Project 1

项目1

• 批准号: 10202084
• 负责人: Cara Charissa Lewis
• 金额: $ 20.34万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10202084
• 关键词: Address; Back; Caring; Chronic; Client; Clinic; Clinical; Collection; Communities; Community Mental Health Centers; Community Practice; Data; Development; Educational workshop; Effectiveness; Elements; Ensure; Ethnography; Evaluation; Evidence based practice; Feedback; Foundations; Goals; Group Processes; Healthcare; Hour; Intervention; Journals; Knowledge; Latinx; Maps; Measurement; Measures; Mental Health; Methods; Modeling; Monitor; Outcome; Participant; Pathway interactions; Population; Process; Provider; Recommendation; Reporting; Research Personnel; Site Visit; Structure; Symptoms; System; Testing; Therapeutic; Washington; Work; Youth; base; clinical implementation; community setting; comorbidity; dashboard; design; experience; improved; preference; social; symptomatic improvement; treatment planning; treatment response; user centered design

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.

项目1概要 对于在社区精神卫生中心（CMHC）接受治疗的青少年来说，合并症是规则，而不是 1，2使用基于测量的护理（MBC）作为青少年共病治疗的基础 问题的解决显著提高了治疗效果，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并提醒临床医生注意非 4，5忠实地实施MBC需要三个要素：（a）常规管理措施， 治疗前的症状、结果和过程，（B）治疗师和客户评分审查，和（c） 重新评估治疗计划。但是MBC很少被忠实地实现;只有不到15%的 提供商报告使用MBC的情况。6以前支持MBC实施的努力 由于CMHC领导者面临着识别障碍和确定障碍优先级的挑战， 战略来克服它们。需要新的方法来确定决定因素并确定其优先次序， 将战略与决定因素相匹配，优化MBC的实施和治疗质量， 社区环境中的心理健康结果。项目1的优化目标是增加MBC的影响， 根据实践伙伴的偏好调整方法。IMPACT中心方法将在六个不同的CMHC中进行试点 诊所（六个诊所中有三个主要为拉丁裔人口服务）。我们关注的IMPACT方法包括（a）快速证据 审查，以揭示有关MBC决定因素的经验数据;（B）快速人种志，以确定和描述 局部决定因素，并在特定的组织，社会和任务背景下对它们进行分析;（c）设计探测器 (e.g.,包括一次性相机、日志、地图在内的工具包），让实践伙伴和青年捕捉和反思 他们的背景方面，是突出的MBC。这些活动将产生一系列决定因素， 由来自每个诊所的合作伙伴对关键性、慢性性和普遍性进行评级，以生成优先级分数。随后，委员会注意到， 我们将使用促进小组过程来开发因果路径图，以将策略与前三项相匹配 决定因素，并澄清其先决条件，主持人，机制，以及近端和结果（定义 方法核心）在六个诊所的每一个产生一个计划，以优化MBC的实施（目标1）。我们将检查 与诊所特定的实施团队一起返回，以跟踪六个月的战略部署。我们将比较 实施后6个月的MBC治疗质量，数据来自两年的历史对照 (Aim 2）。最后，我们将为五种IMPACT方法中的每一种方法共同设计工具包， 社区（目标3）。目标1和2的结果将支持R 01测试实践合作伙伴领导的工作，使用 IMPACT工具包（在目标3中开发），用于优化CMHC中的MBC保真度。优化MBC实施， CMHC可以通过确保最紧迫的症状在早期就被针对来改变青少年心理健康护理。 治疗