Developing a tool to assess, provide feedback, and facilitate discussion of mechanisms of change in frontline addiction treatment

 描述(由申请人提供)：对行为改变机制(MOBCs)的研究已经确定了几个似乎有助于酒精使用障碍(AUD)治疗中成功饮酒结果的过程。通常，不同的循证治疗似乎通过类似的机制发挥作用，这表明，诸如拒绝饮酒自我效能、渴望、禁欲的社会支持和其他MOBC等概念是应该评估、针对治疗并监测变化的关键变量。尽管对MOBC的研究基础在继续扩大，但还需要做更多的工作来了解如何在现实世界的实践环境中利用MOBC。在非AUD的情况下，基于测量的护理研究表明，如果定期评估、呈现给患者并与临床医生讨论，精神健康症状会更快、更大程度地改善。然而，对MOBC采取类似方法--即在治疗期间评估、提供反馈并将MOBC作为常规做法进行讨论--的影响尚未得到检验。此外，还没有探讨如何在实际实践中促进对MOBC的评估、反馈和讨论。基于MOBC的评估工具可能对一线临床医生特别有吸引力，因为(1)不同的临床医生的理论方法往往不同，尽管 基本的MOBC往往是相似的，(2)转向基于结果的绩效衡量和医疗改革将需要增加对相关治疗目标的衡量和记录。拟议的K01职业发展奖提供培训，以支持专注于开发和测试工具的研究职业，以帮助一线临床医生并提高他们的服务交付质量。精心设计的培训计划将提供(1)成瘾治疗的实施科学，(2)使用者的培训 以技术设计为中心，以及(3)跨学科合作、研究传播和拨款撰写。这些目标将通过几种方式实现，包括专家的指导、课程作业、临床培训和实践经验。拟议的研究项目通过开发基于计算机的临床支持工具来补充这些培训目标，该工具以实施为重点，并帮助一线临床医生在治疗过程中评估和审查患者的MOBC数据。该项目将包括以下阶段：(1)评估利益相关者围绕开发这样一个临床支持工具的意见、需求和愿望；(2)反复测试和修改软件原型，以提高工具的易用性和了解其反馈；以及(3)测试工具的可行性、可接受性和对临床医生会议期间行为的影响。这项研究将在公共资助的治疗环境中与一线临床医生和患者一起进行。该奖项将通过提供涉及跨学科研究伙伴关系、以用户为中心的设计和以实施为重点的研究等新领域的培训，来补充候选人在MOBC研究方面的现有优势。

 DESCRIPTION (provided by applicant): Research on mechanisms of behavior change (MOBCs) has identified several processes that appear to facilitate successful drinking outcomes in alcohol use disorder (AUD) treatments. Often, different evidence- based treatments appear work through similar mechanisms, suggesting that constructs such as drink-refusal self-efficacy, craving, social support for abstinence, and other MOBCs are key variables that should be assessed, targeted in treatment, and monitored for change. Although the research base on MOBCs continues to expand, more work is needed to understand how to utilize MOBCs in real-world practice settings. In non- AUD contexts, measurement-based care research has shown that mental health symptoms improve more quickly and to a greater degree if they are routinely assessed, presented to patients, and discussed with clinicians. However, the impact of a similar approach for MOBCs - i.e., assessing, providing feedback, and discussing MOBCs as routine practice during treatment sessions- has not been tested. Moreover, the specific manner in which assessment, feedback, and discussion of MOBCs could be facilitated in real-world practice has not been explored. MOBC-based assessment tools could be particularly appealing to frontline clinicians given that (1) theoretical approaches often vary between clinicians despite the underlying MOBCs often being similar and (2) movement toward outcome-based performance measures and healthcare reform will require increased measurement and documentation of relevant treatment targets. The proposed K01 career development award provides training to support a research career focused on developing and testing tools that assist frontline clinicians and enhance the quality of their service delivery. Carefully devised training plans will provide training in (1) implementation science in addiction treatment, (2) user centered technology design, and (3) cross-disciplinary collaboration, research dissemination, and grant writing. These goals will be achieved through several means including mentorship from experts, coursework, clinical training, and hands-on experience. The proposed research project complements these training aims by developing a computer-based clinical support tool that is implementation-focused and helps frontline clinicians assess and review patient MOBC data during their treatment sessions. The project will include phases to (1) assess opinions, needs, and desires of stakeholders around developing such a clinical support tool, (2) iteratively test and modify a software prototype to increase the ease of using the tool and understanding its feedback, and (3) test the tool's feasibility, acceptability, and impact on clinicians' within-session behavior. The research will take place at a publicly-funded treatment setting with frontline clinicians and patients. The award will complement the candidate's existing strengths in MOBC research by providing training in new domains involving cross- disciplinary research partnerships, user-centered design, and implementation-focused research.