Leveraging Clinical Materials to Monitor Fidelity to Cognitive Processing Therapy

描述（由申请人提供）：认知加工疗法（CPT）是一种基于证据的创伤后应激障碍治疗方法，其大规模实施可以对心理和身体健康、医疗保健利用和生活质量产生巨大影响。一些大型的心理健康系统已经投入了大量资金来培训他们的临床医生进行CPT，但相对而言，很少有人关注培训完成后的监控或提高忠诚度。确定监测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。新出现的证据表明，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提供ebt，并且培训完成后漂移的可能性增加。实现

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.