Project 1

项目1

• 批准号: 10664995
• 负责人: BRYAN J. WEINER
• 金额: $ 18万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10664995
• 关键词: Address; Back; Caring; Chronic; Client; Clinic; Clinical; Collection; Communities; Community Mental Health Centers; Community Practice; Data; Deterioration; Development; Diagnostic; Disparity; Educational workshop; Effectiveness; Elements; Ensure; Ethnography; Evaluation; Evidence based practice; Feedback; Foundations; Goals; Group Processes; Hour; Intervention; Journals; Knowledge; Latinx population; Maps; Measurement; Measures; Mental Health; Mental Health Services; Methods; Modeling; Monitor; Outcome; Participant; Pathway interactions; Process; Provider; Recommendation; Reporting; Research Personnel; Site Visit; Structure; Symptoms; System; Testing; Therapeutic; Washington; Work; Youth; clinical implementation; community setting; comorbidity; dashboard; design; experience; implementation/effectiveness; improved; post implementation; preference; social; symptomatic improvement; treatment planning; treatment response; user centered design

PROJECT 1 SUMMARY For youth receiving care in community mental health centers (CMHCs), comorbidities are the rule rather than the exception.1,2 Using measurement-based care (MBC) as the foundation of treatment for youth with comorbid problems significantly improves the therapeutic impact as it can help define the treatment focus. MBC is the systematic, routine evaluation of symptoms to inform care decisions. Especially in youth, MBC increases the rate of symptom improvement,3 detects clients who would otherwise deteriorate,4 and alerts clinicians to non- responders.4,5 Implementing MBC with fidelity requires 3 elements: (a) routine administration of measures for symptoms, outcomes, and processes before therapy sessions, (b) therapist and client score review, and (c) collaborative reevaluation of the treatment plan. But MBC is rarely implemented with fidelity; less than 15% of providers report using MBC per recommendations.6 Previous efforts to support MBC implementation have yielded suboptimal outcomes because CMHC leaders are challenged to identify and prioritize barriers and select strategies to overcome them. New methods are needed for identifying and prioritizing determinants, and matching strategies to determinants, to optimize MBC implementation and treatment quality to improve youth mental health outcomes in community settings. Project 1's optimization goals are to increase impact of MBC and align methods with preferences of practice partners. IMPACT Center methods will be piloted in six diverse CMHC clinics (three of six serve primarily Latinx populations). IMPACT methods we focus on include (a) rapid evidence reviews to uncover empirical data regarding MBC determinants; (b) rapid ethnography to identify and describe local determinants and situate them in specific organizational, social, and task contexts; and (c) design probes (e.g., kits with disposable camera, journals, maps) to allow practice partners and youth to capture and reflect on aspects of their context that are salient for MBC. These activities will result in a list of determinants that will be rated by partners from each clinic for criticality, chronicity, and ubiquity to generate priority scores. Subsequently, we will use facilitated group processes to develop causal pathway diagrams to match strategies to the top three determinants and clarify their preconditions, moderators, mechanisms, and proximal and outcomes (definitions in Methods Core) at each of the six clinics to yield a plan to optimize MBC implementation (Aim 1). We will check back with clinic-specific implementation teams to track strategy deployment for six months. We will then compare MBC treatment quality for another six months post implementation with data from two years of historical controls (Aim 2). Finally, we will co-design toolkits for each of the five IMPACT Methods for the practice and scientific communities (Aim 3). Results from Aims 1 & 2 will support an R01 testing practice partner-led efforts, using the IMPACT toolkits (developed in Aim 3), to optimize MBC fidelity in CMHCs. Optimizing MBC implementation in CMHCs could transform youth mental health care by ensuring the most pressing symptoms are targeted early in treatment.

项目 1 摘要 对于在社区精神卫生中心 (CMHC) 接受护理的青少年来说，合并症是常态，而不是 例外。1,2 使用基于测量的护理 (MBC) 作为患有共病的青少年的治疗基础 问题可以显着提高治疗效果，因为它可以帮助确定治疗重点。 MBC 是 对症状进行系统、常规的评估，为护理决策提供信息。尤其是在年轻人中，MBC 增加了 症状改善率，3 检测否则会恶化的客户，4 并提醒临床医生注意非 4,5 忠实地实施 MBC 需要 3 个要素： (a) 日常管理措施 治疗前的症状、结果和过程，(b) 治疗师和客户评分审查，以及 (c) 治疗计划的协作重新评估。但 MBC 很少能保真地实现；少于 15% 提供商根据建议报告使用 MBC。6 之前支持 MBC 实施的努力已取得进展 取得了次优的结果，因为 CMHC 领导者面临着识别障碍并确定优先顺序并选择障碍的挑战 克服它们的策略。需要新的方法来识别决定因素并确定其优先顺序，并且 将策略与决定因素相匹配，优化 MBC 实施和治疗质量，以改善青年 社区环境中的心理健康结果。项目1的优化目标是增加MBC的影响力和 根据实践合作伙伴的偏好调整方法。 IMPACT 中心方法将在六个不同的 CMHC 进行试点 诊所（六家诊所中的三家主要服务于拉丁裔人群）。我们关注的 IMPACT 方法包括 (a) 快速证据 进行审查以发现有关 MBC 决定因素的经验数据； (b) 快速民族志识别和描述 局部决定因素并将其置于特定的组织、社会和任务环境中； (c) 设计探针 （例如，带有一次性相机、日记、地图的套件），让实践伙伴和青少年能够捕捉和反思 他们的背景对 MBC 来说很重要。这些活动将产生一系列决定因素 由每个诊所的合作伙伴对关键性、长期性和普遍性进行评级，以生成优先级分数。随后， 我们将使用促进小组流程来开发因果路径图，以将策略与前三项相匹配 决定因素并阐明其先决条件、调节因素、机制以及近端和结果（定义见 方法核心）在六个诊所中的每一个诊所制定一个优化 MBC 实施的计划（目标 1）。我们会检查 返回与诊所特定的实施团队一起跟踪六个月的策略部署。然后我们将比较 根据两年历史对照数据，实施后六个月的 MBC 治疗质量 （目标 2）。最后，我们将为实践和科学的五种 IMPACT 方法中的每一种共同设计工具包。 社区（目标 3）。目标 1 和 2 的结果将支持 R01 测试实践合作伙伴主导的工作，使用 IMPACT 工具包（在目标 3 中开发），用于优化 CMHC 中的 MBC 保真度。优化 MBC 实施 CMHC 可以通过确保尽早针对最紧迫的症状来改变青少年心理保健 治疗。