Pilot to policy: statewide dissemination and implementation of evidence-based treatment for traumatized youth
Pilot to policy: statewide dissemination and implementation of evidence-based treatment for traumatized youth
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DOI：
10.1186/s12913-018-3395-0
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发表时间：
2018-07-28
影响因子：
2.8
通讯作者：
Socolar, Rebecca
中科院分区：
文献类型：
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作者：
Amaya-Jackson, Lisa;Hagele, Dana;Socolar, Rebecca
背景：在北卡罗来纳州(北卡罗来纳州)试行并推广了一种在全州范围内传播创伤青年循证治疗(EBT)的模式。本文描述了由NC儿童治疗计划开发、试点和评估的实施平台，以使用国家儿童创伤应激学习协作(LC)模式采用和实施EBTS来培训机构提供者以创伤为重点的认知行为治疗。这种类型的LC包括成人学习原则，以加强临床技能发展作为培训的一部分，以及许多关键的实施科学策略，同时与机构和临床医生合作实施和维持新的实践。方法：来自北卡罗来纳州东北部的临床医生(n=124)参加了两个TF-CBT LCS中的一个，每个持续12个月。在LC期间，临床医生被期望通过TF-CBT治疗至少两名患者，并由提供电话咨询和培训期间的培训师监测结果。参与的临床医生与281名客户开始治疗。结果：111名临床医生完成了创伤评估电池和TF-CBT的一般培训。65名临床医生达到了所有掌握和保真度要求，以满足花名册标准。156名客户(55%)接受了保真度监测的评估和TF-CBT。随着治疗忠诚度减缓儿童创伤后应激障碍的结果，儿童的外化、内化和创伤后应激症状，以及父母的痛苦程度显著降低。结论：当培训包括：1)基于实践的学习，2)忠诚度指导，3)临床评估和以结果为导向的治疗，4)组织技能建设，以解决机构的障碍，5)通过在线提供者名册将客户与训练有素的临床医生联系起来。在这个试点和随后的队列中，展示了临床医生的表现和客户的结果，从而为NC儿童治疗计划传播一系列EBT服务提供了立法支持。
Background: A model for statewide dissemination of evidence-based treatment (EBT) for traumatized youth was piloted and taken to scale across North Carolina (NC). This article describes the implementation platform developed, piloted, and evaluated by the NC Child Treatment Program to train agency providers in Trauma-Focused Cognitive Behavioral Therapy using the National Center for Child Traumatic Stress Learning Collaborative (LC) Model on Adoption & Implementation of EBTs. This type of LC incorporates adult learning principles to enhance clinical skills development as part of training and many key implementation science strategies while working with agencies and clinicians to implement and sustain the new practice.Methods: Clinicians (n = 124) from northeastern NC were enrolled in one of two TF-CBT LCs that lasted 12 months each. During the LC clinicians were expected to take at least two clients through TF-CBT treatment with fidelity and outcomes monitoring by trainers who offered consultation by phone and during trainings. Participating clinicians initiated treatment with 281 clients. The relationship of clinician and client characteristics to treatment fidelity and outcomes was examined using hierarchical linear regression.Results: One hundred eleven clinicians completed general training on trauma assessment batteries and TF-CBT. Sixty-five clinicians met all mastery and fidelity requirements to meet roster criteria. One hundred fifty-six (55%) clients had fidelity-monitored assessment and TF-CBT. Child externalizing, internalizing, and post-traumatic stress symptoms, as well as parent distress levels, decreased significantly with treatment fidelity moderating child PTSD outcomes. Since this pilot, 11 additional cohorts of TF-CBT providers have been trained to these roster criteria.Conclusion: Scaling up or outcomes-oriented implementation appears best accomplished when training incorporates: 1) practice-based learning, 2) fidelity coaching, 3) clinical assessment and outcomes-oriented treatment, 4) organizational skill-building to address barriers for agencies, and 5) linking clients to trained clinicians via an online provider roster. Demonstrating clinician performance and client outcomes in this pilot and subsequent cohorts led to legislative support for dissemination of a service array of EBTs by the NC Child Treatment Program.