Study protocol: Novel Methods for Implementing Measurement-Based Care with youth in Low-Resource Environments (NIMBLE).
Study protocol: Novel Methods for Implementing Measurement-Based Care with youth in Low-Resource Environments (NIMBLE).
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DOI：
10.1186/s43058-023-00526-z
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发表时间：
2023-11-28
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对于在社区精神卫生中心接受治疗的青少年来说，合并症是规则而不是例外。使用基于测量的护理（MBC），或症状的常规评估，以告知护理决策，作为治疗患有共病问题的青少年的基础，通过关注护理和建立参与和联盟，显着提高了心理治疗的影响。MBC提高了症状改善的速度，检测到否则会恶化的客户，并提醒临床医生无反应者。尽管MBC已被证明具有实用性，但它很少被忠实地实施;只有不到15%的供应商报告根据建议使用MBC。以前为支持实施《禁雷公约》所作的努力取得了次优结果，部分原因是各组织在查明和优先处理障碍以及选择和制定克服这些障碍的战略方面遇到了挑战。需要新的方法来识别和优先考虑障碍，并将策略与障碍相匹配，以优化MBC的实施和治疗质量，从而改善社区环境中的青年心理健康结果。务实的实施方法将在四个不同的社区精神卫生中心进行试点。方法包括（a）快速证据综合;（B）快速人种志;（c）设计工具包（例如，具有一次性相机、日志、地图的套件）;（d）屏障优先化，以及（e）因果途径图解。这些活动将产生可操作的障碍;随后，我们将使用便利的小组流程来确定障碍的优先级，并开发因果路径图，以将策略与障碍相匹配，从而创建优化MBC保真度的实施计划（目标1）。我们将跟踪策略部署6个月，然后将实施后6个月的MBC保真度与2年历史对照数据进行比较（目标2）。最后，我们将与青年、实践界和科学界共同设计一个工具包，用于设计工具包方法（目标3）。优化MBC在社区精神卫生中心的实施可以通过确保在治疗早期针对最紧迫的症状来改变青少年精神卫生保健。讨论部分强调了使用这五种方法的预期挑战和限制，包括考虑到社区精神卫生环境的高压力的招聘和参与。Clinicaltrials.gov. NCT 05644756。于二零二二年十一月十八日注册。本试验进行了回顾性登记。在线版本包含补充材料，可通过10.1186/s43058-023-00526-z获得。
For youth receiving care in community mental health centers, comorbidities are the rule rather than the exception. Using measurement-based care (MBC), or the routine evaluation of symptoms to inform care decisions, as the foundation of treatment for youth with comorbid problems significantly improves the impact of psychotherapy by focusing care and building engagement and alliance. MBC increases the rate of symptom improvement, detects clients who would otherwise deteriorate, and alerts clinicians to non-responders. Despite its demonstrated utility, MBC is rarely implemented with fidelity; less than 15% of providers report using MBC per recommendations. Previous efforts to support MBC implementation have yielded suboptimal outcomes, in part, due to organizations’ challenges with identifying and prioritizing barriers and selecting and developing strategies to overcome them. New methods are needed for identifying and prioritizing barriers, and matching strategies to barriers to optimize MBC implementation and treatment quality to improve youth mental health outcomes in community settings. Pragmatic implementation methods will be piloted in four diverse community mental health centers. Methods include (a) rapid evidence synthesis; (b) rapid ethnography; (c) design kits (e.g., kits with disposable cameras, journals, maps); (d) barrier prioritization, and (e) causal pathway diagramming. These activities will generate actionable barriers; subsequently, we will use facilitated group processes to prioritize barriers and develop causal pathway diagrams to match strategies to barriers to create implementation plans that optimize MBC fidelity (Aim 1). We will track strategy deployment for 6 months, then compare MBC fidelity for another 6 months post-implementation with data from 2 years of historical controls (Aim 2). Finally, we will co-design a toolkit for design kit methods with youth and the practice and scientific communities (Aim 3). Optimizing MBC implementation in community mental health centers could transform youth mental health care by ensuring the most pressing symptoms are targeted early in treatment. The discussion section highlights expected challenges and limits to using the five methods, including recruitment and engagement given the high pressure on community mental health settings. Clinicaltrials.gov. NCT05644756. Registered on 18 November 2022. This trial was retrospectively registered. The online version contains supplementary material available at 10.1186/s43058-023-00526-z.