Implementation of evidence-based treatments for on-campus eating disorders

描述（由申请人提供）：本提案是对PAR-10-038“健康领域的传播和实施研究”的回应。尽管在发展基于证据的心理治疗方面取得了重大进展，但社区治疗师采用这种治疗方法的速度很慢。因此，开发和测试不同的方法来有效地培训治疗师在社区环境中实施循证心理治疗是很重要的。大学校园中饮食失调（EDs）的患病率相对较高，因此提供了一个有效的环境来测试治疗这些失调的策略的实施。我们建议培训治疗师实施人际心理治疗（IPT），以证据为基础的治疗急症。治疗师通常通过研讨会和治疗手册了解新的治疗方法。然而，已经证明，这种方法并不能有效地提高治疗师的技能，也不能维持这些干预措施的使用。因此，在本研究中，我们将比较两种旨在改进此方法的实现策略。第一种是低强度策略，在研讨会之后增加外部专家咨询。第二种是基于理论的高强度方法，侧重于建立内部专业知识。在该策略中，咨询中心的一名工作人员将接受IPT培训，并指导其培训网站内的其他工作人员实施IPT。该战略包括质量控制程序，旨在改善实施和确保治疗的保真度。26个大学咨询中心和大约230名治疗师将随机分配到两种实施策略中的一种。三个中心：华盛顿大学（实施和成本分析中心）、罗格斯大学（保真监测中心）和斯坦福大学（数据协调中心）将进行这项研究。主要目的是比较治疗师对IPT两种培训策略的忠诚度及其对客户结果的影响。第二个目的是检验IPT治疗抑郁症的普遍性。我们假设，高强度方法将被证明比低强度策略更有效，特别是在可持续性方面。探索性调节和中介分析将阐明影响实施和客户结果的机构和治疗师变量。由于这两种方法的资源不同，将确定每一种培训方法的执行和服务费用。实施将在20个月的时间内进行，并进行12个月的后续工作，以测试可持续性，在此期间，华盛顿大学将停止咨询。该项目继续了三个pi和中心之间的长期合作，这些中心过去一直专注于了解饮食失调的潜在因素和基于证据的心理治疗的发展。为了扩展我们在实施理论和程序方面的专业知识，我们与华盛顿大学传播和实施核心的教师建立了合作关系，包括dr。Proctor和Raghavan是这个项目的共同调查员。

DESCRIPTION (provided by applicant): This proposal is a response to PAR-10-038 "Dissemination and Implementation Research in Health." Despite major advances in developing evidence-based psychotherapies, the adoption of such treatments by community therapists has been slow. Hence, it is important to develop and test different methods to effectively train therapists to implement evidence-based psychotherapies in community settings. College campuses have a relatively high prevalence of eating disorders (EDs) and therefore present an efficient environment to test the implementation of strategies to treat these disorders. We propose to train therapists to implement interpersonal psychotherapy (IPT), evidence-based treatments for EDs. Therapists usually learn about new therapies via a workshop and treatment manual. However, it has been shown that this method does not effectively increase therapist skills, nor does it sustain utilization of these interventions. Hence, in this study we will compare two implementation strategies designed to improve upon this approach. The first is a low intensity strategy with the addition of external expert consultation following the workshop. The second is a theoretically-grounded high intensity approach focused on building internal expertise. In this strategy, a staff member from the counseling center will be trained in IPT and coached to train other staff members within the site to implement IPT. This strategy includes quality-control procedures designed to improve implementation and to ensure treatment fidelity. Twenty-six college counseling centers with approximately 230 therapists will be allocated at random to one of the two implementation strategies. Three centers: Washington University (Implementation and Cost Analysis Center), Rutgers University (Fidelity Monitoring Center), and Stanford University (Data Coordinating Center) will conduct the study. The primary aim is to compare therapist fidelity to IPT for the two training strategies and its consequent impact on client outcome. A secondary aim is to examine the generalization of use of IPT for depression. We hypothesize that the high intensity approach will prove significantly more effective than the low intensity strategy, particularly in sustainability. Exploratory moderator and mediator analyses will illuminate the institutional and therapist variables that affect implementation and client outcomes. Because the two approaches differ in resources, the implementation and service costs for each of the training methods will be determined. Implementation will proceed over a twenty month period with a 12-month follow-up to test sustainability, during which period consultation from Washington University will have ceased. This project continues a long-standing collaboration among the three PIs and centers that have focused in the past on understanding factors underlying eating disorders and on the development of evidence- based psychotherapies. To extend our expertise on implementation theory and procedures, we have established collaborations with faculty from the Dissemination and Implementation Core at Washington University, including Drs. Proctor and Raghavan who are co-investigators on this project.