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

研究为家庭干预青少年药物使用的有效性提供了支持 疾病（SUD），行为/犯罪行为和HIV风险行为。成功治疗的进展 这些困难导致更加强调将资源转用于基于证据的运输 治疗（EBT）到“现实世界”的社区设置。这一呼吁的紧迫性体现在不断加大努力 保险公司，社区机构和公共倡导者将EBT带到我们的更大部分 社会然而，将有效的干预措施付诸实践的努力却遇到了有限的困难。 成功此外，EBT的成功运输以及随后在 有效性试验是内在联系的，需要进行系统研究以了解参数 在社区环境中成功实施的重要性得到广泛认可。拟议的研究旨在 解决青少年SUD治疗、行为/犯罪和艾滋病毒风险研究中的一个关键空白 行为通过检查治疗师在社区设置的持续监督。研究提出， 代表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），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研究中心内的一批训练有素的FFT治疗师 已经采用并实施FFT，以研究两种不同的监督策略如何影响治疗师 对干预模型的合格坚持，以及最终在真实的世界实施中的临床结果。 我们将比较基于观察的监督（BOOST）和标准监督的效果， 通常（SAU）的方法，目前使用的FFT有限责任公司对治疗师的能力和青少年行为 结果。这项研究将由隶属于加州精神研究所的16个FFT小组实施 健康，利益相关者在加州实施FFT的协调中心。参与者将 包括来自16个FFT团队3名治疗师（n=48），每个治疗师6名青少年/家庭（n=288）。治疗师 团队将被随机分配到BOOST或SAU。本研究的目的是：（1）考察不同性别间的差异 BOOST和SAU在改善青少年物质使用（目标1a），行为/犯罪行为方面的差异 (Aim 1b）和艾滋病毒危险行为（目标1c）。(2)要检查BOOST和SAU之间的差异， 改善治疗中的参与和保持。(3)要检查BOOST和SAU之间的差异， 治疗师能力（目标3a）和家庭功能改善（目标3b）的比率。(4)探讨 治疗师能力是否介导（目标4a）监督条件和治疗之间的关联 结果，家庭功能的改善，以及更高的参与率和保留率。我们 还将探讨家庭功能的改善（目标4 b）是否介导了监督之间的联系， 条件和治疗结果。

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.