Implementation of a Measurement Feedback System in School Mental Health

学校心理健康测量反馈系统的实施

• 批准号: 8666059
• 负责人: Aaron Robert Lyon
• 金额: $ 16.35万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-05 至 2017-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8666059
• 关键词: Address; Adolescent; Anxiety; Applications Grants; Attention; Award; Behavior; Benchmarking; Caring; Child; Client; Clinic; Clinical; Clinical Psychology; Collaborations; Communities; Community Mental Health Services; Computers; Cultural Diversity; Data; Depressed mood; Development; Education; Effectiveness; Environment; Ethnic Origin; Evaluation; Evidence based practice; Evidence based treatment; Exhibits; Face; Family; Feedback; Focus Groups; Future; Goals; Happiness; Health; Health Personnel; Health Policy; Health Services Research; Health Technology; Healthcare; Information Systems; Intervention; K-Series Research Career Programs; Measurement; Measures; Mental Depression; Mental Health; Mental Health Services; Mentors; Methods; Modeling; Modification; Monitor; Online Systems; Outcome; Patients; Population; Positioning Attribute; Primary Health Care; Process; Process Assessment; Provider; Psychopathology; Public Health; Quality of Care; RQ2; Randomized; Reminder Systems; Research; Research Infrastructure; Research Methodology; Research Support; Research Training; Sampling; Schools; Series; Services; Socioeconomic Status; Structure; Students; Symptoms; System; Technology; Testing; Training; Underinsured; Universities; Washington; Work; Writing; Youth; base; behavioral health; career; computerized; design; ethnic minority population; evidence base; experience; health information technology; implementation research; implementation science; improved; innovation; low socioeconomic status; neglect; programs; randomized trial; routine practice; safety net; socioeconomics; statistics; systems research; theories; tool; treatment as usual; uptake; usability; user centered design; user-friendly

DESCRIPTION (provided by applicant): This Mentored Career Development Award (K08) is designed to provide intensive training in developing a strong program of research that investigates the adaptation and implementation of health information technologies within the school context to increase the availability of high-quality mental health interventions for underserved youth and families. A field of implementation science has recently emerged to address the significant gap between the proliferation of evidence-based practices (EBP) for treating youth mental health problems and their use in usual care treatment settings. Nowhere is this gap more apparent than in schools. Schools provide the bulk of youth mental health services (>70%) and effectively reduce service access disparities by ethnicity and socioeconomic status. Nevertheless, implementation research focused on the school context has been disproportionately limited. To address these gaps and advance implementation science, the candidate's long term career objective is to develop effective methods for promoting the use of EBP among mental health providers in educational settings. Standardized assessment (SA) of psychiatric symptoms is a cornerstone of all EBP and has been significantly associated with improvements in treatment- related outcome. Nevertheless, SA is infrequently utilized by school-based providers, resulting in sub-optimal care. Measurement feedback systems (MFS) use the results of SA to deliver information to clinicians about client progress, represent a structured way to introduce SA into service systems, and have the potential to support effective, client-centered care. The candidate's immediate focus is therefore to increase clinicians' administration of SA tools and incorporation of SA feedback into routine practice through the development of a MFS and an accompanying contextualized adaptation process that are designed specifically for schools. The current K08 Award will uniquely position the candidate to advance this research agenda. His background includes specialized training in child clinical psychology, evidence-based assessment and intervention approaches, research on school-based mental health, mental health services research, and collaboration with community stakeholders. To more effectively bridge the gap between typical and optimal mental health care in schools, he seeks to extend his training to include: (1) design of healthcare technologies that are user-friendly and contextually appropriate, (2) experience with theory and methods to support innovation uptake/implementation in schools, (3) advanced statistics and research methodology, and (4) advanced academic writing. The University of Washington is an outstanding environment in which to engage in the interdisciplinary training required to achieve these training goals. The candidate's primary mentors-Drs. Elizabeth McCauley and Jurgen Unutzer have combined expertise in the assessment and treatment of adolescent psychopathology, training with school-based providers, development of computer products to support evidence-based service delivery, implementation science, and the development and dissemination of measurement feedback tools for client progress monitoring. Additional local and national consultants will contribute expertise in implementation research for youth/family services, user-centered design, school-based mental health, community service provision, decision support tools for youth treatment providers, cultural diversity and mental health care, mental health policy, and qualitative and mixed methods research. The proposed project draws on the training and expertise above to develop and evaluate a contextually- adapted, web-based MFS for use in school-based health centers (SBHCs) through a series of qualitative, quantitative, and mixed methods research aims. The University of Washington Care Management Tracking System is a MFS, developed by Dr. Unutzer, previously found to result in improved care, symptom reductions, and increased functioning among patients. The current study proposes to use SBHC clinician focus groups and direct clinician feedback to adapt this MFS for use by SBHC clinicians. The candidate's prior research has revealed that SBHC providers infrequently utilize SA measures, but supports the feasibility of using structured, computerized methods to increase SA administration. A sample of SBHC clinicians (n = 20) and youth (n = 64, Aim 3) will participate in the project to advance the following Research Aims: (1) evaluate the SBHC context to inform MFS adaptation; (2) assess the adaptation's effectiveness in context; (3) evaluate the system impact on clinician behavior and youth outcomes; and (4) assess the added utility of providing academic data to school clinicians for use in progress monitoring. SBHC clinicians will provide feedback on the optimal design of the MFS and use it to track outcomes among youth experiencing depression and anxiety. Aims 1 and 2 will be evaluated descriptively, using existing benchmarks when applicable. Aim 3 will be tested experimentally via a small-scale randomized trial in which clinicians (and a subset of their caseloads) will be randomized to one of two conditions: (a) use of the school MFS to monitor progress using SA or (b) assessment as usual. Aim 4 will be tested using the MFS, with randomization of youth to two conditions: (a) clinicians receive the results of SA and students' school attendance data from the MFS or (b) data include SA results only. Based on the results of this work, a R01 grant application will be submitted to investigate the larger-scale implementation of the school MFS and contextualized adaptation process among a range of school service delivery models, allowing for more thorough evaluation of its impact on clinician behavior and student functioning.

该指导职业发展奖（K 08）旨在提供强化培训，以制定一项强有力的研究计划，调查学校环境中健康信息技术的适应和实施，以增加高质量的心理健康干预措施的可用性服务不足的青年和家庭。最近出现了一个实施科学领域，以解决治疗青少年心理健康问题的循证实践（EBP）的扩散与其在常规护理治疗环境中的使用之间的巨大差距。这种差距在学校表现得最为明显。学校提供了大部分的青少年心理健康服务（>70%），并有效地减少了种族和社会经济地位之间的服务差距。然而，以学校为重点的实施研究受到了不成比例的限制。为了解决这些差距和推进实施科学，候选人的长期职业目标是制定有效的方法，促进教育环境中的心理健康提供者使用EBP。精神症状的标准化评估（SA）是所有EBP的基石，并与治疗相关结局的改善显著相关。然而，学校提供者很少使用SA，导致次优护理。测量反馈系统（MFS）使用SA的结果向临床医生提供有关客户进展的信息，代表了将SA引入服务系统的结构化方法，并有可能支持有效的，以客户为中心的护理。因此，候选人的直接重点是增加临床医生对SA工具的管理，并通过开发MFS和专门为学校设计的相应情境化适应过程，将SA反馈纳入常规实践。 目前的K 08奖将独特的定位候选人，以推进这一研究议程。他的背景包括儿童临床心理学的专业培训，循证评估和干预方法，校本心理健康研究，心理健康服务研究以及与社区利益相关者的合作。为了更有效地弥合学校中典型和最佳精神卫生保健之间的差距，他寻求扩展他的培训，包括：（1）用户友好和上下文适当的医疗保健技术的设计，（2）理论和方法的经验，以支持学校的创新吸收/实施，（3）先进的统计和研究方法，和（4）先进的学术写作。华盛顿大学是一个杰出的环境，在其中从事所需的跨学科培训，以实现这些培训目标。候选人的主要导师博士伊丽莎白·麦考利和尤尔根·乌努策结合了青少年精神病理学评估和治疗方面的专业知识，与学校提供者进行培训，开发计算机产品以支持以证据为基础的服务提供，实施科学，以及开发和传播客户进度监测的测量反馈工具。更多的当地和国家顾问将在青年/家庭服务的实施研究、以用户为中心的设计、以学校为基础的心理健康、社区服务提供、青年治疗提供者的决策支持工具、文化多样性和心理健康护理、心理健康政策以及定性和混合方法研究方面提供专业知识。 建议的项目利用上述培训和专业知识，通过一系列定性、定量和混合方法研究目标，开发和评估一个适用于学校健康中心（SBHC）的基于网络的MFS。华盛顿大学护理管理跟踪系统是由Unutzer博士开发的MFS，以前发现可以改善护理，减少症状，并增加患者的功能。目前的研究建议使用SBHC临床医生焦点小组和直接的临床医生反馈，以适应SBHC临床医生使用的MFS。候选人先前的研究表明，SBHC供应商很少使用SA措施，但支持使用结构化，计算机化的方法来增加SA管理的可行性。SBHC临床医生（n = 20）和青年样本（n = 64，目标3）将参与该项目，以推进以下研究目标：（1）评估SBHC背景，以告知MFS适应;（2）评估适应背景的有效性;（3）评估系统对临床医生行为和青少年结局的影响;以及（4）评估向学校临床医生提供学术数据以用于进展监测的附加效用。SBHC临床医生将提供关于MFS最佳设计的反馈，并使用它来跟踪经历抑郁和焦虑的青少年的结果。目标1和2将在适用时使用现有基准进行连续评价。目标3将通过一项小规模随机试验进行实验性测试，其中临床医生（及其病例量的一个子集）将被随机分配到以下两种情况之一：（a）使用学校MFS使用SA或（B）照常评估来监测进展。目标4将使用MFS进行测试，将青年随机分为两种情况：（a）临床医生从MFS获得SA结果和学生入学数据，或（B）数据仅包括SA结果。根据这项工作的结果，将提交R 01补助金申请，以调查学校MFS的大规模实施和一系列学校服务提供模式之间的情境化适应过程，从而更彻底地评估其对临床医生行为和学生功能的影响。