Project 2

项目2

• 批准号: 10471250
• 负责人: Shannon Dorsey
• 金额: $ 21.57万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 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 2023-04-08
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10471250
• 关键词: Address; Adolescent; Adoption; Anxiety; Behavioral; Caring; Child; Client; Climate; Clinical; Cognitive Therapy; Communities; Community Mental Health Centers; Community Practice; Consultations; Disease; Ensure; Evidence based practice; Goals; Human Resources; Intervention; Interview; Lead; Leadership; Literature; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Methods; Outcome; Pathway interactions; Phase; Pilot Projects; Population; Problem Solving; Research; Research Project Grants; Resource-limited setting; Resources; Rewards; Testing; Trainers Training; Training; Training Support; Universities; Washington; Work; Youth; base; clinical implementation; community setting; confirmatory trial; dashboard; data de-identification; design; effectiveness testing; experience; ideation; implementation efforts; implementation facilitation; implementation strategy; improved; innovation; meetings; member; peer; pilot test; post-traumatic stress; program dissemination; success; theories; virtual

PROJECT 2 SUMMARY One-third of children and adolescents experience a mental health disorder in their lifetime. Although a number of evidence-based practices (EBPs) have been developed that could address mental health disorders in children and adolescents, they are not commonly available in community settings. To increase the availability of EBPs, implementation efforts have often focused on clinician training. However, research consistently demon- strates that low-resource community settings need additional supports beyond clinician-focused efforts, to im- plement EBPs with fidelity. The Washington State EBP Initiative (“the Initiative”), an IMPACT partner, provides clinician training for community mental health centers in Cognitive Behavioral Therapy (CBT) for four common youth mental health conditions: anxiety, posttraumatic stress, behavioral difficulties, and depression. We propose to partner with the Initiative to optimize Implementation Coaching, an intervention developed and piloted by the PI to support community mental health centers in tailoring recommended implementation strategies for their organization. The goal of Coaching is to generate a positive implementation climate for CBT, leading to high- fidelity CBT delivery and positive outcomes for youth. Defined as the degree to which an innovation (CBT) is expected, supported, and rewarded, implementation climate is an important theoretical mechanism for high- quality implementation. Coaching supports CMHCs through working with CMHC supervisors who are frontline leaders in their organizations. We will first collaborate with CMHC supervisors experienced in CBT implementa- tion to optimize Coaching using Ideation, an IMPACT Challenge III method. Coaching requires optimization be- fore testing: (1) to ensure the best fit for low-resource CMHCs and 2) to be led by peer, CBT-experienced CMHC supervisors (Aim 1). Using a Train-the Trainer approach, we train and support a subset of the 10 collaborating CMHC supervisors from Aim 1 to lead Coaching. We then test the optimized Coaching intervention in a pilot RCT involving 20 CMHCs participating in the Initiative (20 supervisors, at least 60 of their clinicians), examining impact on CBT fidelity and clinical outcomes for youth (Aim 2). We compare standard Initiative implementation supports (10 CMHCs) to these standard supports plus Coaching (10 CMHCs). We use routinely entered, de- identified data to assess CBT fidelity and clinical outcomes. In the Coaching condition, peer CBT-experienced CMHC supervisors will lead Coaching with small groups of supervisors. Coaches will use an IMPACT Challenge II toolkit, co-designed with practice partners to inform their Coaching activities. Expected outcomes include an optimized Coaching strategy that could be integrated into the Initiative's standard implementation support and disseminated to the broader practice community nationally. Study aims also provide opportunities to refine IM- PACT methods and toolkits for Project 3, use in our pilot program, and dissemination to the practice and scientific communities. If effective, Coaching delivered by peer supervisors can be implemented at scale and potentially sustainable to accelerate treatment quality and outcomes for youth.

项目2概要 三分之一的儿童和青少年在其一生中经历过心理健康障碍。虽然 许多循证实践（EBP）已经开发出来，可以解决心理健康障碍 在儿童和青少年中，在社区环境中通常无法获得这些药物。提供更多 EBP的实施工作往往集中在临床医生的培训。然而，研究一直在恶魔- 表明，低资源社区环境需要额外的支持以外的临床医生为重点的努力，以提高- 用忠诚补充EBPs。华盛顿州EBP倡议（“倡议”）是IMPACT的合作伙伴， 社区精神卫生中心的临床医生培训认知行为疗法（CBT）， 青少年心理健康状况：焦虑、创伤后压力、行为困难和抑郁。我们提出 与该倡议合作，优化实施指导，这是一项由联合国开发和试点的干预措施， PI支持社区精神卫生中心为其量身定制建议的实施策略， organization.教练的目标是为CBT创造一个积极的实施氛围，从而提高 为青年提供忠诚的CBT服务和积极的成果。定义为创新的程度（CBT） 期望、支持和奖励的实施氛围是高绩效的重要理论机制， 质量执行。教练通过与CMHC主管（一线）合作，支持CMHC 领导人在他们的组织。我们将首先与在CBT实施方面经验丰富的CMHC主管合作a- 使用IMPACT Challenge III方法Ideation来优化教练。教练需要优化- 预先测试：（1）确保最适合资源不足的CMHC，2）由同行领导，有CBT经验的CMHC 目标1（Aim 1）使用培训师培训方法，我们培训和支持10个合作伙伴中的一个子集。 目标1的CMHC主管领导教练。然后，我们在试点中测试优化的教练干预 随机对照试验涉及参与该计划的20家CMHC（20名主管，至少60名临床医生），检查 对青少年CBT忠诚度和临床结果的影响（目标2）。我们比较标准的倡议实施 支持（10个CMHC）到这些标准支持加上教练（10个CMHC）。我们用常规的输入，去- 识别数据来评估CBT的保真度和临床结果。在教练条件下，同伴CBT经验丰富， CMHC主管将带领小组主管进行辅导。教练将使用IMPACT挑战赛 II工具包，与实践伙伴共同设计，为他们的辅导活动提供信息。预期成果包括： 优化的指导策略，可以集成到该计划的标准实施支持中， 向全国更广泛的实践界传播。研究目标还提供了完善IM的机会- 项目3的PACT方法和工具包，用于我们的试点计划，并传播到实践和科学 社区.如果有效，由同级主管提供的辅导可以大规模实施， 可持续地提高青年的治疗质量和成果。