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

描述(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。尽管在开发循证心理疗法方面取得了重大进展，但社区治疗师采用这种疗法的速度一直很慢。因此，重要的是开发和测试不同的方法，以有效地培训治疗师在社区环境中实施循证心理治疗。大学校园饮食失调(ED)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紊乱的策略的实施情况。我们建议培训治疗师实施人际心理治疗(IPT)，这是一种以证据为基础的EDS治疗方法。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，已经表明，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，在这项研究中，我们将比较两种旨在改进这一方法的实施策略。第一种是低强度战略，在讲习班之后增加了外部专家协商。第二种是以理论为基础的高强度方法，专注于建立内部专业知识。在这一战略中，咨询中心的一名工作人员将接受IPT培训，并接受培训，以培训站点内的其他工作人员实施IPT。这一战略包括旨在改进实施和确保治疗保真度的质量控制程序。26个拥有约230名治疗师的大学咨询中心将被随机分配到两个实施战略中的一个。华盛顿大学(实施和成本分析中心)、罗格斯大学(富达监测中心)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的忠诚度和IPT在这两种培训策略中的作用及其对客户结果的影响。第二个目的是检查IPT在抑郁症治疗中的推广应用。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。探索性主持人和调解人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，将确定每种培训方法的实施和服务费用。实施将在20个月内进行，并进行12个月的后续行动，以测试可持续性，在此期间，华盛顿大学的咨询将停止。该项目继续了三个PI和中心之间的长期合作，这些PIs和中心过去一直专注于了解饮食障碍的潜在因素，并致力于循证心理疗法的发展。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职员工建立了合作关系，其中包括Proctor博士和Raghavan博士，他们是该项目的联合研究员。

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.