IMPLEMENTATION OF COGNITIVE PROCESSING THERAPY FOR PTSD IN DIVERSE COMMUNITIES

描述(由申请人提供)：这是一份以患者为导向的研究职业发展奖(K23)的申请书，重点是在不同的社区精神卫生诊所(CMHC)内实施认知处理疗法(CPT)(1)治疗创伤后应激障碍(PTSD)。候选人建议以她治疗不同创伤后应激障碍患者的经验为基础，通过接受实施科学方面的培训，实现缩小研究与实践差距的长期职业目标，从而减少健康差距。CPT是创伤后应激障碍的两种一线经验性治疗(EBTS)之一。CPT在创伤类型、语言和人群中显示出有效性(1-3)和有效性(4)。然而，大多数社区精神卫生工作者(CMHW)很少(如果有的话)接受EBT培训，如CPT或在日常实践中使用这些培训。这项研究是创建一个框架以系统地解决这一实施差距的第一步，利用既定的实施理论(例如，(5-10))来理解和解决在CMHC中实施CPT的障碍。研究计划：初步研究采用混合方法迭代设计，使用来自早期实施阶段的数据分析来评估和改进后续实施工作。具体地说，本研究融合了三个不同的实施框架：(1)复制有效方案(REP)框架(5-8，11-14)；(2)实施研究综合框架(CFIR；(9))；以及(3)Proctor等人，实施结果变量的分类学(10)，以指导旨在解决以下具体目标的迭代开放试点实施研究：1)在不同的CMHC中预实施CPT之前，使用混合方法识别、评估和解决实施的组织背景和提供者级别的障碍和促进者；2)以英语和西班牙语与不同的提供者和患者进一步调整和预试干预方法和材料；以及3)对CMHW进行培训和试点，测试修改后的手册实施方案的可行性和可接受性，并初步探讨其对患者预后的影响。我们计划评估这个最终的实现协议，以便在未来的RO1中在不同的CMHC中普遍使用。环境：这项研究将在马萨诸塞州综合医院(MGH)和MGH切尔西精神卫生诊所进行，并将补充Naomi Simon、Marty Charns和Debra Kaysen博士的导师Naomi Simon、Marty Charns和Debra Kaysen博士的培训和监督研究计划，并咨询基于社区的研究、CPT和文化能力方面的专家。职业发展计划：以下领域的培训将强调候选人成为在不同社区实施EBTS的长期目标所需的技能，并将为未来的独立调查奠定基础：1)实施科学方法和理论框架；2)在CMHC实施CPT；3)治疗师监督/领导；4)临床试验的文化能力；以及5)混合方法数据分析。

DESCRIPTION (provided by applicant): This is an application for a Mentored Patient-Oriented Research Career Development Award (K23) with a focus on the implementation of cognitive processing therapy (CPT)(1) for post-traumatic stress disorder (PTSD) within a diverse community mental health clinic (CMHC). The candidate proposes to build upon her experience treating diverse PTSD patients by obtaining training in implementation science with the long-term career goal of narrowing the research-practice gap and, consequently, decreasing health disparities. CPT is one of two first line empirically based treatments (EBTs) for PTSD. CPT has shown efficacy(1-3) and effectiveness(4) across trauma types, languages, and populations. However, most community mental health workers (CMHWs) receive little, if any, training in EBTs such as CPT or use them in daily practice. This study is an initial step in creating a framework to address this implementation gap in a systematic manner drawing on established implementation theory (e.g., (5-10)) to understand and address barriers to implementing CPT in CMHCs. Research Plan: The primary study has a mixed-method iterative design with data analysis from earlier implementation stages used to evaluate, and refine subsequent implementation efforts. Specifically, the current study blends three distinct implementation frameworks: (1)Replicating Effective Programs (REP) framework(5-8, 11-14); (2)Consolidated Framework for Implementation Research (CFIR;(9)); and (3)Proctor et al., taxonomy for implementation outcome variables(10), to guide an iterative open pilot implementation study designed to address the following Specific Aims: 1)To identify, assess, and address organizational context and provider level barriers and facilitators of implementation using a mixed-methods approach prior to the pre-implementation of CPT in a diverse CMHC; 2)Further adapt and pre-test intervention methods and materials with diverse providers and patients in English and Spanish; and 3)Train CMHWs and pilot test the feasibility and acceptability of the modified manualized implementation protocol, and to initially explore its effect on patient outcome. We plan to evaluate this final implementation protocol for generalizable utilization across diverse CMHCs in a future RO1. Environment: The study will be based at the Massachusetts General Hospital (MGH) and the MGH Chelsea Mental Health Clinic and will complement a program of training and supervised research under mentors Drs. Naomi Simon, Marty Charns, and Debra Kaysen, with consultation from experts in community based research, CPT, and cultural competency. Career Development Plan: Training in the following areas will emphasize skills necessary for the candidate's long-term objective to become an expert in the implementation of EBTs in diverse communities and will lay the foundation for future independent investigation: 1) implementation science methodology and theoretical frameworks; 2) CPT implementation in CMHCs; 3) therapist supervision/leadership; 4) cultural competency in clinical trials; and 5) mixed-methods data analysis.