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

描述（由申请人提供）：研究为青少年物质使用障碍（SUD）和行为/犯罪行为的家庭干预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强调将资源重新定向，以将循证治疗（EBT）转移到“真实的世界”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EBT带到我们社会的更大部分。然而，将有效干预措施付诸实践的努力成效有限。此外，EBT的成功运输和随后在有效性试验中取得积极成果是内在联系的，并且广泛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关键差距。拟议的研究代表了第三阶段的有效性研究，将评估两种不同的方法，治疗师监督实施功能性家庭治疗（FFT），EBT青少年药物滥用和行为/犯罪行为。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的站点内训练有素的FFT治疗师骨干，以研究两种不同的监督策略如何影响治疗师对干预模型的依从性，并最终影响真实的世界实施的临床结局。我们将比较基于观察的监督（BOOST）的效果，以标准的监督照常（SAU）的方法，目前使用的FFT有限责任公司治疗师的能力和青少年的行为结果。该研究将由加州心理健康研究所附属的16个FFT团队实施，该研究所是加州实施FFT的利益相关者的协调中心。参与者将包括来自16个FFT团队的三名治疗师（n=48）和六名青少年/家庭治疗师（n=288）。治疗师团队将被随机分配到BOOST或SAU。这项研究的目的是：（1）研究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)检查BOOST和SAU在提高治疗参与度和保留率方面的差异。(3)研究BOOST和SAU在治疗师能力（目标3a）和家庭功能改善（目标3b）方面的差异。(4)探讨治疗师能力是否介导监督条件与治疗结果、家庭功能改善以及更高的治疗参与率和保留率之间的关联（目标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（目标4 b）。 公共卫生相关性：建议的有效性研究的目的是解决一个关键的差距，在目前的研究中，通过检查在社区环境中的治疗师的监督实施保真度，治疗师的能力和积极的青年成果的影响。治疗师的行为是如何在临床环境中实施循证治疗的关键，这项研究的成功结果将有助于将经验支持的干预措施带到我们社会的更大部分。

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.