Building Outcomes with Observation-Based Supervision: An FFT Effectiveness Trial

描述（由申请人提供）：研究为家庭干预青少年物质使用障碍（SUD）和行为/犯罪行为的有效性提供了支持。在成功治疗这些困难方面取得的进展，导致人们强调将资源转向将循证治疗（ebt）转移到“现实世界”的社区环境中。这一呼吁的紧迫性反映在保险公司、社区机构和公共倡导者越来越多地努力将电子商务服务引入我们社会的更大阶层。然而，将有效干预措施纳入实践环境的努力取得了有限的成功。此外，ebt的成功运输与随后在有效性试验中取得积极成果具有内在联系，人们普遍认识到需要进行系统调查，以了解在社区环境中成功实施的参数。拟议的研究旨在通过检查社区环境中治疗师的持续监督来解决青少年SUD和行为/犯罪行为治疗研究中的一个关键空白。该研究是一项第三阶段的有效性研究，将评估两种不同的治疗师监督实施功能家庭治疗（FFT）的方法，这是一种针对青少年药物滥用和行为/犯罪行为的EBT。该研究旨在利用广泛的FFT传播基础设施，其中包括已经采用和实施FFT的网站中训练有素的FFT治疗师骨干，以检查两种不同的监督策略如何影响治疗师对干预模式的依从性，并最终影响现实世界实施的临床结果。我们将比较基于观察的监督（BOOST）与FFT LLC目前使用的标准监督（SAU）方法对治疗师能力和青少年行为结果的影响。该研究将由隶属于加州心理健康研究所的16个FFT小组实施，该研究所是在加利福尼亚州实施FFT的利益相关者协调中心。参与者将包括来自16个FFT团队的3名治疗师（n=48）和每个治疗师6名青少年/家庭（n=288）。治疗师团队将被随机分配到BOOST或SAU。本研究的目的是：(1)检验BOOST和SAU在改善青少年物质使用（Aim 1a）和行为/犯罪行为（Aim 1b）方面的差异。(2)探讨BOOST和SAU在改善治疗参与和保留方面的差异。(3)检查BOOST和SAU在治疗师能力率（Aim 3a）和家庭功能改善（Aim 3b）方面的差异。(4)探讨治疗师能力是否在监督条件与治疗结果、家庭功能改善、更高的治疗参与率和保留率之间起中介作用（Aim 4a）。我们还将探讨家庭功能的改善是否介导了监督条件和治疗结果之间的联系（Aim 4b）。

DESCRIPTION (provided by applicant): Research has provided support for the efficacy of family interventions for adolescent substance use disorders (SUD) and conduct/delinquent behaviors. Advances in successfully treating such difficulties have resulted in an emphasis on redirecting resources to transport evidence-based treatments (EBTs) into "real- world" community settings. The urgency of this call is reflected in increasing efforts by insurance companies, community agencies, and public advocates to bring EBTs to larger segments of our society. Efforts to transport efficacious interventions into practice settings, however, have met with limited success. Moreover, the successful transport of EBTs and the subsequent achievement of positive outcomes in effectiveness trials are intrinsically linked, and the need for systematic investigation to understand the parameters for successful implementation in community settings is widely recognized. The proposed study is intended to address a critical gap in research on the treatment of adolescent SUD and conduct/delinquent behaviors by examining the ongoing supervision of therapists in community settings. The research proposed represents a Stage III effectiveness study which will evaluate two distinct approaches to therapist supervision in the implementation of Functional Family Therapy (FFT), an EBT for adolescent substance abuse and conduct/delinquent behaviors. The study is designed to capitalize on the extensive FFT dissemination infrastructure, which includes a cadre of fully trained FFT therapists within sites that have already adopted and implemented FFT, to examine how two distinct supervision strategies affect therapist competent adherence to the intervention model and, ultimately, clinical outcomes in real world implementation. We will compare the effects of an observation-based supervision (BOOST) to the standard supervision as usual (SAU) approach currently used by FFT LLC on therapist competence and adolescent behavioral outcomes. The study will be implemented with 16 FFT teams affiliated with the California Institute of Mental Health, the coordinating center for stakeholders implementing FFT in the State of California. Participants will include three therapists from 16 FFT teams (n=48) and six adolescents/families per therapist (n=288). Therapist teams will be randomly assigned to BOOST or SAU. The aims of the study are: (1) To examine differences between BOOST and SAU in improving adolescent substance use (Aim 1a) and conduct/delinquent behaviors (Aim 1b). (2) To examine differences between BOOST and SAU in improving engagement and retention in treatment. (3) To examine differences between BOOST and SAU in the rates of therapist competence (Aim 3a) and improvements in family functioning (Aim 3b). (4) To explore whether therapist competence mediates the association between supervision condition and treatment outcomes, improvements in family functioning, and greater rates of engagement and retention in treatment (Aim 4a). We also will explore whether improvements in family functioning mediates the link between supervision condition and treatment outcomes (Aim 4b). PUBLIC HEALTH RELEVANCE: The proposed effectiveness study is intended to address a critical gap in the current research by examining the effects of supervision of therapists in community settings on implementation fidelity, therapist competence, and positive youth outcomes. Therapist behavior is the key to how well evidence-based treatments are implemented in clinical settings and successful outcome of this research will help to bring empirically supported interventions to larger segments of our society.