Implementing Feedback Interventions to Improve Outcomes

描述（由申请人提供）：我们拟研究一种理论驱动和实证为基础的反馈干预对提供家庭青少年心理健康服务的辅导员认知和行为的影响。对咨询师的反馈将基于客户对治疗联盟的评分。改善的治疗关系预计对青少年的心理健康有积极的影响。改善心理健康结果的主要方法是在“现实世界”中传播和实施有效的治疗方法。该建议提供了一种对组织环境敏感的改进服务结果的方法。在许多学科的数千项研究中，对表现的反馈已被证明可以提高表现。然而，在一项研究的试验中，反馈导致了表现的下降。要理解反馈效应的异质性，需要对反馈有一个理论上的理解。通过对认知、社会、组织心理学和管理学的基础和应用研究的回顾，我们建立了一个理论模型，旨在阐明和优化反馈对心理健康服务提供者绩效的影响。我们建议靶向治疗联盟（TA），因为它是与积极临床结果相关的最一致的常见治疗因素。我们将对反馈青少年TA评分给辅导员的效果进行2x2随机因子研究。在研究1中，辅导员将被随机分配到“反馈”或“无反馈”的环境中。网站也将被随机分配到“高参与度”或“低参与度”的条件下，在这种情况下，他们的主管会或不会收到客户产生的反馈。我们的模型预测了这两个因素之间的相互作用，这两个因素应该会在咨询师的认知和行为上产生最大的变化，在症状和功能上产生最大的改善。研究2将使用相同的设计来测试除了反馈之外，教育成分（助教辅导员手册）是否会对来访者对助教的评价和随后的治疗结果产生更大的积极影响。我们认为，这项研究既基于理论，又与心理健康提供者高度相关。它为改善精神卫生服务提供了一种创新方法。

DESCRIPTION (provided by applicant): We propose to study the effects of a theory-driven and empirically-based feedback intervention to influence the cognition and behavior of counselors who provide in-home mental health services to adolescents. The feedback to counselors will be based on client ratings of therapeutic alliance. An improved therapeutic relationship is predicted to have a positive effect on the youth's mental health. The predominant approach to improving mental health outcomes is to disseminate and implement efficacious treatments into the "real world". This proposal offers an approach to improving outcomes of services that is sensitive to the organizational context. Feedback on performance has been shown to improve performance in thousands of studies across many disciplines. However, in a trial of the studies feedback resulted in a decrease in performance. A theoretical understanding of feedback is required to understand the heterogeneity of the effect of feedback. Through a review of basic and applied research in cognitive, social, organizational psychology, and management we have developed a theoretical model that aims to elucidate and optimize the effects of feedback on the performance of mental health service providers. We propose to target therapeutic alliance (TA), as it is the most agreed upon common treatment factor associated with positive clinical outcomes. We will conduct a 2x2 randomized factorial study of the effects of feeding back the youth's TA ratings to the counselor. In Study 1, counselors will be randomly assigned by site to either a "feedback" or a "no feedback" condition. Sites will also be randomly assigned to a "high involvement" or "low involvement" condition in which their supervisor does or does not receive the client-generated feedback. Our model predicts an interaction effect between these two factors that should produce the largest change in counselor cognitions and behavior and the greatest improvement in symptoms and functioning. Study 2 will utilize the same design to test whether an educational component (TA counselor's manual) in addition to feedback will have an even greater positive effect on client ratings of TA and subsequent treatment outcomes. We believe that this research is both theory-based and highly relevant to mental health providers. It offers an innovative approach to improving mental health services.