Project 1

项目1总结 对于在社区精神卫生中心(CMHC)接受护理的青少年来说，共病是常态，而不是 例外。1，2以测量为基础的护理(MBC)作为治疗青少年合并症的基础 问题可以显著提高治疗效果，因为它可以帮助确定治疗重点。MBC是 对症状进行系统、常规的评估，为护理决策提供信息。特别是在年轻人中，MBC增加了 症状改善率，3检测否则会恶化的客户，4并提醒临床医生 答复者。4、5忠实地执行管理能力建设需要3个要素：(A)日常管理措施 治疗前的症状、结果和过程，(B)治疗师和病人的评分回顾，以及(C) 协作性地重新评估治疗计划。但MBC很少保真实施；只有不到15%的 提供商报告根据建议使用MBC。6以前支持MBC实施的努力有 结果不太理想，因为CMHC领导者面临识别障碍和确定优先顺序的挑战， 克服它们的策略。需要新的方法来确定和确定决定因素的优先顺序，以及 将战略与决定因素相匹配，优化MBC实施和治疗质量以提高青年 社区环境中的心理健康结果。项目一S的优化目标是增加MBC的影响力和 使方法与实践合作伙伴的偏好保持一致。影响中心方法将在六个不同的CMHC中试行 诊所(六分之三的诊所主要为拉丁裔人口服务)。我们关注的影响方法包括：(A)快速证据 审查以发现关于多民族玻利维亚国决定因素的经验数据；(B)快速人种学，以确定和描述 当地决定因素，并将其置于特定的组织、社会和任务背景下；以及(C)设计探测 (例如，带有一次性相机、期刊、地图的工具包)，以使实践伙伴和青年能够捕捉和反思 它们的上下文方面对MBC来说是突出的。这些活动将产生一系列决定因素，这些决定因素将是 由每个诊所的合作伙伴根据危急程度、慢性病和普遍性进行评级，以生成优先级分数。后来， 我们将使用促进的小组过程来开发因果路径图，以将战略与前三名相匹配 决定因素，并阐明其前提条件、主持人、机制以及近期和结果(定义见 方法在六家诊所中的每一家制定一项计划，以优化MBC的实施(目标1)。我们会查一查 回到诊所特定的实施团队，跟踪六个月的战略部署。然后我们将比较 MBC治疗质量在实施后的另外六个月，来自两年历史对照的数据 (目标2)。最后，我们将共同设计工具包，分别针对五种冲击方法进行实践和科学 社区(目标3)。AIMS 1和2的结果将支持合作伙伴领导的R01测试实践工作，使用 Impact工具包(在AIM 3中开发)，用于优化CMHC中的MBC保真度。在中优化MBC实现 CMHC可以通过确保在早期针对最紧迫的症状来改变青少年的精神卫生保健 治疗。

PROJECT 1 SUMMARY For youth receiving care in community mental health centers (CMHCs), comorbidities are the rule rather than the exception.1,2 Using measurement-based care (MBC) as the foundation of treatment for youth with comorbid problems significantly improves the therapeutic impact as it can help define the treatment focus. MBC is the systematic, routine evaluation of symptoms to inform care decisions. Especially in youth, MBC increases the rate of symptom improvement,3 detects clients who would otherwise deteriorate,4 and alerts clinicians to non- responders.4,5 Implementing MBC with fidelity requires 3 elements: (a) routine administration of measures for symptoms, outcomes, and processes before therapy sessions, (b) therapist and client score review, and (c) collaborative reevaluation of the treatment plan. But MBC is rarely implemented with fidelity; less than 15% of providers report using MBC per recommendations.6 Previous efforts to support MBC implementation have yielded suboptimal outcomes because CMHC leaders are challenged to identify and prioritize barriers and select strategies to overcome them. New methods are needed for identifying and prioritizing determinants, and matching strategies to determinants, to optimize MBC implementation and treatment quality to improve youth mental health outcomes in community settings. Project 1's optimization goals are to increase impact of MBC and align methods with preferences of practice partners. IMPACT Center methods will be piloted in six diverse CMHC clinics (three of six serve primarily Latinx populations). IMPACT methods we focus on include (a) rapid evidence reviews to uncover empirical data regarding MBC determinants; (b) rapid ethnography to identify and describe local determinants and situate them in specific organizational, social, and task contexts; and (c) design probes (e.g., kits with disposable camera, journals, maps) to allow practice partners and youth to capture and reflect on aspects of their context that are salient for MBC. These activities will result in a list of determinants that will be rated by partners from each clinic for criticality, chronicity, and ubiquity to generate priority scores. Subsequently, we will use facilitated group processes to develop causal pathway diagrams to match strategies to the top three determinants and clarify their preconditions, moderators, mechanisms, and proximal and outcomes (definitions in Methods Core) at each of the six clinics to yield a plan to optimize MBC implementation (Aim 1). We will check back with clinic-specific implementation teams to track strategy deployment for six months. We will then compare MBC treatment quality for another six months post implementation with data from two years of historical controls (Aim 2). Finally, we will co-design toolkits for each of the five IMPACT Methods for the practice and scientific communities (Aim 3). Results from Aims 1 & 2 will support an R01 testing practice partner-led efforts, using the IMPACT toolkits (developed in Aim 3), to optimize MBC fidelity in CMHCs. Optimizing MBC implementation in CMHCs could transform youth mental health care by ensuring the most pressing symptoms are targeted early in treatment.