Advancing Sustainability of Evidence-Based Treatments in Community Mental Health

项目摘要/摘要 太多的患者没有接受针对精神健康问题的循证治疗(EBT)。作为回应， 实施科学迅速发展，将循证技术引入常规实践环境，从而改进 病人的结果。不幸的是，关于EBTS可持续性的研究仍然令人震惊地有限。这是 关于这一问题，鉴于环境技术援助活动和效益在实施后经常下降。为了防止这种情况发生 随着人口数量的减少，迫切需要对可持续性进行研究。根据NIMH的战略计划4.2，这款F32将推进 关于可持续性的研究--即可持续性(A)成果、(B)预测因素和(C)机制-- 利用持续的父级R01(R01MH120147)。R01的重点是在以下10个项目中实施EBT 加州的社区精神卫生中心(CMHC)。具体地说，CMHC与R01团队合作 对睡眠和昼夜节律障碍(TRANS-C)患者实施跨诊断干预 患有严重的精神疾病。此外，R01的设计是为了测试是否操纵反式C来“适应” CMHC环境将通过随机化CMHC来提供标准的TRANS-C来改善实施结果 或改编成反式-C。因此，R01的S基础设施允许这款F32测试三个主要目标。与一致 Shediac-Rizkallah and bone的可持续性框架，目标1将进行定性和定量评估 在持续的(A)活动、(B)惠益和(C)能力方面，反式碳的可持续性成果。目标2 将使用分层线性建模来评估操作治疗是否适合上下文预测 可持续发展成果。目标3将使用结构方程建模来测试可能的介体-具体地说， 提供者对以下关系的适配性(即可接受性、适当性和可行性)的看法 操纵的治疗适合性和可持续性结果。为了实现这些目标，申请者将获得 培训：(1)循证技术的可持续性，(2)高级定量分析，(3)机械研究设计，以及 (4)定性和混合方法。该项目提供的研究和培训机会 奖学金将由加州大学伯克利分校蓬勃发展的研究环境和 申请人的赞助人(艾莉森·哈维博士)和专家顾问(香农·威尔特西博士)的指导 斯蒂尔曼、卡拉·刘易斯和索菲亚·拉贝-赫斯凯斯)。总的来说，这笔F32奖学金将支持申请者的 职业目标是成为实施科学领域的一名独立研究员，并拥有研究计划 评估EBTS实施和可持续性的预测因素、机制和结果 社区设置。

Project Summary/Abstract Too many patients do not receive evidence-based treatments (EBTs) for mental health problems. In response, implementation science has rapidly advanced to bring EBTs to routine practice settings, and thereby improve patient outcomes. Unfortunately, research on sustainability of EBTs remains alarmingly limited. This is concerning, given that EBT activities and benefits regularly decline post-implementation. To prevent these declines, research on sustainability is urgently needed. Per NIMH’s Strategic Plan 4.2, this F32 will advance research on sustainability – namely, sustainability (a) outcomes, (b) predictors, and (c) mechanisms – by leveraging an ongoing, parent R01 (R01MH120147). The R01 focuses on implementation of an EBT in 10 of California’s community mental health centers (CMHCs). Specifically, the CMHCs partnered with the R01 team to implement the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) for individuals with serious mental illness. Additionally, the R01 was designed to test whether manipulating TranS-C to “fit” the CMHC context would improve implementation outcomes by randomizing CMHCs to deliver Standard TranS-C or Adapted TranS-C. Thus, the R01’s infrastructure allows this F32 to test three primary aims. Consistent with Shediac-Rizkallah and Bone’s sustainability framework, Aim 1 will evaluate qualitative and quantitative sustainability outcomes of TranS-C, with respect to continued (a) activities, (b) benefits, and (c) capacity. Aim 2 will use hierarchical linear modeling to evaluate whether manipulating treatment fit to context predicts sustainability outcomes. Aim 3 will use structural equation modeling to test possible mediators – specifically, provider perceptions of fit (i.e., acceptability, appropriateness, and feasibility) – of the relation between manipulated treatment fit and sustainability outcomes. To accomplish these aims, the applicant will receive training in: (1) sustainability of EBTs, (2) advanced quantitative analysis, (3) mechanistic research design, and (4) qualitative and mixed methods approaches. The research and training opportunities offered by this fellowship will be supported by the thriving research environment of University of California, Berkeley and mentorship from the applicant’s Sponsor (Dr. Allison Harvey) and expert Consultants (Drs. Shannon Wiltsey Stirman, Cara Lewis, and Sophia Rabe-Hesketh). Collectively, this F32 fellowship will support the applicant’s career goals of becoming an independent investigator in implementation science with a program of research that evaluates the predictors, mechanisms, and outcomes of implementation and sustainability of EBTs in community settings.