Optimization of Fidelity Procedures for Pivotal Response Training in Autism

描述(申请人提供)：为了提高心理健康干预的整体质量和有效性，确定经验性的行为治疗是必不可少的 (ESBTS)，并确保社区环境中的提供者可以获得和使用这些治疗。实施的保真度(FI)，即按照预期实施干预的程度，为培训和保持提供者的有效性提供必要的信息。然而，用于衡量FI并向提供者提供反馈的工具和程序必须是有效和高效的。通过档案数据分析和对个别治疗成分的前瞻性评估，我们的目标是开发和评估用于自闭症儿童的ESBT的FI工具和评估程序。自闭症是儿童心理健康领域关注的一个关键领域；关键反应训练(PRT)是针对这一人群的自然主义ESBT(Humphries，2003；国家标准项目，2009)。PRT通常用于治疗完整性或有效性数据有限的社区环境(Stahmer，Collings&Palinkas，2005)。PRT实施保真度(FI)措施是为在研究环境中使用而开发的，并得到了最低限度的验证和适应，供社区治疗师使用。PRT的具体组成部分尚未得到独立评估，以确定FI如何与儿童结局相关，也没有审查辅助因素，如治疗师的纪律、环境、教育、情感和治疗环境对治疗完整性和儿童结局的影响。本项目的总体目标是为在社区服务环境中提高PRT的忠诚度提供信息。为了实现这一目标，将有六个具体目标：1)通过档案数据分析，评估PRT的FI与期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组件的FI之间的关系。3)使用解构性评估分别测试对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)评估PRT FI工具和评估程序的有效性，包括(A)使用该工具检查对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)前瞻性评估提供者实施PRT与儿童技能和行为之间的关系。拟议的科学模型将生成数据和重要产品，支持在自闭症服务社区使用ESBT。这项研究也将作为评估和改进FI知识和实践的一般模式，供精神卫生服务界和实施科学使用。

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.