Combining an Evidenced Based Treatment with a Measurement Feedback System

将循证治疗与测量反馈系统相结合

• 批准号: 8296062
• 负责人: Leonard Bickman
• 金额: $ 66.56万
• 依托单位: VANDERBILT UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-01 至 2015-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8296062
• 关键词: Address; Adherence; Adolescent; Affect; Attention; Attitude; Behavior; Behavioral; Belief; Caregivers; Characteristics; Client; Clinic; Clinical; Clinical Treatment; Clinical Trials; Communities; Computer Simulation; Data; Development; Educational Intervention; Evidence based treatment; Experimental Designs; Family; Family psychotherapy; Feedback; Foundations; Funding; Goals; Grant; Health system; Healthcare; Indiana; Intervention; Justice; Lead; Licensing; Life; Measurement; Measures; Mediator of activation protein; Mental Health; Mental Health Services; Modeling; National Institute of Mental Health; Outcome; Population; Process; Protocols documentation; Provider; Quasi-experiment; Randomized; Research; Research Personnel; Self Efficacy; Services; Site; Staff Attitudes; Stress; Supervision; System; Testing; Therapeutic; Universities; Work; Youth; base; clinical application; clinical decision-making; community setting; computerized; cost; evidence base; experience; falls; improved; information processing; innovation; operation; public health relevance; standardize measure; theories; treatment adherence; treatment as usual

DESCRIPTION (provided by applicant): The recent, poor meta-analytic results of evidence-based treatment (EBT) represent a crisis in youth mental health services. There is a dire need for innovative approaches to improving transportability, implementation, and outcomes of services. Model adherence (EBT fidelity) is a necessary but not sufficient mechanism for improving outcomes in community settings. Real-world mental health treatment requires attention to the complexities inherent in the interaction between unique settings, therapists, and clients. As such, therapists implementing EBTs need better support for clinical decision making that may lead to adaptations of the EBT in the service of tailoring treatment. A measurement feedback system (MFS) provides the ongoing treatment progress and process information necessary to assist the therapist in making treatment decisions. As a benefit to the MFS, the EBT provides an essential framework for integration of systematic data into logistical, clinical, and supervisory operations. The synergy of the combination of an MFS and an EBT should improve transportability of EBT, implementation of MFS, and youth and family outcomes. We will integrate an existing EBT [and an existing MFS. The EBT is Functional Family Therapy (FFT), an empirically supported intervention for youths in the juvenile justice and mental health systems. Model-specific data on treatment adherence and progress are provided in the FFT Q-system, a computerized model-specific quality improvement system. The MFS is Contextualized Feedback Intervention and Training (CFIT), which provides computerized feedback on treatment progress and process upon weekly completion of brief standardized measures administered to youths, caregivers, and therapists.] We will determine if this innovative combination has the desired synergistic effect on the provider organizations, therapist behavior, and youth/family outcomes in a community mental health agency with 4 sites where 102 therapists will serve over 4000 youths during the life of the study. A current foundation grant is supporting the development and testing of a computerized system that integrates both existing feedback systems. That work will be complete[d in January 2010]. Therapists will be randomly assigned to one of two groups: (1) Basic FFT (FFT only) or (2) Enhanced FFT (FFT + CFIT). Feedback for the Basic FFT condition includes adherence only, consistent with the typical FFT supervision protocol. For the Enhanced FFT condition, feedback also includes information on youth treatment progress and process This study will address the changes in therapist behavior and youth/family outcomes that may result from providing two different types of therapist feedback in community mental health agencies. The proposed project also includes a low-cost quasi-experimental design comparing implementation of CFIT in this study with a current NIMH study where CFIT is implemented in the absence of an EBT. PUBLIC HEALTH RELEVANCE: Evidence-based treatments (EBTs) have not reached their potential to improve the outcomes for clients in community mental health treatment settings. There is a crisis in youth mental health services demanding innovative approaches for improving transportability, implementation, and outcomes of clinical treatments. The proposed study tests whether adding a measurement feedback system (MFS) that provides feedback on the therapeutic process and outcomes, to an existing EBT that only measures model adherence, improves therapist behavior and ultimately youth/family outcomes.

描述(由申请人提供)：最近，循证治疗(EBT)的荟萃分析结果不佳，代表着青少年心理健康服务的危机。迫切需要创新的方法来改善服务的可运输性、执行情况和结果。遵守模式(EBT保真度)是改善社区环境成果的必要机制，但不是充分机制。现实世界的心理健康治疗需要注意独特的环境、治疗师和客户之间的互动所固有的复杂性。因此，实施EBTS的治疗师需要为临床决策提供更好的支持，这可能导致EBT在定制治疗服务中的适应。测量反馈系统(MFS)提供正在进行的治疗进度和过程信息，以帮助治疗师做出治疗决策。作为MFS的一个好处，EBT为将系统数据整合到后勤、临床和监督行动中提供了一个基本的框架。MFS和EBT相结合的协同作用应该会改善EBT的可运输性、MFS的实施以及青年和家庭成果。我们将整合现有的EBT[和现有的MFS。EBT是功能性家庭治疗(FFT)，是一种在青少年司法和心理健康系统中为青少年提供的经验支持的干预措施。关于治疗依从性和进展的特定型号的数据在FFT Q系统中提供，这是一个计算机化的特定型号的质量改进系统。MFS是情景反馈干预和培训(CFIT)，在每周完成向青少年、照顾者和治疗师实施的简短标准化措施后，提供关于治疗进展和过程的计算机化反馈。]我们将确定这一创新组合是否对社区精神卫生机构的提供者组织、治疗师行为和青年/家庭结果产生预期的协同效应，该机构有4个站点，102名治疗师将在研究期间为4000多名青年提供服务。目前的一项基金赠款正在支持开发和测试一个将两个现有反馈系统整合在一起的计算机化系统。这项工作将于2010年1月完成[d]。治疗师将被随机分配到两组中的一组：(1)基本FFT(仅限FFT)或(2)增强FFT(FFT+CFIT)。对基本FFT条件的反馈仅包括遵守，这与典型的FFT监管协议一致。对于增强的快速傅立叶变换条件，反馈还包括关于青少年治疗进展和过程的信息。这项研究将讨论在社区精神卫生机构提供两种不同类型的治疗师反馈可能导致的治疗师行为和青少年/家庭结果的变化。拟议的项目还包括一个低成本的准实验设计，将本研究中实施的CFIT与目前的NIMH研究进行比较，在NIMH研究中，在没有EBT的情况下实施CFIT。 公共卫生相关性：在社区精神卫生治疗环境中，循证治疗(EBT)尚未发挥其改善患者结果的潜力。青年心理健康服务存在危机，需要创新的方法来改善临床治疗的可转移性、实施性和结果。这项拟议的研究测试了在现有的EBT中增加一个提供治疗过程和结果反馈的测量反馈系统(MFS)是否改善了治疗师的行为，并最终改善了青年/家庭结果。