Quality Assessment in Exposure Therapy

项目总结/摘要 经验支持的行为治疗不能有效地传播， 了解关键质量要素。机制知情的质量措施， 通过消除不必要的元素来增强实用性的非凡潜力， 针对多个问题和人群，并通过检测 机制参与治疗早期。社区精神卫生机构（CMHAs）， 然而，由于负担， 资源有限。焦虑暴露疗法是一个理想的原型， 鉴于CMHA对公共卫生的潜在影响， 明确的机制理论。曝光指南（EG），一个简短的质量工具测量治疗师 行为和机制，是基于微分析编码数据开发的，显示出强大的 治疗师行为和患者结果之间的联系，在暴露疗法的三个RCT中， 青年使用这些RCT数据的EG的初始心理测量是有希望的，显示了可靠性， 结构效度和预测效度，试点数据表明它可能是可以接受的， 在社区环境中可行。基于这些发现，我们建议测试这本小说 在社区环境中测量暴露质量，EG，包括其信度和效度， 实用主义，以及哪些社区最终用户可以成为可靠和有效的记者。 大型当地CMHA的治疗师（N = 40）治疗5-21岁的焦虑青年和年轻人 （N = 300）将参与本研究。EG将由1）机构主管完成 每月一次，2）每次治疗的治疗师，3）每次治疗的患者/家庭，以及4）每次治疗的研究评分员 上网时段这项研究的结果将建立一个创新的模型来衡量治疗 触发现实世界治疗变化机制的要素，以及为未来使用 EG作为一种培训工具，以提高社区环境中的接触质量。

Project Summary/Abstract Empirically supported behavioral treatments cannot be effectively disseminated without understanding key quality components. Mechanism-informed quality measures have extraordinary potential to enhance pragmatism by eliminating unnecessary elements and targeting multiple problems and populations, and to enhance predictive value by detecting mechanism engagement early in treatment. Community Mental Health Agencies (CMHAs), however, are often ill-equipped to use such measures of treatment quality due to burden and limited resources. Exposure therapy for anxiety is an ideal prototype for testing a practical, mechanism-informed quality measure in CMHAs given its potential for public health impact and clear theory of mechanism. The Exposure Guide (EG), a brief quality tool measuring therapist behaviors and mechanism, was developed based on microanalytic coded data showing a strong link between therapist behavior and patient outcome across three RCTs of exposure therapy in youth. Initial psychometrics for the EG using these RCT data are promising showing reliability, construct validity, and predictive validity, and pilot data suggests it may be acceptable and feasible in a community setting. Building upon these findings, we propose to test this novel measure of exposure quality, EG, in a community setting including its reliability and validity, its pragmatism, and which community end-users can become reliable and valid reporters. Therapists at a large local CMHA (N = 40) treating anxious youth and young adults ages 5-21 (N = 300) will participate in this study. The EG will be completed by 1) agency supervisors monthly, 2) therapists per session, 3) patient/families per session, and 4) study raters per session. Results from this study will establish an innovative model for measuring therapeutic elements that trigger mechanism of change in real-world therapy as well as inform future use of EG as a training tool to improve exposure quality in community settings.