A Computer-Assisted Cognitive Behavioral Therapy Tool to Enhance Fidelity in CBO

描述（由申请人提供）： 背景和意义：随机对照试验（RTC）已经证明，循证心理疗法（EBP），特别是认知行为疗法（CBT），在治疗焦虑和抑郁症方面非常有效，这是初级保健环境中最常见的心理健康疾病。VA社区门诊诊所（CBOCs）的心理健康（MH）提供者通常位于农村地区，与教育机会隔绝。 现在几乎有一半的退伍军人使用CBOC。研究表明，EBP的交付质量（保真度）影响临床结果。这项研究将测试一种计算机辅助工具（CALM Tools for Living），该工具在治疗抑郁症和四种常见的焦虑症（包括PTSD）时增加了对CBT的忠诚度。尽管一项大型随机对照试验（CALM研究）的结果表明，该工具有助于提高CBT协议的保真度，但这一假设尚未得到验证。这项研究将在弗吉尼亚州VISN 16的主要农村社区组织中测试该工具。 目的：修改计算机辅助CBT工具，以满足CBOC MH提供者和退伍军人的需求，评估对提供者对CBT模型和临床结果的忠诚度的影响，并评估如何最好地支持未来的实施。 具体目标/假设：（1）让CBOC MH供应商修改计算机辅助CBT工具，使其内容与退伍军人和供应商相关并可接受。 我们假设，修改后的工具将是可接受的退伍军人和供应商。(2)比较MH提供者对CBT的忠诚度以及使用该工具和未使用该工具的提供者的临床结果。我们假设使用该工具的临床医生对CBT有更高的保真度，患者的临床结局将是上级。(3)为将来在VA中实施该工具做好准备。 方法：本研究将采用III型混合有效性设计。将使用教学设计与技术（IDT）领域常见的方法来修改该工具。34名CBOC MH提供者将接受CBT培训，并随机使用该工具。这两个群体都将获得外部促进，以鼓励在诊所层面全面实施CBT。MH供应商将治疗 10个病人。将在基线、3个月、6个月和12个月时对患者进行评估。将衡量提供者对CBT协议的忠诚度，最后，将分发一个工具包，供今后实施该工具。 影响：我们希望干预措施能够提高CBOC中MH治疗的技术质量，并改善退伍军人的临床结果。

DESCRIPTION (provided by applicant): Background and Significance: Randomized Controlled Trials (RTCs) have demonstrated that evidence-based psychotherapies (EBPs), particularly Cognitive Behavioral Therapy (CBT), are highly effective in treating anxiety and depression, the most common mental health disorders in primary care settings. Mental health (MH) providers in VA Community-Based-Out-Patient-Clinics (CBOCs) are often located in rural areas and isolated from educational opportunities. Almost half of Veterans now use CBOCs. Studies have shown that the quality of delivery of EBPs (fidelity) impacts clinical outcomes. This study will test a computer-assisted tool (CALM Tools for Living) that increases fidelity to CBT in treating depression and four common anxiety disorders, including PTSD. Although results of a large RCT, the CALM study, suggested that the tool contributed to fidelity to the CBT protocol, this hypothesis has not been tested. This study will test the tool in primarily rural CBOCs in VA VISN16. Objective: To modify a computer-assisted CBT tool to meet the needs of CBOC MH providers and Veterans, to evaluate the impact on providers' fidelity to the CBT model and clinical outcomes, and to assess how best to support future implementation. Specific Aims/Hypothesis: (1) Engage CBOC MH providers in modifying the computer-assisted CBT tool such that its content is relevant and acceptable to Veterans and providers. We hypothesize that the modified tool will be acceptable to both Veterans and providers. (2) Compare MH provider fidelity to CBT and clinical outcomes among providers who used the tool and those who did not. We hypothesize that clinicians who use the tool will have a higher fidelity to CBT and clinical outcomes among patients will be superior. (3) Prepare for future implementation of the tool in the VA. Methodology: This study will use a Type III hybrid effectiveness design. Methods common to the field of Instructional Design and Technology (IDT) will be used to modify the tool. Thirty-four CBOC MH providers will be trained in CBT and randomized to use the tool or not. Both groups will receive external facilitation to encourage the full implementation of CBT into practice on the clinic level. MH providers will treat 10 patients each. Patients will be assessed at baseline, 3, 6, and 12 months. Provider fidelity to the CBT protocol will be measured, and finally, a tool kit for future implementation of the tool wil be disseminated. Impact: We expect the intervention to improve the technical quality of MH treatment in CBOCs and improve clinical outcomes among Veterans.