Influences on the Sustainability of Evidence-Based Psychotherapies

申请者描述(由申请人提供)：申请者建议通过独立职业发展奖(K99)提供资金，以开展一项培训和研究计划，该计划将发展混合方法、研究战略以及传播和组织变革理论知识方面的技能。申请者将结合临床干预研究和组织研究，以确定在社区精神卫生机构内进行培训后，持续使用经验性支持的心理疗法的障碍。拟议的研究项目将通过提供实施混合方法战略的机会来补充培训计划，以评估在社区环境中持续实施经验性支持的治疗的障碍。宾夕法尼亚大学NIMH资助的两个研究中心的导师将在拟议的研究和培训中为申请者提供支持。这两个中心都与费城的精神健康机构建立了合作关系。第一项研究将使用调查来检验社区精神卫生环境中新干预措施可持续性的一些假设障碍，以及微观民族志方法，以产生关于这些环境中特定障碍的更具体的假设。第二项研究将考察在社区心理健康环境中进行了两年多的培训后，认知治疗的使用的自然轨迹。临床医生对CT的态度、特定的组织因素和持续采用CT之间的关系将使用混合方法策略进行检验。这项研究的次要目标将是进行第一次检查，即由于客户的需求和临床实践的现实，治疗方案所经历的“真实世界”修改。这些结果将为RO1的开发提供信息，以测试个人和组织因素的模型，该模型预测社区心理健康环境中采用的可持续性。这项研究计划将产生一些关于影响循证心理治疗长期可持续性的组织和个人因素的第一批数据。所获得的知识可导致实施干预措施，适当解决在社区环境中使用循证治疗的障碍，这反过来将促进更多人获得干预措施，尽管有广泛的经验支持，但目前社区精神卫生消费者还没有广泛获得这些干预措施。

DESCRIPTION (provided by applicant): The applicant is proposing funding through the Pathway to Independence Career Development Award (K99) to conduct a program of training and research that will to develop skills in mixed-methods research strategies and knowledge of theories of dissemination and organizational change. The applicant will interface clinical intervention research and organizational research to determine barriers to the sustained use of empirically supported psychotherapies after training occurs within community mental health agencies. The proposed research projects will complement the training program by providing opportunities to implement the mixed- methods strategies to assess barriers to sustained implementation of empirically supported treatments within community based-settings. Mentors at two NIMH-funded research centers at Penn, both of which have developed collaborative relationships with mental health agencies in Philadelphia, will support the applicant in the proposed research and training. The first study will employ surveys to examine some hypothesized barriers to the sustainability of new interventions in community mental health settings, as well as micro- ethnographic methods to generate more specific hypotheses regarding barriers specific to these settings. The second study will examine the natural trajectory of the use of cognitive therapy after training in community mental health settings over two years. The relationship between clinician attitudes towards CT, specific organizational factors, and the sustained adoption of CT will be examined using a mixed-methods strategy. A secondary goal of this research will be to conduct the first examination the "real world" modifications that the treatment protocol undergoes as a result of the needs of the client and the realities of clinical practice. These results will inform the development of an RO1 to test a model of the individual and organizational factors that predict the sustainability of adoption within community mental health settings. This research program will yield some of the first data regarding the organizational and individual factors that impact the long-term sustainability of evidence-based psychotherapies. The knowledge gained can lead to the implementation of interventions that appropriately address barriers to the use of evidence-based therapies in community settings, which will in turn promote increased access to interventions that, despite extensive empirical support, currently are not widely available to community mental health consumers.