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，提供商的忠诚度也是高度可变的。该项目将向提高护理质量迈出重要一步，方法是利用最新的技术进步，改善在现实世界社区环境中提供干预措施的情况。使用为在移动设备(例如iPad)上使用而优化的基于网络的应用程序是实现这一目标的一种高度创新的方法。需要研究来为这些努力提供信息并评估这一方法。目前的项目旨在开发和建立ETF-CBT的可行性，这是一个基于技术的工具包，用于创伤为重点的认知行为治疗(TF-CBT)，旨在提高治疗的质量、可获得性和效率。ETF-CBT工具包将包括针对移动设备(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照顾者进行会话。这些活动将旨在加强患者的参与，并支持提供商忠实地交付协议的每个主要组成部分。活动是根据工作组-CBT的国家培训员样本中的数据选择的，他们确定了对提供者来说障碍和挑战重大的治疗组成部分。在初步开发后，ETF-CBT工具包将进行阿尔法和贝塔测试。这项测试的结果将指导对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，并将参与分配到TF-CBT与ETF-CBT的20个家庭的可行性RCT。8-15岁有明显创伤后应激障碍症状的青少年将从社区心理健康诊所招募。基线、治疗中期和治疗后的评估将由一名独立的评估者进行，对研究条件视而不见。会议将被录音进行保真度编码，并由一个独立的盲评分者对其进行保真度评级，以研究假设。该试验将提供关于ETF-CBT可行性的数据，并将展示在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，检查技术辅助治疗的递增疗效和效率。虽然这个初始项目确定了单一的治疗方案，但结果将具有广泛的影响，因为TF-CBT具有几个与广泛患者群体高度相关的组成部分(例如，渐进式暴露、行为管理原则、心理教育、降低风险)。由于低维护成本和高可获得性，基于技术的应用程序在全国范围内达到精神健康服务机构的潜力很高。 公共卫生相关性：近900万美国儿童(八分之一)在任何时候都符合至少一种精神健康障碍的标准。这些疾病有有效的治疗方法，但寻求服务的儿童和家庭很少得到治疗；精神卫生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高质量的护理。该项目旨在通过为提供者开发创造性的、以技术为基础的资源，改善为寻求精神卫生保健的家庭提供最佳做法的情况。

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.