Building Outcomes with Observation-Based Supervision: An FFT Effectiveness Trial

研究为青少年药物使用的家庭干预的有效性提供了支持 精神障碍(SUD)、行为/犯罪行为和艾滋病毒危险行为。成功治疗的研究进展 这些困难导致人们更加重视将资源重新用于运输循证证据 治疗(EBTS)进入“真实世界”的社区环境。这一呼吁的紧迫性反映在越来越多的努力中 由保险公司、社区机构和公共倡导者将EBTS带到我们更大的细分市场 社会。然而，将有效干预措施付诸实践的努力遇到了有限的困难 成功。此外，EBTS的成功运输以及随后在#年取得的积极成果 有效性试验是内在联系的，需要进行系统的调查以了解参数 在社区环境中成功实施是得到广泛认可的。这项拟议的研究旨在 解决青少年性欲障碍、行为/犯罪和艾滋病毒风险的治疗研究中的重大差距 通过检查社区环境中治疗师的持续监督来检查行为。这项研究建议 这是一项第三阶段的有效性研究，将评估两种不同的治疗师监督方法 在实施功能性家庭治疗(FFT)中，这是一种针对青少年药物滥用的EBT， 行为/犯罪行为和艾滋病毒危险行为。这项研究旨在利用广泛的 FFT传播基础设施，包括在具有以下条件的站点内的训练有素的FFT治疗师 已经采用并实施了快速傅立叶变换，以检验两种不同的监督策略如何影响治疗师 能够胜任地坚持干预模式，并最终在现实世界实施中取得临床结果。 我们将比较基于观察的监管(Boost)和标准监管的效果，因为 FFT LLC目前使用的关于治疗师能力和青少年行为的常用(SAU)方法 结果。这项研究将在加州心理研究所下属的16个FFT团队中实施 Health是加利福尼亚州实施FFT的利益相关者的协调中心。参与者将 包括来自16个FFT小组的3名治疗师(n=48)和每个治疗师6名青少年/家庭(n=288)。治疗师 球队将被随机分配到BOOST或SAU。这项研究的目的是：(1)考察差异 Boost和SAU在改善青少年药物使用(目标1a)、行为/犯罪行为方面的差异 (目标1b)和艾滋病毒危险行为(目标1c)。(2)检查Boost和SAU之间的差异 改善治疗中的参与度和保留率。(3)检查Boost和SAU在 治疗师能力(目标3a)和家庭功能改善(目标3b)的比率。(四)探索 治疗师能力是否调节(目标4a)监督条件和治疗之间的联系 结果，家庭功能的改善，以及更高的参与率和治疗率。我们 还将探讨家庭功能的改善(目标4b)是否调解监督之间的联系 病情和治疗结果。

Research has provided support for the efficacy of family interventions for adolescent substance use disorders (SUD), conduct/delinquent behaviors, and HIV risk behaviors. Advances in successfully treating such difficulties have resulted in an increased emphasis to redirect resources to transport evidence-based treatments (EBTs) into "real-world" community settings. The urgency of this call is reflected in increasing efforts by insurance companies, community agencies, and public advocates to bring EBTs to larger segments of our society. Efforts to transport efficacious interventions into practice settings, however, have met with limited success. Moreover, the successful transport of EBTs and the subsequent achievement of positive outcomes in effectiveness trials are intrinsically linked and the need for systematic investigation to understand the parameters for successful implementation in community settings is widely recognized. The proposed study is intended to address a critical gap in research on the treatment of adolescent SUD, conduct/delinquent, and HIV risk behaviors by examining the ongoing supervision of therapists in community settings. The research proposed represents a Stage III effectiveness study which will evaluate two distinct approaches to therapist supervision in the implementation of Functional Family Therapy (FFT), an EBT for adolescent substance abuse, conduct/delinquent behaviors, and HIV risk behaviors. The study is designed to capitalize on the extensive FFT dissemination infrastructure, that includes a cadre of fully trained FFT therapists within sites that have already adopted and implemented FFT, to examine how two distinct supervision strategies affect therapist competent adherence to the intervention model and, ultimately, clinical outcomes in real world implementation. We will compare the effects of an observation-based supervision (BOOST) to the standard supervision as usual (SAU) approach currently used by FFT LLC on therapist competence and adolescent behavioral outcomes. The study will be implemented with 16 FFT teams affiliated with the California Institute of Mental Health, the coordinating center for stakeholders implementing FFT in the State of California. Participants will include 3 therapists from 16 FFT teams (n=48) and 6 adolescents/families per therapist (n=288). Therapist teams will be randomly assigned to BOOST or SAU. The aims of the study are: (1) To examine differences between BOOST and SAU in improving adolescent substance use (Aim 1a), conduct/delinquent behaviors (Aim 1b), and HIV risk behaviors (Aim 1c). (2) To examine differences between BOOST and SAU in improving engagement and retention in treatment. (3) To examine differences between BOOST and SAU in the rates of therapist competence (Aim 3a) and improvements in family functioning (Aim 3b). (4) To explore whether therapist competence mediates (Aim 4a) the association between supervision condition and treatment outcomes, improvements in family functioning, and greater rates of engagement and retention in treatment. We also will explore whether improvements in family functioning (Aim 4b) mediates the link between supervision condition and treatment outcomes.