Automated telephone assessment for substance abuse treatment

描述(由申请人提供)：这项拟议的研究源于一个突出的临床需求：对与物质使用障碍共存的精神障碍进行常规评估。在过去的15年里，人们更加关注共生疾病，因为它们可以影响治疗计划、结果和工作人员的培训需求。据我们所知，这项拨款申请提供了第一个拟议的共生障碍自动评估模型。我们的系统旨在进行初步筛查和后来的结果评估。我们选择了交互式语音应答(IVR)技术作为该项目的平台，与其他方法(面对面评估、网络、纸笔自我报告)相比，该技术具有许多优势。PI和顾问团队在共生障碍、IVR和药物滥用评估和治疗方面拥有专业知识。我们还选择了一家在IVR软件方面有出色记录的科技公司进行与健康相关的评估。该项目将从“演示”阶段开始，在该阶段，IVR系统的有限版本将由临床医生、客户和项目管理员的一小部分样本进行评估。我们特别针对这三类参与者，因为他们对IVR系统的看法都同样重要。然后，我们将构建本申请中提出的完整的IVR系统，该系统旨在评估五个关键的共生障碍(药物使用障碍、酒精使用障碍、严重抑郁、恶劣心境和创伤后应激障碍)，以及自杀水平。我们将有60名患者完成初步诊断筛查，其中一半(n=30)也将接受面谈，以确定这些疾病的IVR诊断筛查和结果测量的有效性。所有患者都将接受初步筛查中符合标准的任何疾病的结果评估，另外所有患者都将完成几项一般结果测量。成果评价将每月进行一次，为期三个月(在对这些措施进行初步基线评估之后，作为后续变化的基准)。在本提案的研究部分，我们重点评估几个主要问题：每个参与者类型(临床医生、客户、项目管理员)对IVR系统的满意度；参与者特征与对IVR系统的满意度之间的关系(例如，年龄、性别、治疗环境)；结果随时间的变化(客户在3个月的随访期内改善了多少)；症状和症状的相互作用(共生疾病如何发生以及相互之间的变化)。我们的样本将从大波士顿地区的两个主要药物滥用治疗项目中招募：我们基于全面的文献搜索为我们的IVR系统选择措施，以确定简单和用户友好的心理测量学有效工具。此外，我们的仪器还允许在以后的第二阶段研究中扩展到更多的共生疾病，如果我们的第一阶段结果有保证的话。公共卫生相关性：在这个项目中，我们寻求开发一种系统来评估共生疾病(药物滥用和其他精神疾病)。我们计划使用电话作为一种自动化和低成本的方法。呼叫者将拨打一个免费号码，然后听到自动提问，然后S/他将使用电话键盘回答这些问题(例如，按1表示是或按2表示否)。我们还将进行一项研究，以评估对电话评估系统的满意度和相关问题。如果我们的系统运行良好，这个项目可以帮助更多的人获得治疗共生疾病的帮助。

DESCRIPTION (provided by applicant): The proposed study arises out of a prominent clinical need: routine assessment of psychiatric disorders that co-occur with substance use disorder. The past fifteen years have seen greater focus on co-occurring disorders as they can impact treatment planning, outcomes, and staff training needs. To our knowledge, this grant application offers the first proposed model for automated assessment of co-occurring disorders. Our system is designed to conduct both initial screening and later outcome evaluation. We have selected interactive voice response (IVR) technology as the platform for this project, which offers numerous advantages over other methods (in-person assessment, web, paper-and-pencil self-report). The PI and consultant team have expertise in co-occurring disorders, IVR, and substance abuse assessment and treatment. We have also selected a technology company with an outstanding record in IVR software for health-related assessment. This project would start with a "demonstration" phase in which a limited version of the IVR system would be evaluated by a small subsample of clinicians, clients, and program administrators. We are specifically targeting all three participant types as their views on the IVR system are all equally important. We would then construct the full IVR system proposed in this application, which is designed to assess five key co-occurring disorders (drug use disorder, alcohol use disorder, major depression, dysthymia, and PTSD), plus level of suicidality. We would have a sample of 60 clients complete the initial diagnostic screen, of which half (n=30) would also undergo an in-person interview to ascertain validity of the IVR diagnostic screening and outcome measures for these disorders. All clients would be assessed for outcomes on any of the disorders for which they met criteria on the initial screen, plus all would complete several general outcome measures. The outcome evaluations would occur monthly for three months (after initial baseline assessment on those same measures, which serves as the benchmark for subsequent change). In the research portion of this proposal, we focus on evaluation of several major questions: satisfaction with the IVR system by each participant type (clinicians, clients, program administrators); relationship between participant characteristics and satisfaction with the IVR system (e.g., age, gender, treatment setting); outcome changes over time (how much clients improve during the 3 month followup period); syndrome and symptom interplay (how co-occurring disorders occur and change in relation to each other). Our sample will be recruited from two major substance abuse treatment programs in the greater Boston area: We selected the measures for our IVR system based on a thorough literature search to identify psychometrically valid instruments that are brief and user-friendly. Moreover, our instrumentation also allows for expansion to additional co-occurring disorders on a later Phase II study, if warranted by our Phase I results. PUBLIC HEALTH RELEVANCE: In this project, we seek to develop a system to evaluate co-occurring disorders (substance abuse plus additional psychiatric conditions). We plan to use the telephone as an automated and low-cost method. A caller would dial a toll-free number, and then hear automated questions which s/he would then answer using the telephone keypad (e.g., "press 1 for yes or 2 for no"). We would also conduct a study to evaluate satisfaction with the telephone assessment system and related questions. This project could help more people obtain help for co-occurring disorders, if our system is found to work well.