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

摘要 这项R34研究将首先制定治疗质量保证程序，旨在增加采用 和质量的经验支持的以家庭为基础的服务（FBS）的青少年物质使用（ASU）在通常情况下 护理，然后测试两个系统级的实施战略，安装新的质量程序在亚利桑那州立大学 治疗部位。FBS已经获得了治疗ASU的最强有力的证据基础，并且是一个主要的候选者。 提高ASU在各种护理系统中的服务质量。FBS包括家庭参与 在服务中，评估和治疗中包括家庭成员的系统参数 活动;和家庭治疗技术，临床医生用于直接针对家庭的具体干预措施 家庭成员和家庭为改变而努力。对于FBS，以发挥其增强ASU治疗的潜力 系统，FBS的实施必须得到有效的质量保证（QA）程序的支持， 确保FBS的准确性。为了推进这一努力，拟议的研究将利用一个强大的 申请组织和纽约单一州机构之间的研究-政府伙伴关系， SU服务。这项研究将首先开发创新的质量保证程序（目标1），使用现有的FBS质量 指标，以促进高保真FBS：测量反馈系统的实施（MFS-I），一个务实的 通过每月提供治疗师报告FBS的反馈来提高FBS质量的循证方法 提供沿着简短的在线FBS培训模块。然后，该研究将实验比较两个系统- 水平的实施战略，旨在促进MFS-I利用ASU的日常护理。仅限核心培训 将包含两个3小时的培训课程：绘制现有FBS并确定FBS的现场目标 安装和维持MFS-1。核心+引导是一种附加策略， 从核心培训课程开始开始，然后每月举行一次促进会议，持续一年， 促进MFS-I的使用和FBS改进的进展。该研究将采用三组群集 在15名受试者中测试仅核心训练与核心+促进与无干预对照的随机试验 纽约州有代表性的ASU诊所。MFS-I使用数据将从核心培训收集 和核心+促进网站进行为期一年的随访（在初始核心培训后）; FBS关于家庭的质量数据 将在一年随访期间从所有研究中心收集参与情况和家庭治疗技术使用情况; 所有研究中心的结果数据将从一年基线的管理数据仓库中检索， 一年随访。这些数据将使FBS输送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）和客户的结果（目的3：治疗目标 物质使用变化）。如果研究目标得以实现，研究人员将能够开展 全面的随机对照试验，以测试这些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.