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

基于技术的工具提高心理健康治疗的护理质量

• 批准号: 8446020
• 负责人: Kenneth J Ruggiero
• 金额: $ 33.7万
• 依托单位: MEDICAL UNIVERSITY OF SOUTH CAROLINA
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-15 至 2014-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8446020
• 关键词: Address; Adult; Aftercare; Audiotape; Behavior; Caregivers; Caring; Child; Clinic; Code; Cognitive Therapy; Communities; Community Mental Health Services; Data; Development; Devices; Disease; Ensure; Evaluation; Evidence based intervention; Evidence based treatment; Family; Family Practice; Feasibility Studies; Future; Goals; Health; Health Personnel; Healthcare; Internet; Intervention; Interview; Learning; Maintenance; Manuals; Mental Health; Mental Health Services; Mental disorders; Methodology; Modeling; National Institute of Mental Health; Online Systems; Outcome; Patients; Positioning Attribute; Post-Traumatic Stress Disorders; Preparation; Procedures; Protocols documentation; Provider; Quality of Care; Randomized; Randomized Controlled Trials; Reaction; Recruitment Activity; Research; Research Support; Resources; Risk Reduction; Sampling; Services; Symptoms; Tablets; Technology; Test Result; Testing; Time; Training; Trauma; Treatment Efficacy; Treatment Protocols; Youth; aged; base; biological adaptation to stress; blind; clinical care; clinically significant; community setting; cost; design; effective therapy; efficacy trial; evidence base; improved; innovation; interest; meetings; patient population; psychoeducation; tool; usability; web-accessible

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.

描述（由申请人提供）：许多州正在做出巨大努力，在社区心理健康服务机构中实施基于证据的干预措施。这一目标的一大挑战是使提供者能够达到足够的保真度来建立治疗模型。即使在训练有素的从业者中，提供者的忠诚度也存在很大差异。该项目将利用最新的技术进步来改善现实社区环境中干预措施的实施，从而在提高护理质量方面迈出重要一步。使用针对移动设备（例如 iPad）进行优化的基于网络的应用程序代表了实现这一目标的高度创新的方法。需要进行研究来为这些努力提供信息并评估这种方法。当前的项目旨在开发和建立 eTF-CBT 的可行性，eTF-CBT 是一种基于技术的创伤聚焦认知行为治疗 (TF-CBT) 工具包，旨在提高治疗的质量、可及性和效率。 eTF-CBT 工具包将包含针对移动设备（例如视频、互动游戏、绘图应用程序）进行优化的基于网络的应用程序，这些应用程序用于与儿童和护理人员进行会话。这些活动旨在提高患者参与度并支持提供者忠实地交付方案的每个主要组成部分。活动的选择基于 TF-CBT 国家培训师样本的数据，这些培训师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。初步开发后，eTF-CBT 工具包将进行 alpha 和 beta 测试。该测试的结果将指导 eTF-CBT 工具包的改进，为更广泛的评估做好准备。接下来，我们将进行一项可行性试验，其中我们将招募 10 名当地心理健康提供者，他们将接受 eTF-CBT 资源的培训，并将参加对 20 个分配到 TF-CBT 与 eTF-CBT 的家庭进行的可行性随机对照试验。将从社区心理健康诊所招募具有明显创伤后应激障碍临床症状的 8 至 15 岁青少年。基线、治疗中期和治疗后评估将由对研究情况不知情的独立评估员进行。会议将被录音以进行保真度编码，并由对研究假设不知情的独立评估者进行保真度评级。该试验将提供有关 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。当我们准备大规模随机对照试验来检查技术辅助治疗的增量功效和效率时，这些数据将非常有价值。尽管这个初始项目确定了单一的治疗方案，但结果将产生广泛的影响，因为 TF-CBT 具有与广泛患者群体高度相关的几个组成部分（例如，分级暴露、行为管理原则、心理教育、风险降低）。由于维护成本低且可访问性高，基于技术的应用程序覆盖全国精神卫生服务机构的潜力很大。 公共卫生相关性：近 900 万美国儿童（八分之一）在任何时间点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治疗；心理健康服务提供者在实施这些干预措施时需要更多支持，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基于技术的创造性资源，改善为寻求精神卫生保健的家庭提供最佳实践。