Fidelity, Assessment and Clinical Effectiveness Tracking: Making FFT Sustainable

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Advances in treating adolescent substance abuse and related problems have resulted in an increased emphasis on redirecting resources to transport evidence-based treatments (EBTs) into “real-world” settings, yet the science-practice gap remains a pressing problem. Due to highly complex and multifaceted processes involved in translating EBTs to practice settings and to a host of diffusion barriers, including lack of resources, infrastructure, and technology-based and quality assurance capacity, only a fraction of individuals in treatment for substance use disorder (SUD) receive EBTs. Further, the significant gains achieved in efficacy trials are difficult to replicate in actual practice without intensive monitoring of fidelity, an essential component of success. The lack of feasible cost efficient fidelity monitoring tools and superstructures to ensure community- based practitioners sustain competent and adherent service delivery represents a major impediment for dissemination; innovative methods and procedures are urgently needed. The proposed Phase I SBIR will involve the development of a prototype theory-guided, empirically based, and user-friendly online feedback and monitoring system to guide and sustain the implementation of Functional Family Therapy (FFT) for adolescent substance abuse, a well-established treatment shown to reduce substance use and related problems and enhance youth and family adaptive functioning. The tracking system “Adherence and Clinical Effectiveness” (ACE) will be designed to foster clinicians' self-regulation of treatment adherence and provide community programs with more direct access to quality assurance information pertinent to maintaining fidelity and achieving positive youth and family treatment outcomes. The adoption of the system is expected to bridge the science-practice gap, enhancing the appeal, user-friendliness, and marketability of FFT dissemination services delivered to adolescent outpatient drug treatment programs by LIFFT, Co. Phase I will focus on creating content, and developing and testing the functionality and feasibility of a prototype of the web-based ACE system. Phase II will complete the development of a fully functional, full-featured, commercially viable program and evaluate, in a randomized controlled trial, the acceptability and effectiveness of ACE for enhancing sustainability in treatment settings. The specific aims are: Aim 1: Develop content for ACE, based on FFT theory, empirical evidence, and our prior extensive FFT training, supervision, and dissemination experiences. Aim 2: Program an Alpha prototype of the ACE online framework that contains the basic essential elements of text, graphics, and interactive features. The prototype will include a secure website and fillable electronic forms and other mechanisms for data collection, storage, and retrieval for dashboard data summary and clinical reports. Aim 3: Test the functionality and feasibility of the ACE prototype with an independent pilot sample of 15 FFT clinicians and supervisors. Functionality testing will include login procedures, navigation, uploading of audio files (i.e., “proxy” therapy recordings), and online form submission.