Automated telephone assessment for substance abuse treatment

描述（由申请方提供）：拟定的研究源于突出的临床需求：对与物质使用障碍同时发生的精神疾病进行常规评估。在过去的15年里，人们更加关注并发症，因为它们会影响治疗计划，结果和员工培训需求。据我们所知，这项拨款申请提供了第一个提出的模型，用于自动评估共同发生的疾病。我们的系统旨在进行初步筛查和后期结果评估。我们选择了交互式语音应答（IVR）技术作为这个项目的平台，它提供了许多优于其他方法（亲自评估，网络，纸笔自我报告）的优势。PI和顾问团队在共病、IVR和药物滥用评估和治疗方面具有专业知识。我们亦选择了一间在IVR软件方面有出色记录的科技公司，进行与健康有关的评估。该项目将从一个“演示”阶段开始，在这个阶段，IVR系统的有限版本将由临床医生、客户和程序管理员的一小组样本进行评估。我们特别针对所有三种类型的参与者，因为他们对IVR系统的意见同样重要。然后，我们将构建本申请中提出的完整IVR系统，该系统旨在评估五种关键的并发症（药物使用障碍，酒精使用障碍，重度抑郁症，心境恶劣和创伤后应激障碍）以及自杀倾向的水平。我们将有60名客户完成初步诊断筛选的样本，其中一半（n=30）还将进行面对面访谈，以确定IVR诊断筛选和这些疾病的结果措施的有效性。所有的客户都将被评估他们在初始筛选中符合标准的任何疾病的结果，加上所有人都将完成几项一般结果测量。成果评价将在三个月内每月进行一次（在对这些措施进行初步基线评估后进行，基线评估将作为随后变化的基准）。在本提案的研究部分，我们重点评估了几个主要问题：每种参与者类型（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IVR系统满意度之间的关系（例如，年龄、性别、治疗环境）;随时间的结果变化（在3个月随访期间客户改善多少）;综合征和症状相互作用（共同发生的疾病如何发生以及彼此之间的变化）。我们的样本将从大波士顿地区的两个主要的药物滥用治疗项目中招募：我们选择了我们的IVR系统的措施，基于彻底的文献检索，以确定心理测量有效的工具，是简短的和用户友好的。此外，如果我们的I期研究结果有必要，我们的仪器还允许在以后的II期研究中扩展到其他合并症。公共卫生相关性：在这个项目中，我们寻求开发一个系统来评估共同发生的疾病（药物滥用加上其他精神疾病）。我们计划使用电话作为一种自动化和低成本的方法。呼叫者将拨打免费号码，然后听到自动化的问题，然后她/他将使用电话键盘回答这些问题（例如，“按1表示是，按2表示否”）。我们亦会进行研究，评估市民对电话评估系统的满意程度及有关问题。这个项目可以帮助更多的人获得帮助，共同发生的疾病，如果我们的系统被发现工作良好。

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.