Technology-based Tools to Enhance Quality of Care in Mental Health Treatment

描述（由申请人提供）：许多州正在做出相当大的努力，在社区精神卫生服务机构实施基于证据的干预措施。这一目标的一个巨大挑战是使提供者能够达到足够的保真度水平，以建立治疗模型。提供者的忠诚度是高度可变的，即使在训练有素的从业者。该项目将通过利用最新的技术进步来提高护理质量，以改善现实世界社区环境中的干预措施，从而迈出重要的一步。使用为在移动的设备上使用而优化的基于网络的应用程序（例如，iPad）代表了实现这一目标的高度创新的方法。需要进行研究，为这些努力提供信息，并对这一方法进行评估。目前的项目旨在开发和建立eTF-CBT的可行性，这是一种基于技术的创伤集中认知行为疗法（TF-CBT）工具包，旨在提高治疗的质量，可及性和效率。eTF-CBT工具包将包括基于Web的应用程序，这些应用程序针对移动的设备进行了优化（例如，视频、互动游戏、绘画应用程序），用于与儿童和看护者的会话。这些活动旨在提高患者参与度，并支持提供者忠实地提供方案的每个主要组成部分。选择这些活动的依据是来自TF-CBT国家培训员样本的数据，这些培训员确定了对提供者来说存在重大障碍和挑战的治疗组成部分。在初步开发之后，eTF-CBT工具包将进行alpha和beta测试。这项测试的结果将指导eTF-CBT工具包的改进，为更广泛的评估做准备。接下来，我们将进行一项可行性试验，在该试验中，我们将招募10名当地的心理健康提供者，他们将接受eTF-CBT资源的培训，并将参加一项由20个家庭组成的可行性RCT，这些家庭被分配到TF-CBT与eTF-CBT。将从社区心理健康诊所招募具有创伤后应激障碍临床显著症状的8至15岁青年。基线、治疗中期和治疗后评估将由对研究状况不知情的独立评价者进行。会议将进行录音，以进行保真度编码，并由一名对研究假设不知情的独立评分员对保真度进行评分。本试验将提供eTF-CBT可行性的数据，并将证明RCT中使用的招募、评估和评价程序的可行性。这些数据将是有价值的，因为我们准备了一个大规模的随机对照试验，检查增量疗效和效率的技术辅助治疗。虽然这个初始项目确定了一个单一的治疗方案，但结果将具有广泛的影响，因为TF-CBT具有几个组成部分（例如，分级暴露、行为管理原则、心理教育、风险降低），这些与广泛的患者人群高度相关。基于技术的应用程序到达全国精神卫生服务机构的潜力很大，因为维护成本低，可访问性高。 公共卫生相关性：近900万美国儿童（1/8）在任何时候都符合至少一种精神健康障碍的标准。这些疾病存在有效的治疗方法，但寻求服务的儿童和家庭很少得到服务;心理健康提供者在提供这些干预措施时需要更多的支持，以确保儿童和家庭得到最优质的护理。该项目旨在通过为提供者开发创造性的、基于技术的资源，为寻求精神保健的家庭提供更好的最佳做法。

DESCRIPTION (provided by applicant): Considerable effort is being made in many states to implement evidence based interventions in community mental health service agencies. One big challenge to this goal is enabling providers to achieve an adequate level of fidelity to establishe treatment models. Provider fidelity is highly variable even among well-trained practitioners. This project will take an important step toward enhancing quality of care by capitalizing on recent advances in technology to improve the delivery of interventions in real-world community settings. The use of web-based applications optimized for use on mobile devices (e.g., iPad) represents a highly innovative approach to achieving this aim. Research is needed to inform these efforts and evaluate this approach. The current project aims to develop and establish the feasibility of eTF-CBT, a technology-based toolkit for Trauma- Focused Cognitive Behavioral Therapy (TF-CBT) that is designed to enhance the quality, accessibility, and efficiency of treatment. The eTF-CBT toolkit will consist of web-based applications optimized for use on mobile devices (e.g., videos, interactive games, drawing applications) that are used in session with children and caregivers. These activities will be designed to enhance patient engagement and support providers' delivery of each major component of the protocol with fidelity. Activities were selected based on data from a sample of national trainers in TF-CBT who identified treatment components for which barriers and challenges to providers are significant. After initial development, the eTF-CBT toolkit will undergo alpha and beta testing. The results of this testing will guide refinements to the eTF-CBT toolkit in preparation for more extensive evaluation. Next, we will conduct a feasibility trial in which we will recruit 10 local mental health providers who wll be trained in the eTF-CBT resource and will participate in a feasibility RCT of 20 families assigned to TF-CBT vs. eTF-CBT. Youth aged 8-15 years with clinically significant symptoms of posttraumatic stress disorder will be recruited from community-based mental health clinics. Baseline, mid-treatment, and post-treatment assessments will be conducted by an independent evaluator blind to study condition. Sessions will be audiotaped for fidelity coding, and rated for fidelity by an independent rater blind to study hypotheses. The trial will provide data on the feasibility of eTF-CBT and will demonstrate the feasibility of recruitment, assessment, and evaluation procedures used in the RCT. These data will be valuable as we prepare for a large-scale RCT that examines the incremental efficacy and efficiency of technology-assisted treatment. Although this initial project identifies a single treatment protocol, results will have broad implications because TF-CBT features several components (e.g., graduated exposure, behavior management principles, psychoeducation, risk reduction) that are of high relevance to a wide range of patient populations. The potential for technology-based applications to reach mental health services agencies nationally is high due to low maintenance costs and high accessibility. PUBLIC HEALTH RELEVANCE: Nearly 9 million U.S. children (1 in 8) meet criteria for at least one mental health disorder at any point in time. Effective treatments exist for these disorders, but children and families who seek services rarely receive them; mental health providers need more support in the delivery of these interventions to ensure that children and families are receiving the best quality care. This project aims to improve the delivery of best practices for families who seek mental health care by developing creative, technology-based resources for providers.