Optimization of Fidelity Procedures for Pivotal Response Training in Autism

描述（由申请人提供）：为了提高心理健康干预的整体质量和有效性，必须确定经验支持的行为治疗 （ESBT），并确保社区环境中提供者获得这些治疗的可用性和可用性。执行的忠实度，或干预措施按计划执行的程度，为培训和维持提供者的有效性提供了必要的信息。然而，用于衡量金融服务和向提供者提供反馈的工具和程序必须有效和高效。通过档案数据分析和前瞻性评估的个别治疗成分，我们的目标是开发和评估的FI工具和评估程序ESBT自闭症儿童。自闭症是儿童心理健康领域的一个关键关注领域;自闭症反应训练（PRT）是针对这一人群的自然ESBT（Humphries，2003;国家标准项目，2009）。PRT通常用于社区环境，有关治疗完整性或有效性的数据有限（Stahmer，Collings和Palinkas，2005）。PRT保真度的实施（FI）的措施，开发用于在研究环境中，并已收到最低限度的验证和适应社区治疗师使用。PRT的具体组成部分还没有独立评估，以确定如何FI与儿童的结果，和辅助因素，如治疗师的纪律，设置，教育，影响，治疗的完整性和儿童的结果和治疗环境的影响还没有被检查。本项目的总体目标是为社区服务环境中提高PRT保真度的策略提供信息。为此，将有六个具体目标：1）通过档案数据分析评估PRT的FI与会话内儿童技能和行为之间的关系。2)通过档案数据分析，评估供应商特征与PRT组件FI之间的关系。3)使用解构性评价单独测试PRT组件的可能修改。4)与社区提供者合作，开发和评估PRT FI工具和评估程序。5)评价PRT FI工具和评估程序的有效性，包括（a）检查使用该工具的培训和监督方法的改进，以及（B）在前瞻性研究中分析影响PRT FI和儿童结局的可能调节变量。6)家长评估提供者实施PRT与儿童技能和行为之间的关系。拟议的科学模型将产生支持自闭症服务社区使用ESBT的数据和重要产品。这项研究也将作为一个通用的模型，为精神卫生服务社区和实施科学的FI知识和实践的评估和改进。

DESCRIPTION (provided by applicant): To improve the overall quality and effectiveness of mental health intervention, it is essential to identify empirically supported behavioral treatments (ESBTs) and assure the accessibility and usability of these treatments for providers in community settings. Fidelity of implementation (FI), or the degree to which an intervention is implemented as was intended, provides necessary information for training and maintaining providers' effectiveness. However, the tools and procedures used to measure FI and provide feedback to providers must be effective and efficient. Through archival data analysis and prospective assessment of individual treatment components, we aim to develop and assess an FI instrument and assessment procedures for an ESBT for children with autism. Autism is a key area of concern in the field of child mental health; Pivotal Response Training (PRT) is a naturalistic ESBT for this population (Humphries, 2003; National Standards Project, 2009). PRT is routinely used in community settings with limited data regarding treatment integrity or effectiveness (Stahmer, Collings & Palinkas, 2005). PRT fidelity of implementation (FI) measures were developed for use in research settings and have received minimal validation and adaptation for use by community therapists. The specific components of PRT have not been independently evaluated to determine how FI relates to child outcome, and the effect of ancillary factors such as therapist discipline, setting, education, affect, and the treatment environment on treatment integrity and child outcome have not been examined. The overall goal of this project is to inform strategies for enhancing fidelity of PRT in community service settings Toward this goal, there will be six specific aims: 1) Evaluate relationships between FI of PRT and within-session child skills and behavior via archival data analysis. 2) Evaluate relationships between provider characteristics and FI of PRT components via archival data analysis. 3) Individually test possible modifications to components of PRT using deconstructive evaluation. 4) Develop and evaluate a PRT FI instrument and assessment procedures in partnership with community providers. 5) Evaluate effectiveness of a PRT FI instrument and assessment procedures including (a) examining improvements to training and supervision methods using the instrument and (b) analyzing possible moderating variables affecting FI of PRT and child outcome in a prospective study. 6) Prospectively assess the relationship between provider implementation of PRT and child skills and behavior. The proposed scientific model will generate data and important products supporting ESBT use in the autism services community. This research will also serve as a general model for evaluation and improvement of FI knowledge and practice for the mental health services community and implementation science.