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

项目摘要/摘要 抽动障碍(TD)是一类儿童起病的神经精神障碍，发生在1-3%的 通常会造成身体、社会、学习和人际功能的严重损害 并降低生活质量。目前还没有治愈TD的方法，但大规模的随机对照试验 已经表明，一种名为抽搐综合行为干预(CBIT)的非药物治疗可以 减少抽搐，没有与药物治疗相关的不良副作用。尽管CBIT现在是 建议作为TD的一线干预措施，大多数患者由于缺乏培训而无法接受CBIT 心理医生。鉴于TD患者对CBIT的需求和愿望，对治疗师培训的高需求， 而且缺乏在CBIT方面接受过充分培训的治疗师，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与心理技术公司合作，这家公司专门开发基于计算机的有效产品 重复性行为障碍。在建议的项目中，我们将首先敲定开发一个创新的在线 培训治疗师以提供CBIT的计划(称为CBIT-Trader)。在整个开发过程中，我们 将与多个利益相关者接触，以确定提供商和组织级别的因素 影响在其他保健模式和环境中采用和实施适当的干预措施。vt.在.的基础上 完成后，CBIT-Trader将在一个强化的面对面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 完成CBIT-Trader开发的反馈过程；(2)将CBIT-Trader与传统In-Trader进行比较。 关于治疗师管理CBIT的能力的人员培训，(3)将CBIT培训师与面对面培训进行比较 接受CBIT培训的治疗师治疗时的患者结果，(4)确定和解决治疗师 将促进(或限制)采用和使用CBIT-Trader的因素，以及(5)确定可能 影响治疗师在培训后继续使用CBIT的情况。为了测试这些目标，我们使用了一个 有效性-实施混合设计，进行随机对照试验，比较CBIT-Trader与 美国抽动秽语协会的行为治疗培训研究所(BTI)，是目前的黄金- 培训CBIT治疗师的标准。我们计划招募234名CBIT-天真的治疗师-患者二人组参与 这项研究。我们的主要治疗师的结果将是提供CBIT的治疗师技能，这将在 训练后(0周)，与患者一起实施CBIT后(10周)，以及6个月随访(34周)。 我们的主要患者结果将在治疗前(0周)、治疗后(0周)评估总体临床改善情况 治疗10周，随访6个月(34周)。作为次要目标，我们还将评估治疗师- 级别促进者和采用CBIT培训师的障碍，以及在其 练习，在训练之后。如果CBIT-Trader有效地培训治疗师，使其能够准确地提供CBIT，那么它具有 有可能增加治疗TD的治疗师数量。此外，这项技术本身可能是 可轻松推动技术开发和其他类似培训计划的测试 循证干预(EBI)，从而加快EBI的传播和可用于其他临床 有问题。此外，CBIT-Trader提出了一种独特的研究方法，可以很容易地应用 寻求扩大对具有以下情况的EBI的培训和治疗结果的评估的类似项目 历史上过于依赖人力资本密集型培训方法。

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.