Influences on the Sustainability of Evidence-Based Psychotherapies

申请者建议通过独立职业发展奖(K99)提供资金，以开展一项培训和研究计划，以发展混合方法、研究战略以及传播和组织变革理论知识方面的技能。申请者将结合临床干预研究和组织研究，以确定在社区精神卫生机构内进行培训后，持续使用经验性支持的心理疗法的障碍。拟议的研究项目将通过提供实施混合方法战略的机会来补充培训方案，以评估在以下方面持续实施经验性支持的治疗的障碍 基于社区的设置。宾夕法尼亚大学NIMH资助的两个研究中心的导师将支持申请者，这两个中心都与费城的精神健康机构建立了合作关系 在拟议的研究和培训中。第一项研究将使用调查来检验一些假设 社区精神卫生环境中新干预措施的可持续性障碍，以及微民族志 方法，以生成关于这些环境中特定障碍的更具体的假设。 第二项研究将检查在培训后使用认知治疗的自然轨迹 两年多的社区精神卫生环境。临床医生对CT的态度与 具体的组织因素以及CT的持续采用将采用混合方法进行审查 策略。这项研究的次要目标是对“真实世界”进行第一次考察。 根据患者的需要和临床实践的实际情况对治疗方案进行的修改。这些结果将为RO1的开发提供信息，以测试个人和组织因素的模型，该模型预测社区心理健康环境中采用的可持续性。这项研究计划将产生一些关于影响循证心理治疗长期可持续性的组织和个人因素的第一批数据。所获得的知识可以导致实施干预措施，适当地解决在社区环境中使用循证治疗的障碍，这反过来将促进更多地获得干预措施，尽管有广泛的经验支持，但目前社区精神卫生消费者还没有广泛获得这些干预措施

The applicant is proposing funding through the Pathway to Independence Career Development Award (K99) to conduct a program of training and research that will to develop skills in mixed-methods research strategies and knowledge of theories of dissemination and organizational change. The applicant will interface clinical intervention research and organizational research to determine barriers to the sustained use of empirically supported psychotherapies after training occurs within community mental health agencies. The proposed research projects will complement the training program by providing opportunities to implement the mixedmethods strategies to assess barriers to sustained implementation of empirically supported treatments within community based-settings. Mentors at two NIMH-funded research centers at Penn, both of which have developed collaborative relationships with mental health agencies in Philadelphia, will support the applicant in the proposed research and training. The first study will employ surveys to examine some hypothesized barriers to the sustainability of new interventions in community mental health settings, as well as microethnographic methods to generate more specific hypotheses regarding barriers specific to these settings. The second study will examine the natural trajectory of the use of cognitive therapy after training in community mental health settings over two years. The relationship between clinician attitudes towards CT, specific organizational factors, and the sustained adoption of CT will be examined using a mixed-methods strategy. A secondary goal of this research will be to conduct the first examination the "real world" modifications that the treatment protocol undergoes as a result of the needs of the client and the realities of clinical practice. These results will inform the development of an RO1 to test a model of the individual and organizational factors that predict the sustainability of adoption within community mental health settings. This research program will yield some of the first data regarding the organizational and individual factors that impact the long-term sustainability of evidence-based psychotherapies. The knowledge gained can lead to the implementation of interventions that appropriately address barriers to the use of evidence-based therapies in community settings, which will in turn promote increased access to interventions that, despite extensive empirical support, currently are not widely available to community mental health consumers