Improving Quality of Care in Child Mental Health Service Settings

项目概要/摘要 确保儿童获得最高质量的精神卫生保健是国家的首要任务。然而，护理质量 在传统的服务环境中仍然是高度可变的。需要新颖、可扩展的解决方案来解决 以可持续的方式修改护理质量指标。为此，供应商忠诚度和儿童的 参与是临床结果和实际干预目标的关键相关因素。有巨大 通过技术解决这两个问题的机会。儿童教育的研究表明，互动游戏，触摸- 屏幕学习和演示视频增强了参与度、知识、动力和学习。这些 好处也可能延伸到治疗环境，其中基于技术的活动的战略整合 可以提高儿童的学习，加强治疗联盟，并保持供应商的协议。我们 在NIMH R34的最后阶段，我们试用了一个基于患者和提供者信息的平板电脑工具包 旨在促进以创伤为中心的认知行为疗法（TF-CBT）的实施， 之所以被选中，是因为它使用其他治疗方法所共有的技术来解决广泛的症状， 情绪和行为障碍基于平板电脑的工具包由许多组件组成（例如，视频， 交互式游戏、绘图应用程序），其被设计为以某种方式促进提供者-患者交互 这增强了儿童的参与，并支持坚持治疗模式。基于平板电脑的工具包 在我们的试点工作中，受到儿童、照顾者和提供者的好评。此外， 我们的NIMH R34应用程序中概述的可行性得到满足或超过。我们现建议进行一项 混合有效性-实施试验，以检查平板电脑干预可能改善的程度 忠诚、参与和儿童的心理健康结果。我们将进行随机对照试验， 120名心理健康服务提供者和360个家庭与南卡罗来纳州和佛罗里达的数十家诊所合作。 提供者将被随机分配到平板电脑辅助与标准TF-CBT。8-16岁青少年， 将招募临床上升高的创伤后应激障碍症状。基线和基线后3、6、9和12个月 评估将由独立、不知情的评估人员进行。会议将录像， 由对研究假设不知情的独立评分者对参与度和忠诚度进行观察性编码。我们还将 检查成本，并与家庭、提供者、主管和机构进行半结构化访谈 领导人通报未来的传播和实施举措。基于技术的资源 可扩展的，易于使用的，旨在有效地融入日常实践的，可能已经持续的国家 冲击这些举措的投资回报最终将取决于它们改善利差的潜力 最佳做法治疗的质量和提供给需要它们的儿童的质量。

PROJECT SUMMARY/ABSTRACT Assuring children access to the highest quality mental health care is a top national priority. Yet, quality of care continues to be highly variable in traditional service settings. Novel, scalable solutions are needed to address modifiable quality-of-care indicators in sustainable ways. To this end, provider fidelity and children's engagement are key correlates of clinical outcome and practical targets for intervention. There is tremendous opportunity to address both through technology. Studies in child education show that interactive games, touch- screen learning, and demonstration videos enhance engagement, knowledge, motivation, and learning. These benefits also may extend to the therapeutic context, where strategic integration of technology-based activities may enhance children's learning, strengthen the therapeutic alliance, and keep providers on protocol. We are in the final stages of an NIMH R34 in which we piloted a patient- and provider-informed tablet-based toolkit designed to facilitate delivery of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) – a treatment that was selected because it addresses a wide range of symptoms using techniques shared by other treatments for emotional and behavioral disorders. The tablet-based toolkit consists of numerous components (e.g., videos, interactive games, drawing applications) that are designed to facilitate provider-patient interactions in a way that enhances children's engagement and supports adherence to the treatment model. The tablet-based toolkit was very well received by children, caregivers, and providers in our pilot work. Moreover, all benchmarks for feasibility outlined in our NIMH R34 application were met or exceeded. We now propose to conduct a hybrid effectiveness-implementation trial to examine the extent to which the tablet intervention may improve fidelity, engagement, and children's mental health outcomes. We will conduct a randomized controlled trial with 120 mental health providers and 360 families in partnership with dozens of clinics in the Carolinas and Florida. Providers will be assigned randomly to tablet-facilitated vs. standard TF-CBT. Youth aged 8-16 years with clinically elevated symptoms of PTSD will be recruited. Baseline and 3-, 6-, 9-, and 12-month post-baseline assessments will be conducted by independent, blind evaluators. Sessions will be videorecorded for observational coding of engagement and fidelity by independent raters blind to study hypotheses. We will also examine costs and conduct semi-structured interviews with families, providers, supervisors, and agency leaders to inform future dissemination and implementation initiatives. Technology-based resources that are scalable, easy to use, and designed for efficient integration into everyday practice may have sustained national impact. The return on investment of these initiatives will ultimately rest on their potential to improve the spread of best-practice treatments and the quality with which they are delivered to the children who need them.