Pragmatic Strategies for Assessing and Enhancing High Fidelity Delivery of Interpersonal Psychotherapy (IPT) in Community Practice

项目摘要/摘要 人际心理治疗(IPT)是一种经过充分描述和经验验证的治疗方法 抑郁症。虽然它的功效是无懈可击的，但它在社区中的保真度往往很低。 我们需要经过充分验证的保真度措施，以确保它在社区中交付 以高质量让患者最大限度地受益。 本提案是对NIMH RFA-MH-17-500《评估的实用策略》的回应 在实践中提高心理治疗的质量。RFA特别要求提案制定和测试 评估心理治疗忠诚度的实用策略，既具有心理测量学的严密性，又具有 可在社区中使用，并强烈强调需要大样本量，以便 各种工具和战略都得到了极好的验证。此外，《框架协议》强调将 所有利益攸关方都参与了文书和战略的制定过程。 对此，我们建议分两个阶段进行研究。第一阶段将是一个为期三年的开发项目 并验证3种保真度工具(供治疗师、患者和主管使用)以及 从病历中提取保真度数据，以衡量IPT交付的依从性和质量。 具体步骤包括审查IPT和其他心理治疗专家的质量反馈， 社区治疗师、监督员、管理人员和患者，以及随后的发展 IPT有效性、保真度和收集所产生数据的工具的原型测量。这些 然后，将在社区中对250名临床医生-患者二人组进行试点测试，将其与 IPT的专家评级和标准结果衡量标准。这项研究将在公众心理中进行 洛杉矶县的医疗系统，使我们能够与非常多样化的治疗师和 病人。我们在洛杉矶做了广泛的工作，包括培训1300多名IPT治疗师，开发 实施治疗的基础设施，并与 洛杉矶县精神卫生部门和洛杉矶县内的35个独立机构。 第二阶段将是对我们的最终工具的前瞻性验证，我们将使用数据最终确定 来自我们的试点试验以及其他利益相关者和专家的意见。我们将通过以下方式测试最终的仪器 将它们与IPT的专家评级进行比较，并与另一套独特的 社区里有250个治疗师和病人的双胞胎。最后，我们将从所有人那里收集数据 利益攸关方确认可行性，并估计实施成本和系统负担。 总之，我们将开发和测试一个经过良好验证的系统来衡量ipt治疗的保真度。 在社区中提供和实施，包括治疗师使用的经过充分验证的措施， 监督员和病人。

PROJECT SUMMARY/ ABSTRACT Interpersonal Psychotherapy (IPT) is a well-described and empirically validated treatment for depression. Though its efficacy is unassailable, it is often delivered with low fidelity in the community. We are in need of well-validated measures of fidelity to ensure that it is being delivered in the community at high quality so that patients benefit maximally. This proposal is submitted in response to NIMH RFA-MH-17-500, “Pragmatic Strategies for Assessing Psychotherapy Quality in Practice.” The RFA specifically requests that proposals develop and test pragmatic strategies for evaluating psychotherapy fidelity that are both psychometrically rigorous and feasible for use in the community, and strongly emphasizes the need for large sample sizes so that the instruments and strategies are extremely well validated. Moreover, the RFA emphasizes the inclusion of all stakeholders in the process of instrument and strategy development. In response, we propose to conduct a two-phase study. Phase I will be a three year project to develop and validate 3 fidelity instruments (to be used by therapists, patients, and supervisors) as well as tools to abstract fidelity data from the medical record to measure the adherence and quality of the delivery of IPT. Specific steps include a review of qualitative feedback by IPT and other psychotherapy experts, community therapists, supervisors, administrators, and patients, with subsequent development of prototype measures of IPT effectiveness fidelity and tools to collect the data generated. These measures will then be pilot tested with 250 clinician-patient dyads in the community, comparing them to expert ratings of IPT and to standard outcome measures. The study will take place in the public mental health system in Los Angeles County, allowing us to work with an extremely diverse set of therapists and patients. We have done extensive work in LA, including training over 1300 therapists in IPT, developing an infrastructure to implement the treatment, and have established extensive liaison relationships with the LA County Department of Mental Health and 35 individual agencies within LA County. Phase II will be a prospective validation of our final instruments, which we will finalize using the data from our pilot trial and additional stakeholder and expert input. We will test the final instruments by comparing them to expert ratings of IPT and to standard outcome measures with another unique set of 250 therapist-patient dyads in the community. At the conclusion, we will collect data from all stakeholders to confirm feasibility and to estimate the cost of implementation and burden on the system. In sum, we will develop and test a well-validated system to measure of the fidelity of IPT treatment delivery and implementation in the community, including well-validated measures for use by therapists, supervisors, and patients.