Developing a Robust Evidence-Based Implementation Package for Youth Autism

项目摘要 拟议研究的目标是开发实施工具，以促进提高护理质量 为自闭症谱系障碍(ASD)学龄儿童提供社区精神健康服务 设置。NIMH战略研究重点呼吁创新服务提供模式，以改善 不同社区和人口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、有效和 可在非专业设置中扩展，并可用于服务系统干预，旨在提高功能 自闭症患者的结局(目标4)。为了实现这些目标，为患有自闭症的学龄青年提供循证医学计划 需要为在大多数患有自闭症的年轻人所在的社区环境中实施做好准备和优化 接受治疗。为患有自闭症的青少年实施循证医学计划需要有效的质量控制(QC) 程序(治疗师培训和支持程序以及评估成功的质量控制工具 培训/支持程序)。作为迈向这些目标的第一步，在拟议的项目中，我们将完成 三个主要目标：(A)发展灵活的、基于互联网的、视频支持的培训和实时治疗师 指导应用程序，以支持临床医生实施青少年自闭症模块化EBPS(MEYA)，a 为患有自闭症的学龄青年编制循证计划简编；(B)编制MEYA诚信量表，一个务实的 治疗诚信量表旨在衡量MEYA培训系统的成功，并作为 监督中的反馈工具；以及(C)评估这些MEYA质量控制程序的可行性和承诺，以 通过多个关键媒介(治疗师知识、参与度)改善治疗师对Meya的交付 基线研究。由来自社区青少年治疗中心的最终用户组成的利益相关者小组 自闭症患者将就MEYA培训系统和诚信量表的设计特点向研究团队提供建议。 一名软件设计师和录像师将与研究团队合作实现Meya培训系统， 它将包括多种设计功能，以最大限度地提高临床医生的参与度、积极性和学习指导 通过当代的执行和学习模式(例如，Proctor等人，2011年)。梅亚正直性量表 将根据1020 Meya和对比治疗会话的现有档案进行改进和验证 来自NIH资助的临床试验。这项多基线研究将招募15名从事青少年ASD工作的临床医生 在社区环境中。在这次试验中，将评估MEYA培训系统的可接受性和可行性， 主要的结果衡量标准将是治疗师在MEYA诚信量表上的得分 干预行动。MEYA培训系统和廉洁量表将根据利益攸关方和 临床医生反馈并准备在未来测试MEYA培训的R01有效性试验中进行评估 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.