CBT for Pediatric OCD: Effective Therapist Behaviors and Community Training Pilot

描述（由申请人提供）：社区治疗师很少使用具有经验支持的干预措施，并且先前将经验支持的行为治疗（ESBT）传播到社区环境的尝试并不是基于对治疗过程的关键成分的理解，没有这些成分，社区治疗师可能无法得到充分的培训。以原则为基础的培训，使用积极的学习策略，并结合反馈的保真度持有承诺的应用和可持续性ESBT在社区设置。儿童强迫症有一个明确的治疗理论（暴露和反应预防），是一种理想的疾病，可以用来测试一个改进的训练模型，将理论、治疗师的行为和患者的结果联系起来。该项目的第一阶段（R21）将使用理论推导的观察编码系统来检查治疗师在治疗过程中的行为，这些儿童（N = 160）接受了CBT，作为儿科OCD（POTS）的三个多中心治疗试验的一部分。具体来说，我们将寻找证据，规定和禁止治疗师在治疗过程中的行为与理论机制的变化（习惯化）和患者的治疗结果。我们还将验证一个简短的忠诚度评级系统，该系统测量规定和禁止的治疗师行为，为在社区环境中向治疗师提供有关这些行为的反馈做好准备。第二阶段（R33）将使用R21数据开发和试点两种基于理论的CBT培训交付形式的随机试验，用于治疗儿童强迫症的社区提供者。两个社区中心的治疗师（N = 16）将随机接受工作坊加每周监督或工作坊加电话咨询服务。所有的治疗师将定期收到关于在R21阶段使用忠诚度评级系统确定的规定和禁止行为的反馈。我们将测量治疗师水平的结果（例如，知识、熟练程度、满意度）和患者水平的结果（例如，症状、残疾、服务利用、满意度），以评估培训和相关治疗的可行性和可接受性，并为R 01试验做准备。这项研究的结果将为未来治疗师基于理论的培训计划的发展提供信息，以及将暴露作为其他焦虑症的工具进行教学。 公共卫生相关性：目前的研究将使用一个基于理论的模型来检查接受CBT的儿童样本中的治疗师行为，这是儿科强迫症治疗研究（Pediatric OCD Treatment Study; POTS）的三个多中心治疗试验之一。第一阶段将使用观察性编码系统（R21阶段）;第二阶段将使用R21阶段的数据，为治疗强迫症儿童（5-17岁）的社区治疗师开发和试点培训计划。治疗师将随机接受两种不同形式之一，以提供基于理论的培训和维持计划，并提供保真度反馈（R33阶段）。我们将测试这两种形式的培训计划的可行性和可接受性，以及治疗师和患者水平的结果，包括保持收益的伴随措施。

DESCRIPTION (provided by applicant): Community therapists rarely use interventions with empirical support and prior attempts to disseminate empirically supported behavioral treatments (ESBTs) to community settings have not been based on understanding key ingredients of the therapeutic process, without which community therapists may be inadequately trained. Principle-based training that uses active learning strategies and incorporates feedback about fidelity holds promise for application and sustainability of ESBTs in community settings. Pediatric OCD has a clear theory underlying treatment (Exposure and Response Prevention) and is an ideal disorder with which to test an improved training model linking theory, in-session therapist behavior, and patient outcome. The first phase (R21) of this project will use a theory-derived observational coding system to examine therapist behavior during treatment for a sample of children (N = 160) who received CBT as part of three multisite treatment trials for pediatric OCD (POTS). Specifically, we will look for evidence that prescribed and proscribed therapist behaviors during treatment are related to theoretical mechanism of change (habituation) and to patient treatment outcome. We will also validate a short fidelity rating system that measures prescribed and proscribed therapist behaviors, in preparation for providing feedback about those behaviors to therapists in community settings. The second phase (R33) will use R21 data to develop and pilot a randomized trial of two delivery formats of theory-based CBT training for community providers treating pediatric OCD. Therapists (N = 16) across two community sites will be randomized to receive a workshop plus weekly supervision or a workshop plus telephone consultation service. All therapists will receive regular feedback about prescribed and proscribed behaviors identified in the R21 phase using the fidelity rating system. We will measure therapist-level outcomes (e.g., knowledge, proficiency, satisfaction) and patient-level outcomes (e.g., symptoms, disability, service utilization, satisfaction) for purposes of assessing feasibility and acceptability of training and related treatment and in preparation for R01 trial. Results from this study will inform development of future theory-based training programs for therapists as well as teaching use of exposure as a tool for other anxiety disorders. PUBLIC HEALTH RELEVANCE: The current study will use a theory-based model to examine therapist behavior in a sample of children who received CBT as part of one of three multi-site treatment trials for pediatric OCD (Pediatric OCD Treatment Study; POTS). The first phase will use an observational coding system (R21 phase); and the second phase will use the R21 phase data to develop and pilot a training program for community therapists treating children (age 5-17) with OCD. Therapists will be randomized to receive one of two different formats for delivery of a theory-based training and maintenance program with fidelity feedback (R33 phase). We will test feasibility and acceptability of the training program in both formats as well as accompanying measures of therapist, and patient-level outcomes, including maintenance of gains.