IMPLEMENTATION OF COGNITIVE PROCESSING THERAPY FOR PTSD IN DIVERSE COMMUNITIES

描述（由申请人提供）：这是一个指导的以患者为导向的研究职业发展奖（K23）的应用程序，重点是在一个多元化的社区精神卫生诊所（CMHC）内实施认知加工疗法（CPT）（1）治疗创伤后应激障碍（PTSD）。候选人建议建立在她的经验治疗不同的创伤后应激障碍患者通过获得实施科学的培训与缩小研究实践差距，从而减少健康差距的长期职业目标。CPT是PTSD的两种一线经验治疗（EBT）之一。CPT已在创伤类型、语言和人群中显示出疗效（1-3）和有效性（4）。然而，大多数社区精神卫生工作者（CMHWs）很少接受EBT（如CPT）的培训，或在日常实践中使用它们。这项研究是建立一个框架的第一步，以系统的方式利用既定的执行理论（例如，（5-10））了解和解决CMHC实施CPT的障碍。研究计划：主要研究采用混合方法迭代设计，早期实施阶段的数据分析用于评估和改进后续实施工作。具体来说，目前的研究混合了三个不同的实施框架：（1）复制有效的计划（REP）框架（5-8，11-14）;（2）实施研究的综合框架（CFIR;（9））;和（3）普罗克特等人，实施结果变量的分类法（10），以指导迭代开放式试点实施研究，旨在解决以下具体目标：1）在不同CMHC中预实施CPT之前，使用混合方法方法识别、评估和解决组织背景和提供者级别的实施障碍和促进因素; 2）进一步调整和预先测试干预方法和材料与不同的供应商和病人在英语和西班牙语; 3）培训CMHW并对修改后的手动执行协议的可行性和可接受性进行试点测试，并初步探索其对患者预后的影响。我们计划在未来的RO 1中评估该最终实施方案在不同CMHC中的可推广利用。工作环境：该研究将在马萨诸塞州总医院（MGH）和MGH切尔西心理健康诊所进行，并将在导师Naomi Simon，Marty Charns和Debra Kaysen博士的指导下补充培训和监督研究计划，并咨询社区研究，CPT和文化能力专家。职业发展计划：以下领域的培训将强调候选人长期目标所需的技能，成为在不同社区实施EBT的专家，并为未来的独立调查奠定基础：1）实施科学方法和理论框架; 2）CMHC中CPT的实施; 3）治疗师监督/领导; 4）临床试验的文化能力;（5）混合方法数据分析。 公共卫生相关性：数以百万计的美国人患有创伤后应激障碍，但许多人没有接受一线，有效的循证心理治疗，如认知加工疗法（CPT），由于缺乏培训和实施这些循证心理治疗在社区精神卫生设置。挑战包括需要能够在不同人群中实施这些有时间限制的有效疗法，并增加社区中获得这些治疗的机会。这项职业发展补助金将侧重于制定战略，在多样化的社区环境中实际和成功地实施CPT治疗PTSD，并为候选人提供实施科学所需的培训，使其成为转化研究人员，重点是将PTSD的循证心理疗法从研究诊所转移到社区的有效实施。

DESCRIPTION (provided by applicant): This is an application for a Mentored Patient-Oriented Research Career Development Award (K23) with a focus on the implementation of cognitive processing therapy (CPT)(1) for post-traumatic stress disorder (PTSD) within a diverse community mental health clinic (CMHC). The candidate proposes to build upon her experience treating diverse PTSD patients by obtaining training in implementation science with the long-term career goal of narrowing the research-practice gap and, consequently, decreasing health disparities. CPT is one of two first line empirically based treatments (EBTs) for PTSD. CPT has shown efficacy(1-3) and effectiveness(4) across trauma types, languages, and populations. However, most community mental health workers (CMHWs) receive little, if any, training in EBTs such as CPT or use them in daily practice. This study is an initial step in creating a framework to address this implementation gap in a systematic manner drawing on established implementation theory (e.g., (5-10)) to understand and address barriers to implementing CPT in CMHCs. Research Plan: The primary study has a mixed-method iterative design with data analysis from earlier implementation stages used to evaluate, and refine subsequent implementation efforts. Specifically, the current study blends three distinct implementation frameworks: (1)Replicating Effective Programs (REP) framework(5-8, 11-14); (2)Consolidated Framework for Implementation Research (CFIR;(9)); and (3)Proctor et al., taxonomy for implementation outcome variables(10), to guide an iterative open pilot implementation study designed to address the following Specific Aims: 1)To identify, assess, and address organizational context and provider level barriers and facilitators of implementation using a mixed-methods approach prior to the pre-implementation of CPT in a diverse CMHC; 2)Further adapt and pre-test intervention methods and materials with diverse providers and patients in English and Spanish; and 3)Train CMHWs and pilot test the feasibility and acceptability of the modified manualized implementation protocol, and to initially explore its effect on patient outcome. We plan to evaluate this final implementation protocol for generalizable utilization across diverse CMHCs in a future RO1. Environment: The study will be based at the Massachusetts General Hospital (MGH) and the MGH Chelsea Mental Health Clinic and will complement a program of training and supervised research under mentors Drs. Naomi Simon, Marty Charns, and Debra Kaysen, with consultation from experts in community based research, CPT, and cultural competency. Career Development Plan: Training in the following areas will emphasize skills necessary for the candidate's long-term objective to become an expert in the implementation of EBTs in diverse communities and will lay the foundation for future independent investigation: 1) implementation science methodology and theoretical frameworks; 2) CPT implementation in CMHCs; 3) therapist supervision/leadership; 4) cultural competency in clinical trials; and 5) mixed-methods data analysis. PUBLIC HEALTH RELEVANCE: Millions of Americans suffer from Posttraumatic Stress Disorder, yet many do not receive first line, effective evidence based psychotherapies such as Cognitive Processing Therapy (CPT) due to lack of training and implementation of these evidence based psychotherapies in community mental health settings. Challenges include the need to be able to implement these time limited, effective therapies in diverse populations and to increase access to these treatments in the community. This career development grant will focus on developing strategies to practically and successfully implement CPT for PTSD in a diverse community setting and will provide the candidate with the needed training in implementation science to become a translational researcher, focusing on moving evidence based psychotherapies for PTSD from research clinics to effective implementation in the community.