等初级保健环境中。基于计算机的工具（基于协调焦虑学习和管理（CALM）计划）旨在支持基于初级保健的心理健康提供者提供CBT。本研究的目的是修改CALM工具，以满足退伍军人事务部（VA）社区门诊诊所（CBOCs）和农村“退伍军人”的心理健康临床医生的需求，使用外部促进来实施CBT，并确定CALM工具与CALM手动版本的效果，以提高对CBT治疗模型的保真度，并进行需求评估，以了解如何最好地支持未来在日常护理中实施CALM工具。焦点小组将为重新设计CALM工具提供信息。将招募区域VA CBOC的心理健康提供者; CBT专家;实施循证心理健康实践的VA专家;以及患有广泛性焦虑症，恐慌症，社交焦虑症，创伤后应激障碍，“有或没有”抑郁症的退伍军人。混合III型设计将用于检查接受CBT培训加上CALM工具或CALM手动版本对治疗保真度的影响。外部促进将被用作实施两种CBT交付方法的总体战略。还将收集有关目标疾病症状的数据。为了帮助准备未来在VA CBOC中实施CALM工具，我们将与参与临床试验的心理健康提供者及其CBOC主任进行实施需求评估。该项目将有助于为患有焦虑症和创伤后应激障碍（PTSD）（有或没有抑郁症）的退伍军人提供VA CBOCs高保真CBT的策略。如果成功的话，这项研究的结果可以用来通知全国推出的CALM工具在VA CBOCs，包括提供建议，优化采用和持续使用的计算机化的CALM工具之间的心理健康提供者在这种情况下。ClinicalTrials.gov，NCT 02488551
Broadly disseminating and implementing evidence-based psychotherapies with high fidelity, particularly cognitive behavioral therapy (CBT), has proved challenging for many health-care systems, including the Department of Veterans Affairs, especially in primary care settings such as small or remote clinics. A computer-based tool (based on the coordinated anxiety learning and management (CALM) program) was designed to support primary care-based mental health providers in delivering CBT. The objectives of this study are to modify the CALM tool to meet the needs of mental health clinicians in veterans affairs (VA) community-based outpatient clinics (CBOCs) and rural "veterans", use external facilitation to implement CBT and determine the effect of the CALM tool versus a manualized version of CALM to improve fidelity to the CBT treatment model, and conduct a needs assessment to understand how best to support future implementation of the CALM tool in routine care. Focus groups will inform the redesign of the CALM tool. Mental health providers at regional VA CBOCs; CBT experts; VA experts in implementation of evidence-based mental health practices; and veterans with generalized anxiety disorder, panic disorder, social anxiety disorder, posttraumatic stress disorder, "with or without" depression will be recruited. A hybrid type III design will be used to examine the effect of receiving CBT training plus either the CALM tool or a manual version of CALM on treatment fidelity. External facilitation will be used as the overarching strategy to implement both CBT delivery methods. Data will also be collected on symptoms of the targeted disorders. To help prepare for the future implementation of the CALM tool in VA CBOCs, we will perform an implementation need assessment with mental health providers participating in the clinical trial and their CBOC directors. This project will help inform strategies for delivering CBT with high fidelity in VA CBOCs to veterans with anxiety disorders and PTSD with or without depression. If successful, results of this study could be used to inform a national rollout of the CALM tool in VA CBOCs including providing recommendations for optimizing the adoption and sustained use of the computerized CALM tool among mental health providers in this setting. ClinicalTrials.gov, NCT02488551