Leveraging Clinical Materials to Monitor Fidelity to Cognitive Processing Therapy

利用临床材料监测认知加工治疗的保真度

• 批准号: 8581853
• 负责人: SHANNON Wiltsey STIRMAN
• 金额: $ 19.26万
• 依托单位: BOSTON UNIVERSITY MEDICAL CAMPUS
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-08-09 至 2015-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8581853
• 关键词: Address; Adherence; Adoption; Attention; Behavior; Behavior Therapy; Behavioral; Canada; Caregivers; Client; Clinical; Cognitive; Cognitive Therapy; Collaborations; Communities; Community Healthcare; Complex; Consultations; Data; Data Analyses; Data Set; Department of Defense; Development; Device or Instrument Development; Effectiveness; Elements; Ensure; Evidence based treatment; Gold; Guidelines; Health; Health Personnel; Health system; Healthcare; Healthcare Systems; Intervention; Interview; Investments; Measurement; Measures; Mental Health; Methodology; Methods; Modeling; Monitor; Outcome; Outcomes Research; Patient Self-Report; Patients; Post-Traumatic Stress Disorders; Process; Property; Provider; Psyche structure; Psychometrics; Psychotherapy; Quality of life; Recording of previous events; Records; Relative (related person); Reporting; Research; Research Personnel; Resources; Sampling; Staging; Surveys; Symptoms; System; Testing; Texas; Time; Training; Trauma; Veterans; base; behavior change; clinical material; clinical practice; community setting; cost; evidence base; health care service utilization; improved; method development; physical conditioning; programs; psychosocial; public health relevance; routine care; skills; tool

DESCRIPTION (provided by applicant): Large-scale implementation of Cognitive Processing Therapy (CPT), an evidence based treatment for Post- traumatic Stress Disorder, can have a tremendous impact on mental and physical health, healthcare utilization, and quality of life. Several large mental health systems have invested heavily in programs to train their clinicians in CPT, but relatively little attention has been devoted to the monitoring or promotion of fidelity after training is complete. Identifying strategies to monitor fidelity is critical to ensuring consmer access to high quality, evidence-based treatments (EBTs). Emerging evidence suggest that when CPT and other cognitive behavioral therapies (CBT) are delivered with low levels of fidelity, clinical outcomes are negatively impacted. Yet few clinicians deliver EBTs with fidelity n everyday practice, and the likelihood of drift increases after training is complete. Implementation models therefore highlight the importance of ongoing fidelity monitoring and support. The lack of a scalable, effective, and efficient method of monitoring fidelity is a key barrier to efforts to monitor and enhance fidelity for CPT and other CBTs. Observation and expert ratings are time- and resource-intensive and unlikely to be feasible or affordable in large systems. Self-report fidelity assessments increase clinician and consumer burden and there is evidence that they may not accurately reflect in-session behavior. To date, monitoring strategies that do not involve observation, client/caregiver reports, or clinician self-reports have not been tested. To address this critical implementation challenge, we propose to refine and evaluate a method of monitoring fidelity that utilizes clinical progress notes and CPT worksheets that are routinely completed in session. Because the worksheets were developed to guide the implementation of core CPT elements, they may be used to corroborate information from progress notes and to elucidate the clinician's ability to convey key skills and concepts in session. Consultation with stakeholders in large mental health systems suggests that because this method minimizes the time required to collect and assess fidelity, it is feasible and preferable to observation and self-reports. Preliminary data indicates that this strategy is promising. This research will be conducted by a team of investigators with expertise in CPT and CBT, training, implementation, psychotherapy process and outcome research, psychometric methodologies, and longitudinal data analysis, with input from community stakeholders. Because the core elements of CPT and its worksheets are based on and common to other CBTs, this research has broad implications for monitoring fidelity to CBTs in a variety of mental health and healthcare systems and settings. This research will set the stage for subsequent research to evaluate the measure to monitor and support fidelity in these settings. The resulting products have the potential to significantly improve effots to monitor and ensure ongoing high quality implementation of CPT in community and VA settings.

描述（由申请人提供）：大规模实施认知处理疗法（CPT）是一种针对创伤后应激障碍的循证治疗方法，可以对精神和身体健康、医疗保健利用率和生活质量产生巨大影响。一些大型精神卫生系统已投入巨资开展临床医生 CPT 培训项目，但对培训完成后忠诚度的监测或促进的关注相对较少。确定监控保真度的策略对于确保消费者获得高质量的循证治疗 (EBT) 至关重要。新的证据表明，当 CPT 和其他认知行为疗法 (CBT) 的保真度较低时，临床结果会受到负面影响。然而，很少有临床医生在日常实践中忠实地进行 EBT，并且培训完成后出现偏差的可能性会增加。执行 因此，模型强调了持续保真度监控和支持的重要性。缺乏可扩展、有效且高效的保真度监控方法是监控和提高 CPT 和其他 CBT 保真度的主要障碍。观察和专家评级需要大量时间和资源，并且在大型系统中不太可行或负担得起。自我报告的保真度评估增加了临床医生和消费者的负担，并且有证据表明它们可能无法准确反映会话中的行为。迄今为止，不涉及观察、客户/护理人员报告或临床医生自我报告的监测策略尚未经过测试。为了解决这一关键的实施挑战，我们建议完善和评估一种监控保真度的方法，该方法利用临床进展记录和在会议中例行完成的 CPT 工作表。由于工作表是为了指导核心 CPT 要素的实施而开发的，因此它们可用于证实进度记录中的信息，并阐明临床医生在治疗中传达关键技能和概念的能力。与利益相关者协商 大型精神卫生系统表明，由于这种方法最大限度地减少了收集和评估保真度所需的时间，因此它是可行的，并且比观察和自我报告更可取。初步数据表明这一策略是有前景的。这项研究将由在 CPT 和 CBT、培训、实施、心理治疗过程和结果研究、心理测量方法和纵向数据分析方面具有专业知识的研究人员团队进行，并听取社区利益相关者的意见。由于 CPT 的核心要素及其工作表是基于其他 CBT 且与其他 CBT 相同，因此这项研究对于监测各种心理健康和医疗保健系统和环境中 CBT 的忠诚度具有广泛的意义。这项研究将为后续研究评估在这些环境中监控和支持保真度的措施奠定基础。由此产生的产品有可能显着改善社区和退伍军人事务部环境中 CPT 的监测和持续高质量实施。