Finalizing and Testing an Online Therapist Training and Assistance Program to Facilitate Implementation of Comprehensive Behavioral Intervention for Tic Disorders (CBIT-Trainer)

最终确定并测试在线治疗师培训和援助计划，以促进抽动障碍综合行为干预的实施（CBIT-Trainer）

• 批准号: 10679070
• 负责人: Michael B Himle
• 金额: $ 88.34万
• 依托单位: PSYC TECH, LTD
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-16 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10679070
• 关键词: Address; Adopted; Adoption; Affect; Aftercare; Attitude; Behavior Disorders; Behavior Therapy; Behavioral tic; Benchmarking; Childhood; Clinical; Collection; Computers; Consultations; Continuing Education; Data; Development; Distress; Effectiveness; Enrollment; Evaluation; Evidence based intervention; Evidence based practice; Evidence based treatment; Feedback; Gilles de la Tourette syndrome; Happiness; Impairment; Individual; International; Intervention; Letters; Measures; Modality; Motor; Neurodevelopmental Disorder; Outcome; Patient-Focused Outcomes; Patients; Persons; Pharmacotherapy; Phase; Population; Process; Protocols documentation; Provider; Qualitative Methods; Quality of life; Randomized, Controlled Trials; Recommendation; Reporting; Research; Research Methodology; Risk; Self Administration; Self Efficacy; Severities; Small Business Innovation Research Grant; Speed; Techniques; Technology; Testing; Tic disorder; Training; Training Programs; Treatment outcome; Vocal Tic Disorders; blind; disability; effectiveness/implementation design; effectiveness/implementation hybrid; follow-up; health care model; human capital; implementation facilitation; implementation framework; implementation process; impression; improved; innovation; neuropsychiatric disorder; nondrug therapy; optimism; patient response; peer support; phase 1 study; phase 1 testing; pilot test; preference; prevent; primary outcome; programs; psychoeducation; psychoeducational; repetitive behavior; satisfaction; side effect; skills; social; technology development; treatment response; trial comparing

Project Summary/Abstract Tic disorders (TD) are a class of childhood-onset neuropsychiatric disorders that occur in 1-3% of the population and often cause significant impairment in physical, social, academic, and interpersonal functioning and reduce quality of life. There is currently no cure for TD, however large-scale randomized controlled trials have shown that a non-drug treatment known as Comprehensive Behavioral Intervention for Tics (CBIT) can reduce tics without the adverse side effects associated with pharmacotherapy. Although CBIT is now recommended as a first-line intervention for TD, most patients cannot get CBIT due to a lack of trained therapists. Given the need and desire for CBIT among individuals with TD, high demand for therapist trainings, and the lack of therapists adequately trained in CBIT, there is a clear need for innovative ways to train more providers in this evidence-based treatment. The current proposal partners two of the primary developers of CBIT with PsycTech, a company that specializes in developing effective computer-based products for repetitive behavior disorders. In the proposed project, we will first finalize development of an innovative online program for training therapists to deliver CBIT (called CBIT-Trainer). Throughout the development process, we will engage multiple stakeholders in order to identify provider- and organizational-level factors shown to influence adoption and implementation of adapted interventions in other health-care models and settings. Upon completion, CBIT-Trainer will be tested against an intensive in-person therapist training program in a randomized controlled trial. This Phase II project will accomplish five aims: (1) to use a stakeholder-informed feedback process to complete the development of CBIT-Trainer, (2) to compare CBIT-Trainer to traditional in- person training on therapists’ ability to administer CBIT, (3) to compare CBIT-Trainer to in-person training on patient outcomes when they are treated by a CBIT-trained therapist, (4) to identify and address therapist factors that will improve (or limit) adoption and use of CBIT-Trainer, and (5) to identify therapist factors likely to influence therapists’ continued use of CBIT in their practice after training. To test these aims, we utilize an effectiveness-implementation hybrid design to conduct a randomized controlled trial comparing CBIT-Trainer to the Tourette Association of America’s Behavior Therapy Training Institute (BTI), which is the current gold- standard for training CBIT therapists. We plan to enroll 234 CBIT-naïve therapist-patient dyads to participate in the study. Our primary therapist outcomes will be therapist skill in delivering CBIT, which will be assessed at post-training (Week 0), after administering CBIT with a patient (Week 10), and at 6-month follow-up (Week 34). Our primary patient outcomes will be overall clinical improvement assessed at pre-treatment (Week 0), post- treatment (Week 10), and 6-month follow up (Week 34). As a secondary aim, we will also assess therapist- level facilitators and barriers to adopting CBIT-Trainer, as well as implementing and sustaining CBIT in their practice, after training. If CBIT-Trainer is effective for training therapists to deliver CBIT with fidelity, it has the potential to increase the number of therapists available to treat TD. In addition, the technology itself could be leveraged easily to advance the technological development and testing of similar training programs for other evidence-based interventions (EBIs), thereby speeding dissemination and availability of EBIs for other clinical problems. Moreover, CBIT-Trainer is proposing a unique research methodology that could be readily applied to similar projects seeking to expand the evaluation of training and treatment outcomes for EBIs that have historically relied too heavily on a human-capital intensive training approach.

项目概要/摘要 抽动障碍 (TD) 是一类儿童期发病的神经精神疾病，发生于 1-3% 的儿童 人口，常常对身体、社会、学术和人际功能造成严重损害 并降低生活质量。目前还没有治愈 TD 的方法，但大规模随机对照试验 研究表明，称为抽动症综合行为干预 (CBIT) 的非药物治疗可以 减少抽动，而不会产生与药物治疗相关的不良副作用。虽然 CBIT 现在 推荐作为 TD 的一线干预措施，但大多数患者由于缺乏训练有素而无法获得 CBIT 治疗师。鉴于 TD 患者对 CBIT 的需求和渴望，以及对治疗师培训的高需求， 由于缺乏接受过 CBIT 充分培训的治疗师，因此显然需要创新的方法来培训更多 这种循证治疗的提供者。目前的提案与两个主要开发商合作 CBIT 与 PsycTech 合作，PsycTech 是一家专门为以下领域开发有效的计算机产品的公司 重复性行为障碍。在拟议的项目中，我们将首先完成创新在线的开发 培训治疗师提供 CBIT 的计划（称为 CBIT-Trainer）。在整个开发过程中，我们 将让多个利益相关者参与进来，以确定提供者和组织层面的因素 影响其他卫生保健模式和环境中适应性干预措施的采用和实施。之上 完成后，CBIT-Trainer 将在一个密集的现场治疗师培训计划中进行测试 随机对照试验。该第二阶段项目将实现五个目标：（1）使用利益相关者知情的 反馈流程来完成 CBIT-Trainer 的开发，(2) 将 CBIT-Trainer 与传统的内部培训进行比较 就治疗师实施 CBIT 的能力进行个人培训，(3) 将 CBIT-Trainer 与现场培训进行比较 接受 CBIT 培训的治疗师治疗时的患者结果，(4) 识别并解决治疗师问题 改善（或限制）CBIT-Trainer 采用和使用的因素，以及 (5) 确定治疗师可能采取的因素 影响治疗师在培训后在实践中继续使用 CBIT。为了测试这些目标，我们利用 有效性-实施混合设计，进行随机对照试验，将 CBIT-Trainer 与 美国抽动秽语协会行为治疗培训学院 (BTI)，该学院是目前的金牌机构 培训 CBIT 治疗师的标准。我们计划招募 234 名未接触过 CBIT 的治疗师-患者二人组来参与 研究。我们的主要治疗师结果将是治疗师提供 CBIT 的技能，这将在 训练后（第 0 周）、对患者进行 CBIT 后（第 10 周）以及 6 个月随访时（第 34 周）。 我们的主要患者结局将是在治疗前（第 0 周）、治疗后评估的整体临床改善 治疗（第 10 周）和 6 个月随访（第 34 周）。作为次要目标，我们还将评估治疗师- 采用 CBIT-Trainer 以及在其各自领域实施和维持 CBIT 的促进因素和障碍 练习，训练后。如果 CBIT-Trainer 能够有效地培训治疗师准确地提供 CBIT，那么它具有 增加可用于治疗 TD 的治疗师数量的潜力。此外，该技术本身可以 轻松利用来推进其他类似培训计划的技术开发和测试 基于证据的干预措施 (EBI)，从而加快 EBI 在其他临床中的传播和可用性 问题。此外，CBIT-Trainer 提出了一种可以轻松应用的独特研究方法 类似的项目寻求扩大对 EBI 的培训和治疗结果的评估，这些项目已经 历史上过于依赖人力资本密集型培训方法。