Combining an Evidenced Based Treatment with a Measurement Feedback System

将循证治疗与测量反馈系统相结合

• 批准号: 8130586
• 负责人: Leonard Bickman
• 金额: $ 62.07万
• 依托单位: VANDERBILT UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-01 至 2015-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8130586
• 关键词: Address; Adherence; Adolescent; Affect; Attention; Attitude; Behavior; Behavioral; Belief; Caregivers; Characteristics; Client; Clinic; Clinical; Clinical Treatment; Clinical Trials; Communities; Computer Simulation; Data; Development; Educational Intervention; Evidence based treatment; Experimental Designs; Family; Family psychotherapy; Feedback; Foundations; Funding; Goals; Grant; Health system; Healthcare; Indiana; Intervention; Justice; Lead; Licensing; Life; Measurement; Measures; Mediator of activation protein; Mental Health; Mental Health Services; Modeling; National Institute of Mental Health; Outcome; Population; Process; Protocols documentation; Provider; Quasi-experiment; Randomized; Research; Research Personnel; Self Efficacy; Services; Site; Staff Attitudes; Stress; Supervision; System; Testing; Therapeutic; Universities; Work; Youth; base; clinical application; clinical decision-making; community setting; computerized; cost; evidence base; experience; falls; improved; information processing; innovation; operation; public health relevance; standardize measure; theories; treatment adherence; treatment as usual

DESCRIPTION (provided by applicant): The recent, poor meta-analytic results of evidence-based treatment (EBT) represent a crisis in youth mental health services. There is a dire need for innovative approaches to improving transportability, implementation, and outcomes of services. Model adherence (EBT fidelity) is a necessary but not sufficient mechanism for improving outcomes in community settings. Real-world mental health treatment requires attention to the complexities inherent in the interaction between unique settings, therapists, and clients. As such, therapists implementing EBTs need better support for clinical decision making that may lead to adaptations of the EBT in the service of tailoring treatment. A measurement feedback system (MFS) provides the ongoing treatment progress and process information necessary to assist the therapist in making treatment decisions. As a benefit to the MFS, the EBT provides an essential framework for integration of systematic data into logistical, clinical, and supervisory operations. The synergy of the combination of an MFS and an EBT should improve transportability of EBT, implementation of MFS, and youth and family outcomes. We will integrate an existing EBT [and an existing MFS. The EBT is Functional Family Therapy (FFT), an empirically supported intervention for youths in the juvenile justice and mental health systems. Model-specific data on treatment adherence and progress are provided in the FFT Q-system, a computerized model-specific quality improvement system. The MFS is Contextualized Feedback Intervention and Training (CFIT), which provides computerized feedback on treatment progress and process upon weekly completion of brief standardized measures administered to youths, caregivers, and therapists.] We will determine if this innovative combination has the desired synergistic effect on the provider organizations, therapist behavior, and youth/family outcomes in a community mental health agency with 4 sites where 102 therapists will serve over 4000 youths during the life of the study. A current foundation grant is supporting the development and testing of a computerized system that integrates both existing feedback systems. That work will be complete[d in January 2010]. Therapists will be randomly assigned to one of two groups: (1) Basic FFT (FFT only) or (2) Enhanced FFT (FFT + CFIT). Feedback for the Basic FFT condition includes adherence only, consistent with the typical FFT supervision protocol. For the Enhanced FFT condition, feedback also includes information on youth treatment progress and process This study will address the changes in therapist behavior and youth/family outcomes that may result from providing two different types of therapist feedback in community mental health agencies. The proposed project also includes a low-cost quasi-experimental design comparing implementation of CFIT in this study with a current NIMH study where CFIT is implemented in the absence of an EBT. PUBLIC HEALTH RELEVANCE: Evidence-based treatments (EBTs) have not reached their potential to improve the outcomes for clients in community mental health treatment settings. There is a crisis in youth mental health services demanding innovative approaches for improving transportability, implementation, and outcomes of clinical treatments. The proposed study tests whether adding a measurement feedback system (MFS) that provides feedback on the therapeutic process and outcomes, to an existing EBT that only measures model adherence, improves therapist behavior and ultimately youth/family outcomes.

描述（由申请人提供）：最近，基于证据的治疗（EBT）的荟萃分析结果不佳，代表了青年心理健康服务的危机。迫切需要采取创新办法，改善服务的可运输性、执行情况和成果。模型坚持（EBT的忠诚度）是一个必要的，但不是足够的机制，以改善社区环境中的结果。现实世界的心理健康治疗需要注意独特的环境，治疗师和客户之间的相互作用中固有的复杂性。因此，实施EBT的治疗师需要更好地支持临床决策，这可能导致EBT在定制治疗服务中的适应性调整。测量反馈系统（MFS）提供正在进行的治疗进展和过程信息，以帮助治疗师做出治疗决策。作为MFS的一个优势，EBT为将系统数据整合到后勤、临床和监督操作中提供了一个必要的框架。MFS和EBT相结合的协同作用应改善EBT的可移植性，MFS的实施以及青年和家庭的成果。我们将整合现有的EBT [和现有的MFS。EBT是功能性家庭治疗（FFT），这是一种针对青少年司法和精神卫生系统中的青少年的经验支持干预。关于治疗依从性和进展的模型特定数据在FFT Q系统中提供，FFT Q系统是一种计算机化的模型特定质量改进系统。MFS是情境化反馈干预和培训（CFIT），它在每周完成对青少年，护理人员和治疗师的简短标准化措施后，提供有关治疗进展和过程的计算机化反馈。我们将确定这种创新的组合是否对社区精神卫生机构的提供者组织，治疗师行为和青少年/家庭结果具有预期的协同效应，该机构有4个站点，其中102名治疗师将在研究期间为4000多名青少年提供服务。目前基金会的一笔赠款正在支持开发和测试一个计算机化系统，该系统将现有的两个反馈系统结合起来。这项工作将于2010年1月完成。治疗师将被随机分配到两组之一：（1）基本FFT（仅FFT）或（2）增强FFT（FFT + CFIT）。基本FFT条件的反馈仅包括遵守，与典型的FFT监督协议一致。对于增强FFT条件，反馈还包括信息的青年治疗进展和过程本研究将解决治疗师的行为和青年/家庭的结果，可能会导致提供两种不同类型的治疗师反馈社区精神卫生机构的变化。拟议的项目还包括一个低成本的准实验设计比较CFIT在本研究中的实施与目前的NIMH研究CFIT是在没有EBT的情况下实施。 公共卫生关系：循证治疗（EBT）尚未发挥其潜力，以改善社区精神卫生治疗环境中客户的结果。青年心理健康服务存在危机，需要创新的方法来改善临床治疗的可移植性、实施和结果。拟议的研究测试是否增加一个测量反馈系统（MFS），提供反馈的治疗过程和结果，现有的EBT，只测量模型的坚持，改善治疗师的行为，并最终青年/家庭的结果。