Developing a Robust Evidence-Based Implementation Package for Youth Autism

项目摘要 拟议研究的目的是开发实施工具，以促进提高护理质量 为接受社区精神健康服务的自闭症谱系障碍学龄青少年提供 设置. NIMH战略研究优先事项要求创新的服务提供模式，以改善 不同社区和人群接受精神卫生服务的结果，包括使用 以技术为基础的战略，使循证实践（EBP）可用，可交付，有效， 在非专业设置中可扩展，并用于旨在改善功能的服务系统干预 ASD患者的结局（目标4）。为了实现这些目标，自闭症学龄青少年的EBP 需要准备和优化，以便在社区环境中实施， 接受治疗。为ASD青少年实施EBP需要有效的质量控制（QC） 程序（治疗师培训和支持程序以及质量控制工具，以衡量 培训/支持程序）。作为实现这些目标的第一步，在拟议的项目中，我们将完成 三个主要目标：（a）开发一个灵活的，基于互联网的，视频支持的培训和真实的时间治疗师 指导应用程序，以支持临床医生实施模块化EBP的青年ASD（MEYA）， （B）制定MEYA正直量表，这是一个务实的 治疗完整性量表，旨在衡量MEYA培训系统的成功，并作为 （c）评估这些MEYA质量控制程序的可行性和前景， 通过多个关键中介（治疗师知识，参与）改善治疗师提供MEYA 基线研究由社区青少年治疗中心的最终用户组成的利益攸关方小组 自闭症患者将为研究团队提供MEYA培训系统和诚信量表的设计特点。 一名软件设计师和摄像师将与研究小组合作，实现MEYA培训系统， 它将包括多个设计功能，以最大限度地提高临床医生的参与度，激励和学习指导 当代的实施和学习模式（例如，普罗克特等人，2011年）。MEYA完整性量表 将根据1020个MEYA和比较治疗疗程的现有档案进行完善和验证 临床试验中获得的。这项多基线研究将招募15名与ASD青少年一起工作的临床医生 in community社区settings设置.将在本试验中评估MEYA培训系统的可接受性和可行性， 主要的结局指标将是治疗师在MEYA诚信量表上的评分， 干预。MEYA培训系统和诚信量表将根据利益相关者和 临床医生反馈，并准备在未来的R 01有效性试验中评估MEYA培训 该系统与社区环境中通常使用的不同培训和监督方法相结合。

Project Summary The objective of the proposed study is to develop implementation tools to facilitate an improved quality of care for school-aged youth with autism spectrum disorder (ASD) receiving services in community mental health settings. The NIMH Strategic Research Priorities call for innovative service delivery models to improve the outcomes of mental health services received in diverse communities and populations, including the use of technology-based strategies to make evidence based practices (EBPs) available, deliverable, effective, and scalable in non-specialty settings, and for service system interventions designed to improve functional outcomes for people with ASD (Objective 4). To achieve these goals, EBPs for school-aged youth with ASD need to be prepared and optimized for implementation in the community settings where most youth with ASD receive treatment. Implementation of EBPs for youth with ASD will require effective Quality Control (QC) procedures (therapist training and support procedures and QC instruments to gauge the success of the training/support procedures). As a first step towards these goals, in the proposed project we will accomplish three primary aims: (a) Develop a flexible, internet-based, video supported training and real time therapist guidance application to support clinician implementation of the Modular EBPs for Youth with ASD (MEYA), a compendium of EBPs for school-aged youth with ASD; (b) Develop the MEYA Integrity Scale, a pragmatic treatment integrity scale designed to gauge the success of the MEYA Training System and serve as a feedback tool in supervision; and (c) Assess the feasibility and promise of these MEYA QC procedures to improve therapist delivery of MEYA via key mediators (therapist knowledge, engagement) in a multiple baseline study. A panel of stakeholders comprised of end-users from community treatment centers for youth with autism will advise the research team on design features of the MEYA Training System and Integrity Scale. A software designer and videographer will work with the research team to realize the MEYA Training System, which will include multiple design features to maximize clinician engagement, motivation, and learning guided by contemporary models of implementation and learning (e.g., Proctor et al., 2011). The MEYA Integrity Scale will be refined and validated against a pre-existing archive of 1020 MEYA and comparison treatment sessions from NIH-funded clinical trials. The multiple baseline study will recruit 15 clinicians working with youth with ASD in community settings. The MEYA Training System will be assessed for acceptability and feasibility in this trial, and the primary outcome measure will be therapists' scores on the MEYA Integrity Scale following the onset of the intervention. The MEYA Training System and Integrity Scale will be refined based on stakeholder and clinician feedback and prepared for evaluation in a future R01 effectiveness trial testing the MEYA Training System in conjunction with different training and supervision approaches typically used in community settings.