IMPLEMENTATION OF COGNITIVE PROCESSING THERAPY FOR PTSD IN DIVERSE COMMUNITIES

描述（由申请人提供）：这是一份申请以指导患者为导向的研究职业发展奖（K23）的申请，重点是在多元化社区精神卫生诊所（CMHC）中实施创伤后应激障碍（PTSD）的认知加工疗法（CPT）(1)。候选人建议在她治疗各种PTSD患者的经验基础上，通过获得实施科学方面的培训，以缩小研究与实践之间的差距，从而减少健康差距为长期职业目标。CPT是治疗创伤后应激障碍的两种一线经验性治疗方法之一。CPT在创伤类型、语言和人群中均显示出疗效（1-3）和有效性(4)。然而，大多数社区精神卫生工作者（CMHWs）几乎没有接受过诸如CPT之类的ebt培训，或者在日常实践中使用它们。本研究是创建框架的第一步，以系统的方式利用已建立的实施理论（例如，（5-10））来理解和解决在cmhc中实施CPT的障碍，以解决这一实施差距。研究计划：主要研究有一个混合方法迭代设计，从早期的实施阶段进行数据分析，用于评估和改进后续的实施工作。具体而言，目前的研究融合了三种不同的实施框架：(1)复制有效计划（REP）框架（5- 8,11 -14）；(2)实施研究综合框架（CFIR;(9)）；（3)Proctor等人，实施结果变量的分类（10），以指导一项旨在解决以下具体目标的迭代开放试点实施研究：1）在不同的CMHC中预先实施CPT之前，使用混合方法方法识别、评估和解决组织背景和提供者层面的障碍和实施促进者；2)进一步适应和预先测试不同的提供者和患者的干预方法和材料，英语和西班牙语；3)培训cmhw，试点测试修改后的手动实施方案的可行性和可接受性，并初步探讨其对患者预后的影响。我们计划在未来的RO1中评估这一最终实现协议，以便在不同的cmhc中推广应用。环境：该研究将在马萨诸塞州总医院（MGH）和MGH切尔西精神健康诊所进行，并将补充指导医生的培训和监督研究项目。Naomi Simon， Marty Charns和Debra Kaysen，在社区研究，CPT和文化能力方面的专家的咨询下。职业发展规划：以下领域的培训将强调候选人成为在不同社区实施电子商务考试专家的长期目标所必需的技能，并为未来的独立调查奠定基础：1)实施科学的方法和理论框架；2) CPT在CMHCs中的实施；3)治疗师监督/领导；4)临床试验文化胜任力；5)混合方法数据分析。

DESCRIPTION (provided by applicant): This is an application for a Mentored Patient-Oriented Research Career Development Award (K23) with a focus on the implementation of cognitive processing therapy (CPT)(1) for post-traumatic stress disorder (PTSD) within a diverse community mental health clinic (CMHC). The candidate proposes to build upon her experience treating diverse PTSD patients by obtaining training in implementation science with the long-term career goal of narrowing the research-practice gap and, consequently, decreasing health disparities. CPT is one of two first line empirically based treatments (EBTs) for PTSD. CPT has shown efficacy(1-3) and effectiveness(4) across trauma types, languages, and populations. However, most community mental health workers (CMHWs) receive little, if any, training in EBTs such as CPT or use them in daily practice. This study is an initial step in creating a framework to address this implementation gap in a systematic manner drawing on established implementation theory (e.g., (5-10)) to understand and address barriers to implementing CPT in CMHCs. Research Plan: The primary study has a mixed-method iterative design with data analysis from earlier implementation stages used to evaluate, and refine subsequent implementation efforts. Specifically, the current study blends three distinct implementation frameworks: (1)Replicating Effective Programs (REP) framework(5-8, 11-14); (2)Consolidated Framework for Implementation Research (CFIR;(9)); and (3)Proctor et al., taxonomy for implementation outcome variables(10), to guide an iterative open pilot implementation study designed to address the following Specific Aims: 1)To identify, assess, and address organizational context and provider level barriers and facilitators of implementation using a mixed-methods approach prior to the pre-implementation of CPT in a diverse CMHC; 2)Further adapt and pre-test intervention methods and materials with diverse providers and patients in English and Spanish; and 3)Train CMHWs and pilot test the feasibility and acceptability of the modified manualized implementation protocol, and to initially explore its effect on patient outcome. We plan to evaluate this final implementation protocol for generalizable utilization across diverse CMHCs in a future RO1. Environment: The study will be based at the Massachusetts General Hospital (MGH) and the MGH Chelsea Mental Health Clinic and will complement a program of training and supervised research under mentors Drs. Naomi Simon, Marty Charns, and Debra Kaysen, with consultation from experts in community based research, CPT, and cultural competency. Career Development Plan: Training in the following areas will emphasize skills necessary for the candidate's long-term objective to become an expert in the implementation of EBTs in diverse communities and will lay the foundation for future independent investigation: 1) implementation science methodology and theoretical frameworks; 2) CPT implementation in CMHCs; 3) therapist supervision/leadership; 4) cultural competency in clinical trials; and 5) mixed-methods data analysis.