Integrating implementation science and cultural adaptation to understand intervention modifications within school-based mental health

项目摘要/摘要 Ruth L.Kirschstein国家研究服务奖的目标是支持申请者在 建立一个独立的研究项目所需的专业技能，目标是改善 实施与环境相关和文化响应的循证治疗(EBTS) 因此，促进为历来得不到充分服务的青年提供公平的心理健康服务。这是F32 应用建议研究以解决NIMH战略优先事项4.1：提高效率和效果 通过研究，特别是通过为萌芽中的知识库做出贡献，对现有的精神健康服务进行评估 关于在实践中对EBTS进行的修改，从而优化EBTS在 真实世界的背景。F32的研究部分响应了NIH领导人的行动号召 实施科学小组，他们倡导编制一个全面的 识别在实践中对EBTS进行的修改并解释其影响的知识 相关结果。拟议的研究将分两个阶段进行：研究1将开发一种新的 整合了实施科学和文化适应的理论模型的编码方案，使用 修改德尔福程序，由实施科学研究人员和 文化适应研究人员(研究目标1)。使用此编码方案，研究2将检查 对学校内正在实施的EBT进行的修改，通过混合使用定量和 定性研究方法。具体地说，将通过以下途径从以学校为基础的精神健康提供者那里收集数据 量化测量和半结构访谈，以及研究1中制定的编码方案 用于确定在学校实施EBT时对其进行了哪些修改，以及为什么 正在制定(研究目标2)。最后，将测试一组假设，以估计该结构 通过检查EBT类型之间的预期关联来验证研究1中开发的编码方案的有效性 修改与临床医生和学校层面的变量(研究目标3)。结合起来，这两项研究将 为职业发展奖奠定坚实的基础，重点关注EBT修改对以下方面的影响 儿童/青少年心理健康结果。此外，通过设计和参与为期三年的 通过有针对性的培训活动，申请者将发展以学校为基础的心理健康研究方面的专业知识，同时 获得实施科学、文化适应和混合方法方面的关键知识和技能 研究。要实现的具体培训目标是：1)建立与背景相关的干预方面的专门知识 研究，特别强调以学校为基础的心理健康研究；2)扩展概念 在实践环境中通过集成两个相关但不同的 文献--实施科学和文化适应；3)发展混合的经验和专门知识 方法研究；4)加强经费撰写和稿件撰写技巧。

Project Summary/Abstract The goal of this Ruth L. Kirschstein National Research Service Award is to support the applicant in developing the specialized skills necessary to build an independent program of research with the goal of improving the implementation of contextually relevant and culturally responsive evidence-based treatments (EBTs) in schools, and thereby promoting equitable mental health services for historically underserved youth. This F32 application proposes research to address NIMH strategic priority 4.1: Improve the efficiency and effectiveness of existing mental health services through research, specifically by contributing to the budding knowledgebase on the modifications made to EBTs in practice, and thereby optimizing the effective implementation of EBTs in real-world contexts. The research component of this F32 responds to a call to action by leaders of the NIH Implementation Science Team, who have advocated for the compilation of a comprehensive body of knowledge identifying the modifications that are made to EBTs in practice and explaining their impacts on relevant outcomes. The proposed research will be conducted in two stages: Study 1 will develop a novel coding scheme that integrates theoretical models from implementation science and cultural adaptation, using modified Delphi procedures with an expert panel comprised of implementation science researchers and cultural adaptation researchers (Research Aim 1). Using this coding scheme, Study 2 will examine the modifications made to an EBT being implemented within schools, through the use of mixed quantitative and qualitative methods. Specifically, data will be collected from school-based mental health providers via quantitative measures and semi-structured interviews, and the coding scheme developed in Study 1 will be used to identify which modifications are being made to an EBT as it is implemented in schools, and why they are being made (Research Aim 2). Finally, a set of hypotheses will be tested in order to estimate the construct validity of the coding scheme developed in Study 1 by examining expected associations between types of EBT modifications and clinician- and school-level variables (Research Aim 3). In combination, these two studies will provide a strong foundation for a Career Development Award focused on the impact of EBT modifications on child/adolescent mental health outcomes. In addition, by designing and engaging in a three-year progression of targeted training activities, the applicant will develop expertise in school-based mental health research, while gaining critical knowledge and skills in implementation science, cultural adaptation, and mixed methods research. Specific training goals to be achieved are to: 1) Build expertise in contextually relevant intervention research, with a particular emphasis on school-based mental health research; 2) Expand conceptual knowledge of the modifications made to EBTs in practice settings by integrating two pertinent, yet disparate, literatures—implementation science and cultural adaptation; 3) Develop experience and expertise in mixed methods research; and 4) Strengthen grant-writing and manuscript-writing skills.