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。实现这一目标的一大挑战是使提供者能够达到足够的保真度，以建立治疗模型。即使在训练有素的从业人员中，提供者的忠诚度也存在很大差异。该项目将在提高护理质量方面迈出重要的一步，利用最新的技术进步来改善在现实世界社区环境中提供干预措施的情况。使用针对移动设备（如iPad）优化的基于web的应用程序是实现这一目标的一种高度创新的方法。需要进行研究，为这些努力提供信息，并对这种方法进行评估。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工具包将包括针对移动设备优化的基于网络的应用程序（例如，视频，互动游戏，绘画应用程序），用于与儿童和照顾者的会话。这些活动将旨在加强患者的参与，并支持提供者忠实地提供方案的每个主要组成部分。活动的选择是基于国家TF-CBT培训师样本的数据，这些培训师确定了对提供者来说障碍和挑战较大的治疗成分。在最初的开发之后，eTF-CBT工具包将进行alpha和beta测试。该测试的结果将指导改进eTF-CBT工具包，为更广泛的评估做准备。接下来，我们将进行可行性试验，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，并将参与20个家庭的可行性随机对照试验，分配给TF-CBT与eTF-CBT。将从社区精神卫生诊所招募年龄在8-15岁、有明显创伤后应激障碍临床症状的青年。基线、治疗中和治疗后的评估将由独立的盲评估者进行。会议将被录音以进行保真编码，并由独立的评估者对研究假设进行保真评级。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、评估和评估程序的可行性。这些数据将是有价值的，因为我们准备进行大规模的随机对照试验，以检查技术辅助治疗的增量疗效和效率。虽然这个最初的项目确定了一个单一的治疗方案，但结果将具有广泛的意义，因为TF-CBT具有几个组成部分（例如，逐步暴露、行为管理原则、心理教育、风险降低），这些组成部分与广泛的患者群体高度相关。基于技术的应用进入全国精神卫生服务机构的潜力很大，因为维护成本低，可及性高。

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.