Implementation Support for Prevention Program Delivery by College Peer Educators

大学同伴教育者对预防计划实施的实施支持

• 批准号: 10117004
• 负责人: ERIC M STICE
• 金额: $ 65.62万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-12-15 至 2022-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10117004
• 关键词: Address; Adoption; Caring; Characteristics; Clinic; Communication; Competence; Cost Savings; Counseling; Data; Eating Disorders; Education; Educational workshop; Effectiveness; Female; Future; Goals; Individual; Institute of Medicine (U.S.); Intervention; Knowledge; Leadership; Measures; Mental Depression; Mental Health; Mental disorders; Methods; Monitor; National Research Council; Outcome; Participant; Population; Positioning Attribute; Prevalence; Prevention; Prevention program; Procedures; Process; Program Effectiveness; Program Sustainability; Randomized; Services; Speed; Structure; Students; Substance abuse problem; Surveys; Testing; Trainers Training; Training; Training Support; Universities; Waiting Lists; base; college; cost; cost effective; cost effectiveness; effective intervention; evidence base; experience; follow-up; group intervention; high risk; implementation research; implementation strategy; indexing; innovation; peer; peer support; programs; quality assurance; recruit; relative cost; research to practice; response; skills; treatment as usual; university student; web site; young adult

ABSTRACT Several interventions for mental health problems are efficacious and effective, but few are routinely offered to college students, who represent 59% of young adults. This is regrettable because college students are at high risk for mental health problems (e.g., depression, substance abuse, eating disorders), and college counseling centers lack sufficient clinicians to offer individual therapy to all afflicted students and are not well positioned to deliver prevention programs. One solution for this service shortfall is to have peer educators deliver scripted group-based prevention programs, which can more efficiently reduce the burden of mental illness than individual therapy. Targeting college students is a cost-effective tactic for delivering prevention programs and has vast potential reach because 85% of colleges have peer educator programs. Peer educators have effectively delivered several prevention programs, sometimes producing larger effects than clinicians, as was the case in a preliminary trial of a group-based prevention program with a particularly strong evidence-base. Guided by Wandersman et al. (2012), we propose to evaluate 3 levels of implementation support (training, technical assistance, and quality assurance/improvement) for the delivery of a prevention program. We will randomize 45 colleges to: (1) a Training condition where experts provide an intensive discrete 2-day initial train-the-trainer workshop that simultaneously trains peer educators to deliver the intervention and campus supervisors to train and support future peer educators, plus the facilitator guide and facilitator support website; (2) a Training + Technical Assistance condition, adding a ½ day implementation training to articulate goals, needs, leadership structure, adoption options, recruitment strategies, and communication; or (3) a Training + Technical Assistance + Quality Assurance/Quality Improvement condition adding 1 year of technical assistance, coaching, and quality assurance to enhance implementation skills and sustainability. We will test whether greater implementation support is associated with graded increases in fidelity and competence in delivering the scripted prevention program (Aim 1), student attendance of the intervention and effectiveness of the program on pre-to-post changes in outcomes compared to usual care data collected before implementation (Aim 2), and reach and sustainability of the program (Aim 3). We will test whether Consolidated Framework for Implementation Research (CFIR) indices of perceived intervention characteristics, outer and inner setting factors, peer educator attributes, and process factors after the initial training correlate with fidelity, competence, attendance, effectiveness, reach, and sustainability over the implementation period and test whether at the end of the initial 1-year implementation period the 3 conditions differ on relevant CFIR indices and on the progress and timing of implementation (Aim 4). We will evaluate the prevention program delivery cost in the 3 conditions and the relative cost-effectiveness of each condition in terms of attaining intervention fidelity, competence, attendance, effectiveness, reach, and sustainability, as well as general cost-savings at the clinics (Aim 5).

抽象的 一些针对心理健康问题的干预措施是有效且有效的，但很少有常规干预措施可以用于治疗心理健康问题。 大学生，占年轻人的 59%。这是令人遗憾的，因为大学生处于高水平 心理健康问题的风险（例如抑郁、药物滥用、饮食失调）和大学咨询 中心缺乏足够的临床医生为所有受影响的学生提供个体治疗，并且没有能力为所有受影响的学生提供个体治疗。 提供预防计划。解决这一服务不足的一种解决方案是让同伴教育者提供脚本化的服务 基于团体的预防计划，比其他计划更有效地减轻精神疾病的负担 个体治疗。针对大学生是实施预防计划和 具有巨大的潜在影响力，因为 85% 的大学都有同伴教育计划。同伴教育者有 有效实施了多项预防计划，有时产生的效果比临床医生更大，就像 该案件是一项基于群体的预防计划的初步审判，具有特别有力的证据基础。 由万德斯曼等人指导。 (2012)，我们建议评估 3 个级别的实施支持（培训、 技术援助和质量保证/改进）以实施预防计划。我们将 将 45 所大学随机分配到：(1) 培训条件，专家提供为期 2 天的密集离散初始培训 培训师培训研讨会，同时培训同伴教育者进行干预和校园活动 培训和支持未来同伴教育者的主管，以及辅导员指南和辅导员支持网站； (2) 培训 + 技术援助条件，添加 ½ 天的实施培训来阐明目标， 需求、领导结构、采用选项、招聘策略和沟通；或 (3) 培训 + 技术援助 + 质量保证/质量改进条件添加 1 年技术支持 协助、指导和质量保证，以提高实施技能和可持续性。我们将测试 更大的实施支持是否与忠诚度和能力的分级提高相关 实施脚本化的预防计划（目标 1）、学生参与干预的情况以及干预的有效性 与实施前收集的常规护理数据相比，关于结果前后变化的计划 （目标 2），以及该计划的范围和可持续性（目标 3）。我们将测试综合框架是否 感知干预特征、外部和内部环境的实施研究（CFIR）指数 初始培训后的因素、同伴教育者属性和过程因素与忠诚度、能力、 实施期间的出勤率、有效性、影响力和可持续性，并测试最终是否 在最初的 1 年实施期间，3 个条件在相关 CFIR 指数和进展方面有所不同 以及实施时间（目标 4）。我们将在 3 种情况下评估预防计划的实施成本 以及每种情况在获得干预保真度、能力方面的相对成本效益， 出勤率、有效性、覆盖范围和可持续性，以及诊所的总体成本节约（目标 5）。