Testing a System-level Implementation Intervention to Improve the Quality of Family-Based Services for Adolescent Substance Use

摘要 这项R34研究将首先开发旨在提高采用率的治疗质量保证程序 青少年药物使用(ASU)的经验性支持家庭服务(FBS)通常的质量 注意，然后测试在亚利桑那州立大学安装新质量程序的两个系统级实施策略 治疗地点。FBS已经获得了治疗ASU的最有力的证据基础，是首选候选方案 用于提高亚利桑那州立大学在各种护理系统中的服务质量。FBS包括两个家庭参与 在服务中，家庭成员被纳入评估和治疗的系统参数 活动；和家庭治疗技术，临床医生用来直接针对家庭的具体干预 为变革发挥作用的成员和家庭。FBS发挥潜力加强ASU治疗 系统，FBS的实施必须得到有效的质量保证(QA)程序的支持，旨在 确保FBS的交付保真度。为了推进这一努力，拟议的研究将利用强有力的 申请组织与纽约州单一州机构之间的研究-政府合作伙伴关系 SU服务公司。该研究将首先开发创新的质量保证程序(目标1)，利用现有的FBS质量 促进高保真FBS的指标：实施的测量反馈系统(MFS-I)，一个务实的 通过对治疗师报告的FBS提供每月反馈来提高FBS质量的循证方法 与简短的在线FBS培训模块一起交付。然后，这项研究将对两个系统进行实验比较- 一级实施战略，旨在促进MFS-I在亚利桑那州立大学的日常护理中的利用。仅限核心培训 将包含两个3小时的培训课程：映射现有的FBS和确定FBS的站点目标 改进以及安装和维持MFS-I。核心+促进是一种相加战略，它将 从核心培训课程开始，然后继续每月举行一年的促进会议，以 促进MFS-I的使用和FBS的改进。这项研究将以三组集群为特色 15%的随机试验测试仅核心培训与核心+促进与不干预对照 纽约州有代表性的亚利桑那州立大学诊所。将从核心培训中收集MFS-I利用率数据 和Core+促进站点进行为期一年的跟踪(在最初的Core培训之后)；FBS关于家庭的质量数据 参与和家庭治疗技术的使用将从所有网站收集超过一年的跟踪；和客户 所有站点的结果数据将在一年基线内从行政数据仓库中检索，并 为期一年的随访。这些数据将使FBS交付的条件间比较成为可能(目标2：MFS-I 利用、家庭参与、家庭治疗技术的使用)和患者结果(目标3：治疗目标 成就、物质使用变化)。如果研究目标得以实现，研究人员将有能力进行 完全支持RCT，以在规模上测试这些FBS质量改进程序的有效性。

Abstract This R34 study will first develop treatment quality assurance procedures designed to increase the adoption and quality of empirically supported family-based services (FBS) for adolescent substance use (ASU) in usual care, and then test two system-level implementation strategies for installing the new quality procedures in ASU treatment sites. FBS have achieved the strongest evidence base for treating ASU and are a prime candidate for upgrading the quality of ASU services in various systems of care. FBS comprise both family participation in services, the systemic parameters wherein family members are included in assessment and treatment activities; and family therapy techniques, the specific interventions that clinicians use to directly target family members and family functioning for change. For FBS to fulfill their potential to enhance ASU treatment systems, FBS implementation must be supported by effective quality assurance (QA) procedures designed to ensure that FBS are delivered with fidelity. To advance this effort, the proposed study will leverage a strong research-government partnership between the applicant organization and the New York single-state agency for SU services. The study will first develop innovative QA procedures (Aim 1) that use existing FBS quality metrics to promote high-fidelity FBS: Measurement Feedback System for Implementation (MFS-I), a pragmatic evidence-based method for increasing FBS quality by providing monthly feedback on therapist-reported FBS delivery along with brief online FBS training modules. The study will then experimentally compare two system- level implementation strategies designed to foster MFS-I utilization in usual care for ASU. Core Training Only will contain two 3-hour training sessions: Mapping existing FBS and identifying site goals for FBS improvement; and Installing and sustaining the MFS-I. Core + Facilitation is an additive strategy that will begin with the Core Training sessions and then continue with monthly facilitation meetings for one year to promote MFS-I use and progress toward FBS improvement. The study will feature a three-group cluster randomized trial testing Core Training Only versus Core + Facilitation versus no-intervention Control in 15 representative ASU clinics across New York State. MFS-I utilization data will be collected from Core Training and Core + Facilitation sites for one-year follow-up (after initial Core Training); FBS quality data on family participation and family therapy technique use will be collected from all sites over one-year follow-up; and client outcome data for all sites will be retrieved from administrative data warehouses over one-year baseline and one-year follow-up. These data will enable between-condition comparisons of FBS delivery (Aim 2: MFS-I utilization, family participation, family therapy technique use) and client outcomes (Aim 3: therapeutic goal achievement, substance use change). If study aims are achieved, investigators would be positioned to mount a fully powered RCT to test the effectiveness of these FBS quality improvement procedures at scale.