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(RTCs)已经证明，循证心理疗法(EBPs)，特别是认知行为疗法(CBT)在治疗焦虑和抑郁方面非常有效，焦虑和抑郁是初级保健环境中最常见的精神健康障碍。退伍军人事务部社区门诊(CBOC)的精神卫生(MH)提供者通常位于农村地区，与教育机会隔绝。几乎一半的退伍军人现在使用CBOC。研究表明，EBPS(保真度)的交付质量影响临床结果。这项研究将测试一种计算机辅助工具(平静生活工具)，它可以提高CBT在治疗抑郁症和包括创伤后应激障碍在内的四种常见焦虑症方面的保真度。尽管一项大型随机对照试验的研究结果表明，该工具有助于提高CBT方案的保真度，但这一假设尚未得到检验。这项研究将在弗吉尼亚州VISN16的主要农村CBOC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，评估其对提供者对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提供者参与修改计算机辅助CBT工具，使其内容相关并为退伍军人和提供者所接受。我们假设，修改后的工具将被退伍军人和供应商都接受。(2)在使用和未使用该工具的提供者之间，比较MH提供者与CBT和临床结果的保真度。我们假设，使用该工具的临床医生将对CBT有更高的保真度，患者的临床结果将更好。(3)为将来在退伍军人管理局实施该工具做好准备。研究方法：本研究将采用III型混合有效性设计。教学设计与技术(IDT)领域通用的方法将被用来修改该工具。34名CBOC MH提供商将接受CBT培训，并随机选择是否使用该工具。这两个小组都将得到外部促进，以鼓励在临床层面上全面实施CBT。卫生保健提供者将治疗 每组10名患者。患者将在基线、3个月、6个月和12个月时进行评估。将衡量供应商对CBT协议的忠诚度，最后将分发今后实施该工具的工具包。影响：我们期望该干预能够提高CBOCs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.