A Hybrid Type 2 Trial of Trauma-Focused Cognitive Behavioral Therapy and a Pragmatic Individual-Level Implementation Strategy

项目摘要 大多数经历严重创伤相关症状的青年没有得到指定的服务， 当他们这样做时，收到的服务并不是以证据为基础的。教育部门承担了70%-80%的责任 在为青少年提供的所有心理健康服务中，有(1)循证治疗的有限菜单 (2)有必要加强学校对EBT的吸收和使用 以及为遭受创伤的年轻人提供的其他社区环境。 创伤集中认知行为疗法是治疗创伤暴露的一种有效方法 青少年，但目前还没有研究评估在学校实施TF-CBT的效果。 此外，严重的实施障碍限制了成功采用、保真交付和 对TF-CBT的支持；特别是个体临床医生变量，如围绕核心的信念和态度 干预的组成部分(例如，暴露在令人恐惧的刺激中)。这两个差距揭示了研究的必要性 它同时检查了TF-CBT在学校教授时的有效性和实施情况。 个别提供商行为的改变是成功实施任何EBT的关键组成部分。连 当循证政策、支持性领导和有效培训等因素到位时， 实施最终取决于供应商对变革的动力和承诺。他们的信仰和 在学校中成功实施的态度(基础)干预是一种促进的、以小组为基础的混合干预 实施战略。基础是简短、务实的，旨在加强标准的EBP培训和 咨询程序。它的目标是理论上派生的与行为相关的个人水平决定因素 使用激励和意志行为改变策略进行改变。Basis已被评为可行并 适合SBMH临床医生，并被发现增加了临床医生的态度，对社会规范的感知，以及 在一项小型(n=24)随机试验中使用EBT的实施意图(R21MH108714)。 考虑到有必要审查工作队--CBT在学校范围内的有效性和重要性 在加强EBT培训和咨询的个人层面战略中，目前的提议是混合型2 有效性-使用混合方法对120名SBMH临床医生和480名学生进行实施试验。这 该项目旨在同时测试TF-CBT在学校的有效性和基础上的影响 最近的机制和工作队-CBT的实施结果。具体地说，该提案旨在试验性地 评估学校中的TF-CBT与常规治疗相比，包括干预机制的变化，心理 健康结果和TF-CBT成本效益(目标1)；并从实验上评估BASIC与 注意力控制，包括变化的执行机制、工作队--CBT的执行结果以及 基本成本效益(目标2)。Tf-CBT和基代表潜在的健壮性和可推广性 极大地提高创伤暴露青年获得服务的机会和服务质量的战略。

PROJECT ABSTRACT Most youth who experience significant trauma-related symptoms do not receive indicated services and, when they do, the services received are not evidence-based. The education sector is responsible for 70-80% of all mental health services delivered to youth, but there are (1) a limited menu of evidence-based treatments (EBTs) for trauma available for use in schools and (2) a need to enhance the uptake and use of EBT in schools and other community settings for youth exposed to trauma. Trauma-focused cognitive behavior therapy (TF-CBT) is an efficacious treatment for trauma-exposed youth, but there are no studies that have evaluated the effectiveness of TF-CBT when delivered in schools. Additionally, significant implementation barriers limit the successful adoption, delivery with fidelity, and sustainment of TF-CBT; especially individual clinician variables, such as beliefs and attitudes surrounding core components of the intervention (e.g., exposure to feared stimuli). These two gaps reveal the need for research that simultaneously examines effectiveness and implementation of TF-CBT when delivered in schools. Individual provider behavior change is a critical component of successful implementation of any EBT. Even when factors such as evidence-informed policy, supportive leadership, and effective training are in place, implementation ultimately rests with providers’ motivation and commitment to change. The Beliefs and Attitudes for Successful Implementation in Schools (BASIS) intervention is a facilitated, group-based blended implementation strategy. BASIS is brief, pragmatic, and is designed to augment standard EBP training and consultation procedures. It targets theoretically-derived individual-level determinants associated with behavior change using motivational and volitional behavior change strategies. BASIS has been rated as feasible and appropriate by SBMH clinicians, and found to increase clinicians’ attitudes, perceptions of social norms, and implementation intentions to use EBT in a small (n = 24) randomized trial (R21MH108714). Considering the need to examine the effectiveness of TF-CBT in the context of schools and the importance of individual-level strategies that augment EBT training and consultation, the current proposal is a hybrid type 2 effectiveness-implementation trial with 120 SBMH clinicians and 480 students using mixed methods. This project is designed to simultaneously test the effectiveness of TF-CBT in schools and the impact of BASIS on proximal mechanisms and TF-CBT implementation outcomes. Specifically, the proposal aims to experimentally evaluate TF-CBT in schools versus treatment as usual, including intervention mechanisms of change, mental health outcomes, and TF-CBT cost-effectiveness (Aim 1); and experimentally evaluate BASIS versus and attention control, including implementation mechanisms of change, TF-CBT implementation outcomes, and BASIS cost-effectiveness (Aim 2). TF-CBT and BASIS represent potentially robust and generalizable strategies for greatly enhancing the accessibility and quality of services for trauma-exposed youth.