Project 2

项目2总结 三分之一的儿童和青少年在他们的一生中经历过精神健康障碍。尽管一个 已经开发了许多基于证据的实践(EBP)来解决精神健康障碍 在儿童和青少年中，它们在社区环境中并不常见。要提高可用性， 在循证医学计划中，实施工作往往侧重于临床医生培训。然而，研究一直是恶魔- 表明低资源社区环境需要额外的支持，而不是以临床医生为重点的努力，以促进 用忠诚度来实现EBPS。华盛顿州EBP倡议(“该倡议”)是Impact合作伙伴，提供 四种常见认知行为疗法(CBT)对社区精神卫生中心临床医生的培训 青少年心理健康状况：焦虑、创伤后应激、行为困难和抑郁。我们建议 为了与优化执行指导的倡议合作，由 PI支持社区精神卫生中心为其制定建议的实施策略 组织。培训的目标是为CBT创造一个积极的实施环境，导致高- 忠诚度CBT交付和对青年的积极成果。定义为创新(CBT)的程度 预期、支持和回报的实施氛围是实现高绩效的重要理论机制 高质量实施。教练通过与一线的CMHC主管合作为CMHC提供支持 组织中的领导者。我们将首先与在CBT实施方面经验丰富的CMHC主管合作- 使用Ideation优化教练，这是一种影响挑战III的方法。指导需要优化- 前测试：(1)确保最适合低资源的CMHC，2)由具有CBT经验的同行领导CMHC 主管(目标1)。使用培训-培训者的方法，我们培训和支持10个协作的子集 CMHC从目标1监督到领导教练。然后，我们在试点中测试优化的教练干预 参与倡议的20家社区卫生保健机构(20名主管，至少60名临床医生)参与的随机对照试验，检查 对青少年CBT保真度和临床结果的影响(目标2)。我们比较标准计划的实施情况 支持这些标准支持(10个CMHC)，外加指导(10个CMHC)。我们使用常规输入的，去掉- 确定了评估CBT保真度和临床结果的数据。在教练的条件下，同行经历了CBT CMHC主管将带领一小群主管进行指导。教练员将使用影响挑战赛 II工具包，与实践合作伙伴共同设计，为他们的指导活动提供信息。预期结果包括 优化的指导战略，可以整合到倡议的标准实施支持和 在全国范围内向更广泛的实践界传播。学习目标还提供完善IM的机会- 项目3的PACT方法和工具包，用于我们的试验计划，并传播到实践和科学 社区。如果有效，由同行主管提供的指导可以大规模实施，甚至有可能 可持续的，以加快青年的治疗质量和结果。

PROJECT 2 SUMMARY One-third of children and adolescents experience a mental health disorder in their lifetime. Although a number of evidence-based practices (EBPs) have been developed that could address mental health disorders in children and adolescents, they are not commonly available in community settings. To increase the availability of EBPs, implementation efforts have often focused on clinician training. However, research consistently demon- strates that low-resource community settings need additional supports beyond clinician-focused efforts, to im- plement EBPs with fidelity. The Washington State EBP Initiative (“the Initiative”), an IMPACT partner, provides clinician training for community mental health centers in Cognitive Behavioral Therapy (CBT) for four common youth mental health conditions: anxiety, posttraumatic stress, behavioral difficulties, and depression. We propose to partner with the Initiative to optimize Implementation Coaching, an intervention developed and piloted by the PI to support community mental health centers in tailoring recommended implementation strategies for their organization. The goal of Coaching is to generate a positive implementation climate for CBT, leading to high- fidelity CBT delivery and positive outcomes for youth. Defined as the degree to which an innovation (CBT) is expected, supported, and rewarded, implementation climate is an important theoretical mechanism for high- quality implementation. Coaching supports CMHCs through working with CMHC supervisors who are frontline leaders in their organizations. We will first collaborate with CMHC supervisors experienced in CBT implementa- tion to optimize Coaching using Ideation, an IMPACT Challenge III method. Coaching requires optimization be- fore testing: (1) to ensure the best fit for low-resource CMHCs and 2) to be led by peer, CBT-experienced CMHC supervisors (Aim 1). Using a Train-the Trainer approach, we train and support a subset of the 10 collaborating CMHC supervisors from Aim 1 to lead Coaching. We then test the optimized Coaching intervention in a pilot RCT involving 20 CMHCs participating in the Initiative (20 supervisors, at least 60 of their clinicians), examining impact on CBT fidelity and clinical outcomes for youth (Aim 2). We compare standard Initiative implementation supports (10 CMHCs) to these standard supports plus Coaching (10 CMHCs). We use routinely entered, de- identified data to assess CBT fidelity and clinical outcomes. In the Coaching condition, peer CBT-experienced CMHC supervisors will lead Coaching with small groups of supervisors. Coaches will use an IMPACT Challenge II toolkit, co-designed with practice partners to inform their Coaching activities. Expected outcomes include an optimized Coaching strategy that could be integrated into the Initiative's standard implementation support and disseminated to the broader practice community nationally. Study aims also provide opportunities to refine IM- PACT methods and toolkits for Project 3, use in our pilot program, and dissemination to the practice and scientific communities. If effective, Coaching delivered by peer supervisors can be implemented at scale and potentially sustainable to accelerate treatment quality and outcomes for youth.