Implementing Feedback Interventions to Improve Outcomes

描述（由申请人提供）：我们建议研究理论驱动和基于实践的反馈干预的效果，以影响为青少年提供家庭心理健康服务的咨询师的认知和行为。 对咨询师的反馈将基于治疗联盟的客户评级。 改善治疗关系预计对青年的心理健康有积极影响。 改善心理健康结果的主要方法是在“真实的世界”中传播和实施有效的治疗。 这项建议提出了一种改进服务成果的办法，这种办法对组织环境具有敏感性。 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，在一项试验的研究反馈导致性能下降。 要理解反馈效应的异质性，需要对反馈有理论上的理解。 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，我们开发了一个理论模型，旨在阐明和优化反馈对心理健康服务提供者绩效的影响。 我们建议以治疗联盟（TA）为目标，因为它是与积极临床结局相关的最常见的治疗因素。 我们将进行一项2x2随机析因研究，研究将青少年的TA评分反馈给辅导员的影响。 在研究1中，将由研究中心将辅导员随机分配到“反馈”或“无反馈”条件下。 还将随机将研究中心分配到“高参与度”或“低参与度”条件下，在该条件下，其主管接收或不接收客户生成的反馈。 我们的模型预测了这两个因素之间的相互作用效应，应该产生最大的变化，在咨询师的认知和行为和最大的改善症状和功能。 研究2将利用相同的设计，以测试是否教育组件（TA辅导员的手册），除了反馈将有一个更大的积极影响客户评级TA和随后的治疗结果。 我们认为，这项研究是基于理论和高度相关的心理健康提供者。 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.