IMPROVING THE IMPLEMENTATION AND SUSTAINMENT OF EBPS IN MENTAL HEALTH: DEVELOPING AND PILOTING THE COLLABORATIVE ORGANIZATIONAL APPROACH TO SELECTING AND TAILORING IMPLEMENTATION STRATEGIES (COAST-IS

项目摘要 儿童和青年经历创伤的速度令人震惊，这可能导致严重的心理健康问题。 以创伤为中心的认知行为疗法（TF-CBT）是一种循证实践（EBP），适用于那些 经历与创伤有关的情感或行为困难。然而，就像其他EBP一样，TF-CBT 即使组织和系统采用了它，实施问题也会限制其 有效性实施和维持TF-CBT和其他EBP的保真度可能需要多个 选择和调整执行战略，以解决多层次、具体情况的决定因素 （障碍和促进因素）。理想的情况是，执行战略的选择和调整将以下列因素为指导： 相关利益相关者的理论、证据和投入;然而，指导选择和定制的方法 的战略没有得到很好的发展。此K 01的目的是与SAMHSA资助的国家 儿童创伤压力网络（NCTSN），以制定和试行协作组织方法， 选择和定制实施战略（COAST-IS）。COAST-IS干预将涉及 指导组织领导者和治疗师使用干预映射来选择和定制策略。 干预映射是一个多步骤的过程，它本质上是生态的，并结合了理论，证据， 利益攸关方的观点，以确保干预措施的组成部分有效地解决关键的决定因素， 变化在第一年合作开发COAST-IS后，我们将进行一项随机试点试验， 在NCTSN学习协作中进行干预，随机分配八个组织进行学习 仅协作条件或学习协作加COAST-IS条件。我们将评估 COAST-IS的目标是：1）评估可接受性，适当性，可行性和实用性， 评估组织利益相关者对干预地图核心要素的忠诚度; 和3）证明在更大的有效性试验中测试COAST-IS的可行性。完成这些 目的和准备一个更大的混合方法的有效性试验，申请人将接受培训1） 干预开发，2）合作研究，3）实用的随机对照试验，以及4）混合 在Morris Weinberger、Greg Aarons、Loretta Jones和Ken威尔斯博士的指导下进行方法研究。 这项工作是重要的，因为它将产生一个系统的方法，整合理论，证据， 利益攸关方的观点，以提高执行战略的有效性和准确性。最后， COAST-IS可能有潜力改善各种EBP的实施和维持， 精神卫生和其他卫生部门。

PROJECT SUMMARY Children and youth experience trauma at alarming rates, which can lead to serious mental health problems. Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is an evidence-based practice (EBP) for those who experience emotional or behavioral difficulties related to trauma. However, much like other EBPs, TF-CBT is underutilized, and even when organizations and systems adopt it, implementation problems can limit its effectiveness. Implementing and sustaining TF-CBT and other EBPs with fidelity may require that multiple implementation strategies be selected and tailored to address multilevel, context-specific determinants (barriers and facilitators). Ideally, the selection and tailoring of implementation strategies would be guided by theory, evidence, and input from relevant stakeholders; however, methods to guide the selection and tailoring of strategies are not well-developed. The purpose of this K01 is to partner with the SAMHSA-funded National Child Traumatic Stress Network (NCTSN) to develop and pilot the Collaborative Organizational Approach to Selecting and Tailoring Implementation Strategies (COAST-IS). The COAST-IS intervention will involve coaching organizational leaders and therapists to use Intervention Mapping to select and tailor strategies. Intervention Mapping is a multistep process that is inherently ecological and incorporates theory, evidence, and stakeholder perspectives to ensure that intervention components effectively address key determinants of change. After collaboratively developing COAST-IS in Year 1, we will conduct a randomized pilot trial of the intervention within an NCTSN learning collaborative, randomly assigning eight organizations to the learning collaborative-only condition or the learning collaborative plus COAST-IS condition. We will then evaluate COAST-IS in the following aims: 1) to assess the acceptability, appropriateness, feasibility, and utility of COAST-IS; 2) to evaluate organizational stakeholders' fidelity to the core elements of Intervention Mapping; and 3) to demonstrate the feasibility of testing COAST-IS in a larger effectiveness trial. To accomplish these aims and prepare for a larger mixed methods effectiveness trial, the applicant will receive training in 1) intervention development, 2) partnered research, 3) pragmatic randomized controlled trials, and 4) mixed methods research under the direction of Drs. Morris Weinberger, Greg Aarons, Loretta Jones, and Ken Wells. This work is significant because it will yield a systematic method that integrates theory, evidence, and stakeholder perspectives to improve the effectiveness and precision of implementation strategies. Ultimately, COAST-IS may have the potential to improve implementation and sustainment of a wide-range of EBPs in mental health and other health sectors.