Testing a System-level Implementation Intervention to Improve the Quality of Family-Based Services for Adolescent Substance Use

测试系统级实施干预措施，以提高针对青少年药物使用的家庭服务质量

• 批准号: 10403185
• 负责人: Aaron Hogue
• 金额: $ 1.25万
• 依托单位: PARTNERSHIP TO END ADDICTION
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-15 至 2021-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10403185
• 关键词: Achievement; Adolescent; Adoption; Caregivers; Client; Clinic; Clinical; Cluster randomized trial; Code; Cognitive Therapy; Data; Data Collection; Ensure; Family; Family member; Family psychotherapy; Feedback; Fostering; Goals; Government; Hour; Internships; Intervention; Measurement; Methods; National Institute of Drug Abuse; New York; Outcome; Positioning Attribute; Prevention; Problem behavior; Procedures; Recovery; Reporting; Research; Research Personnel; Resources; Services; Site; Strategic Planning; System; Techniques; Testing; Therapeutic; Training; Training Activity; Work; adolescent substance use; archive data; archived data; base; care systems; data archive; data management; data warehouse; design; effectiveness testing; evidence base; family support; follow-up; implementation intervention; implementation strategy; improved; innovation; interest; loved ones; meetings; posters; public health priorities; public health relevance; quality assurance; randomized trial; service delivery; substance use; substance use treatment; symposium; treatment as usual; treatment services; treatment site

Abstract This R34 study will first develop treatment quality assurance procedures designed to increase the adoption and quality of empirically supported family-based services (FBS) for adolescent substance use (ASU) in usual care, and then test two system-level implementation strategies for installing the new quality procedures in ASU treatment sites. FBS have achieved the strongest evidence base for treating ASU and are a prime candidate for upgrading the quality of ASU services in various systems of care. FBS comprise both family participation in services, the systemic parameters wherein family members are included in assessment and treatment activities; and family therapy techniques, the specific interventions that clinicians use to directly target family members and family functioning for change. For FBS to fulfill their potential to enhance ASU treatment systems, FBS implementation must be supported by effective quality assurance (QA) procedures designed to ensure that FBS are delivered with fidelity. To advance this effort, the proposed study will leverage a strong research-government partnership between the applicant organization and the New York single-state agency for SU services. The study will first develop innovative QA procedures (Aim 1) that use existing FBS quality metrics to promote high-fidelity FBS: Measurement Feedback System for Implementation (MFS-I), a pragmatic evidence-based method for increasing FBS quality by providing monthly feedback on therapist-reported FBS delivery along with brief online FBS training modules. The study will then experimentally compare two systemlevel implementation strategies designed to foster MFS-I utilization in usual care for ASU. Core Training Only will contain two 3-hour training sessions: Mapping existing FBS and identifying site goals for FBS improvement; and Installing and sustaining the MFS-I. Core + Facilitation is an additive strategy that will begin with the Core Training sessions and then continue with monthly facilitation meetings for one year to promote MFS-I use and progress toward FBS improvement. The study will feature a three-group cluster randomized trial testing Core Training Only versus Core + Facilitation versus no-intervention Control in 15 representative ASU clinics across New York State. MFS-I utilization data will be collected from Core Training and Core + Facilitation sites for one-year follow-up (after initial Core Training); FBS quality data on family participation and family therapy technique use will be collected from all sites over one-year follow-up; and client outcome data for all sites will be retrieved from administrative data warehouses over one-year baseline and one-year follow-up. These data will enable between-condition comparisons of FBS delivery (Aim 2: MFS-I utilization, family participation, family therapy technique use) and client outcomes (Aim 3: therapeutic goal achievement, substance use change). If study aims are achieved, investigators would be positioned to mount a fully powered RCT to test the effectiveness of these FBS quality improvement procedures at scale. Description of Intern Work 1. Use archived data from the research lab to formulate an original research hypothesis and develop a poster submission to a national conference of interest to the Intern. 2. Serve as an observational fidelity coder for an ongoing randomized trial of a fidelity training and feedback system for pragmatic delivery of core techniques of family therapy and cognitive-behavioral therapy for adolescent behavioral problems. 3. Assist in online training, data collection, and data management activities with partnering clinical agencies for an ongoing randomized trial of a fidelity training and feedback system for pragmatic delivery of core techniques of family therapy and cognitive-behavioral therapy for adolescent behavioral problems. 4. Assist in creating a public-facing data archive of family support service resources aimed at caregivers interested in prevention, treatment, and/or recovery from substance use issues among their loved ones.

抽象的 这项 R34 研究将首先开发治疗质量保证程序，旨在提高采用率 通常情况下针对青少年药物使用（ASU）的经验支持的基于家庭的服务（FBS）的质量 护理，然后测试在 ASU 中安装新质量程序的两个系统级实施策略 治疗地点。 FBS 已获得治疗 ASU 的最强有力的证据基础，是主要候选者 提升 ASU 在各个护理系统中的服务质量。 FBS 包括家庭参与 在服务中，将家庭成员纳入评估和治疗的系统参数 活动;和家庭治疗技术，临床医生用来直接针对家庭的具体干预措施 成员和家庭致力于变革。让 FBS 发挥其增强 ASU 治疗的潜力 系统，FBS 的实施必须得到有效的质量保证 (QA) 程序的支持，该程序旨在 确保 FBS 保真交付。为了推进这项工作，拟议的研究将利用强大的 申请组织与纽约单一州机构之间的研究-政府合作伙伴关系 苏服务。该研究将首先开发利用现有 FBS 质量的创新 QA 程序（目标 1） 促进高保真 FBS 的指标：实施测量反馈系统 (MFS-I) 通过每月提供治疗师报告的 FBS 反馈来提高 FBS 质量的循证方法 连同简短的在线 FBS 培训模块一起交付。然后该研究将通过实验比较两种 系统级 旨在促进 ASU 日常护理中 MFS-I 利用率的实施策略。仅核心训练 将包含两个 3 小时的培训课程：绘制现有 FBS 并确定 FBS 的站点目标 改进;安装和维护 MFS-I。核心 + 促进是一种附加策略，它将 从核心培训课程开始，然后继续每月举行一年的促进会议，以 促进 MFS-I 的使用并在 FBS 改善方面取得进展。该研究将分为三组 随机试验在 15 人中测试仅核心训练与核心 + 促进与无干预对照 纽约州的代表性亚利桑那州立大学诊所。 MFS-I 利用率数据将从核心训练中收集 以及用于一年后续行动的核心 + 促进网站（在初始核心培训之后）； FBS 家庭质量数据 将从所有地点收集一年随访期间的参与和家庭治疗技术使用情况；和客户 所有站点的结果数据将从一年基线的行政数据仓库中检索， 一年的随访。这些数据将使 FBS 递送的条件间比较成为可能（目标 2：MFS-I 利用率、家庭参与、家庭治疗技术的使用）和客户结果（目标 3：治疗目标 成就、物质使用变化）。如果研究目标得以实现，研究人员将能够开展一项研究 全面的 RCT 大规模测试这些 FBS 质量改进程序的有效性。 实习工作描述 1. 使用研究实验室的存档数据制定原始研究假设并开发 向实习生感兴趣的全国会议提交海报。 2. 担任观察保真度编码员，进行保真度训练和随机试验 用于实用地提供家庭治疗和认知行为核心技术的反馈系统 青少年行为问题的治疗。 3. 协助临床合作伙伴进行在线培训、数据收集和数据管理活动 机构正在进行一项针对务实的忠诚度培训和反馈系统的随机试验 提供家庭治疗和青少年行为认知行为治疗的核心技术 问题。 4. 协助建立面向公众的面向照顾者的家庭支持服务资源数据档案 对亲人的药物使用问题的预防、治疗和/或康复感兴趣。