TRANSPORTABILITY OF NEW TREATMENTS: MST AS A TEST CASE

本研究探讨了一个复杂的家庭为基础的心理健康治疗，多系统治疗（MST），社区设置的有效运输相关的因素。因此，这项研究直接解决了临床（心理治疗）和心理健康服务研究中的主要差距，这些研究涉及将有效的治疗方法转化为有效的心理健康服务。MST已被证明有效地改善儿童行为和家庭功能的随机试验与青年经历严重的临床问题。在三项针对暴力和慢性少年犯的随机试验中，MST降低了长期再逮捕率和家庭外安置率，并改善了儿童行为和家庭功能。早期的随机试验证明了MST在治疗虐待/忽视儿童和青少年性犯罪者方面的前景，一项正在进行的研究正在评估其作为精神病住院治疗替代方案的有效性。为了响应政策制定者和提供者制定MST方案的需求，在8个州和加拿大建立了27个方案，每年为1 500名青年和家庭提供服务。最近对MST的研究表明，临床医生对MST治疗方案的依从性与年轻人的良好结局之间存在显著相关性。因此，在将模型及其有利结果转移到常规护理环境中的最大挑战是确定支持MST干预的保真度的组织和组织外条件。具体来说，本研究将检查儿童和与MST相关的结果，由临床医生在26个项目中提供。参与者将是2550名被转介到MST项目的青年和家庭以及这些项目雇用的临床医生和管理人员。将使用多方法多源测量组合来检查组织和组织外因素，这些因素被认为支持对MST和伴随儿童结局的保真度。本研究的目的是：1）。记录临床医生对特定治疗模式的依从性与常规护理环境中儿童结局之间的关系; 2）。检查组织内变量对临床医生依从性的影响; 3）。考察与可迁移性相关的组织变量在多大程度上受到选定的组织外因素的影响; 4）。检查临床医生变量对依从性的影响; 5）。测试一个治疗效果的中介模型，其中组织内和组织外因素以及个体临床医生变量对结果的影响是由临床医生依从性介导的。

This study examines the factors associated with the effective transport of a complex family-based mental health treatment, Multisystemic Therapy (MST), to community settings. As such, the study directly addresses major gaps in both clinical (psychotherapy) and mental health services research pertaining to the translation of efficacious treatments to effective mental health services. MST has proven effective in improving child behavior and family functioning in randomized trials with youth experiencing serious clinical problems. In three randomized trials with violent and chronic juvenile offenders, MST reduced long-term rates of rearrest and out-of-home placement and improved child behavior and family functioning. Earlier randomized trials demonstrated the promise of MST in treating child abuse/neglect and juvenile sex offenders, and an ongoing study is evaluating its effectiveness as an alternative to psychiatric hospitalization. In response to demand from policy makers and providers to develop MST programs, 27 programs serving 1500 youth and families annually have been established in 8 states and Canada. Recent research on MST has demonstrated a significant association between clinicians' adherence to the MST treatment protocol and favorable outcomes for youth. Thus, the foremost challenge in transporting the model and its favorable outcomes to usual care settings is determining the organizational and extra- organizational conditions that support the fidelity of MST interventions. Specifically, this study will examine the child and outcomes associated with MST as delivered by clinicians in 26 programs. Participants will be 2550 youth and families referred to MST programs and the clinicians and administrators employed by those programs. A multi-method multi-source measurement battery will be used to examine the organizational and extra-organizational factors thought to support fidelity to MST and concomitant child outcomes. The aims of this study are to: 1). Document the relationship between clinician adherence to a specific treatment model and child outcomes in usual care settings; 2). Examine the impact of intra-organizational variables on clinician adherence; 3). Examine the extent to which organizational variables relevant to transportability are influenced by selected extra-organizational factors; 4). Examine the influence of clinician variables on adherence; 5). Test a mediation model of treatment effectiveness in which the impact of intra- and extra-organizational factors and individual clinician variables on outcomes is mediated by clinician adherence.