Evidence-Based Practices and Service Outcomes in Usual Care for ASA

ASA 日常护理的循证实践和服务成果

• 批准号: 7862365
• 负责人: SARAH E. DAUBER
• 金额: $ 25.84万
• 依托单位: PARTNERSHIP TO END ADDICTION
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-07-01 至 2012-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7862365
• 关键词: Adherence; Adolescent; Adoption; Alcohol consumption; Benchmarking; Caregivers; Caring; Client; Client satisfaction; Clinical; Code; Cognitive Therapy; Communities; Competence; Controlled Study; Counseling; Country; Crime; Data; Development; Device or Instrument Development; Disease; Drug abuse; Drug usage; Effectiveness; Elements; Evaluation; Evidence based practice; Family Process; Family psychotherapy; Funding; Future; Hand; Healthcare; Knowledge; Laboratory Study; Learning; Life; Manuals; Measures; Mental Health; Mental disorders; Methods; Monitor; Nature; Outcome; Parents; Participant; Patient Self-Report; Pharmaceutical Preparations; Phase; Prevention; Prevention approach; Procedures; Process; Productivity; Program Evaluation; Psychometrics; Public Health; Randomized; Reporting; Research; Research Training; Resources; Sampling; Services; Site; Specific qualifier value; Structure; Symptoms; Techniques; Testing; Therapeutic; Training; Treatment outcome; Validity and Reliability; Videotape; Youth; adolescent substance abuse; care systems; clinical care; clinical research site; community setting; comparative; control trial; cost; drug abuser; evidence base; follow-up; innovation; juvenile justice system; motivational enhancement therapy; programs; psychologic; public health relevance; randomized trial; research study; routine practice; satisfaction; service utilization; sound; substance abuse treatment; treatment as usual; treatment program; treatment site; user-friendly

DESCRIPTION (provided by applicant): The ultimate objective of the proposed study is to examine the fidelity and effectiveness of evidence-based practices (EBPs) for adolescent substance abuse when implemented by community therapists in usual care. Although clinicians and treatment programs espouse allegiance to various EBPs, and a large proportion report using manualized treatments in routine practice, there is little reliable knowledge about the treatment ingredients actually delivered in community settings. To support adoption and training efforts, it is critical to know whether EBPs retain their integrity and potency in the hands of end users. The proposed study would be the first to examine implementation effects of EBPs for ASA in natural service conditions using rigorous observational methods. The study will leverage the resources of CASALEAP, an ongoing randomized trial testing the effectiveness of existing ASA treatment services in four clinical sites. Each site endorses at least two of the following EBPs as a primary treatment approach for ASA: cognitive-behavioral therapy (CBT), family therapy (FT), 12-step drug counseling (DC), and motivational interviewing (MI). The CASALEAP trial is collecting the following implementation data on a projected N = 205 participants: videotapes of three treatment sessions (2, 6,10) and a pilot therapist self-report checklist of EBP adherence after every session. At minimal cost, the proposed study will augment CASALEAP assessment procedures in two innovative ways. First, videotaped sessions will be coded by clinically trained raters using validated observational measures of adherence and competence for all four EBPs: CBT, FT, DC, and MI. Tapes will also be rated for therapeutic alliance with adolescents and caregivers. Second, data from completed pilot versions of the therapist-report checklist will be analyzed, participating therapists will be trained to reliably complete a reduced-item version of the checklist, and the new brief version will be tested for reliability and construct and criterion validity. The first aim of the study is to determine whether EBP adherence, competence, and alliance predict service utilization and one-year outcomes for ASA in usual care. The second aim is to develop and test a brief, psychometrically sound therapist-report measure of adherence to EBPs for ASA that can be included in program evaluation toolkits for monitoring treatment service implementation in systems of care. The third aim is to examine whether routine implementation of EBPs in community agencies approaches fidelity benchmarks set by research-trained therapists in controlled studies. PUBLIC HEALTH RELEVANCE: Adolescent substance abuse (ASA) continues to be a highly prevalent, often life-threatening, and costly public health problem. The costs of ASA include those associated with treatment and prevention, crime, and lost productivity; recent estimates of ASA-related costs, available for alcohol consumption only, total $58 billion dollars per year. Also, co-occurrence of ASA with other psychiatric disorders has been established in both community and clinical samples. Adolescent drug abusers with comorbid conduct disorders create a significant burden on the juvenile justice system; for example, in the year 2000 over 203,000 juveniles were arrested for drug abuse violations. For all these reasons, ASA treatment is among the most pressing youth mental health needs in the country. However little is known about the nature and quality of ASA services currently available in usual care settings. This study will begin to fill this gap by providing a rigorous evaluation of the implementation of evidence-based practices for ASA in usual care.

描述（由申请人提供）：拟议研究的最终目标是检查社区治疗师在通常的护理中实施基于证据的实践（EBP）对青少年药物滥用的忠诚和有效性。尽管临床医生和治疗计划拥护效忠各种EBP，以及在常规实践中使用手动治疗的大量报告，但几乎没有关于在社区环境中实际提供的治疗成分的可靠知识。为了支持采用和培训工作，至关重要的是要知道EBP是否将其诚信和效力保留在最终用户手中。拟议的研究将是第一个使用严格的观察方法在自然服务条件下对ASA进行EBP的实施效应的效果。该研究将利用Casaleap的资源，这是一项正在进行的随机试验，测试了四个临床部位现有的ASA治疗服务的有效性。每个站点至少认可以下EBP中的两个EBP作为ASA的主要治疗方法：认知行为疗法（CBT），家庭疗法（FT），12步毒品咨询（DC）和动机访谈（MI）。 Casaleap试验正在收集有关预计n = 205名参与者的以下实施数据：三个治疗课程（2，6,10）的录像带和每次会议后EBP依从性的试点治疗师自我报告清单。拟议的研究以最少的成本将以两种创新的方式增强卡萨拉普评估程序。首先，录像会议将通过经过验证的所有四个EBP的依从性和能力的观察措施：CBT，FT，DC和MI对临床训练的评估者进行编码。录音带还将被评为与青少年和看护人的治疗联盟。其次，将分析来自治疗师报告清单的完整试点版本的数据，将对参与的治疗师进行培训以可靠地完成清单的减少项目，并将测试新的简短版本的可靠性以及构造和标准效度。该研究的第一个目的是确定EBP的依从性，能力和联盟是否可以预测服务利用率以及在常规护理中的ASA的一年结果。第二个目的是开发和测试一个简短的，心理上合理的治疗师报告，以遵守ASA的EBP的衡量标准，该测量可以包括在计划评估工具包中，以监视护理系统中的治疗服务实施。第三个目的是检查社区机构中EBP的常规实施是否在对照研究中采用了由研究训练的治疗师设定的忠诚基准。公共卫生相关性：青少年药物滥用（ASA）仍然是一个非常普遍的，通常威胁生命和昂贵的公共卫生问题。 ASA的成本包括与治疗和预防，犯罪和生产力失去相关的成本；最近估计与ASA相关的成本，仅可用于饮酒，每年总计580亿美元。同样，在社区和临床样本中，已经建立了ASA与其他精神病障碍的同时出现。有合并症的青少年毒品滥用者对少年司法系统造成了重大负担。例如，在2000年，超过203,000名少年因违反药物滥用而被捕。由于所有这些原因，ASA治疗是该国青年心理健康需求最紧迫的。然而，对于当前在通常的护理环境中可用的ASA服务的性质和质量知之甚少。这项研究将通过对在通常的护理中的ASA实施基于证据的实践进行严格的评估来开始填补这一空白。