Local Quality Assurance Tool for Family Therapy in Usual Care for Adolescent Substance Use

青少年药物使用日常护理家庭治疗的本地质量保证工具

• 批准号: 9012070
• 负责人: Aaron Hogue
• 金额: $ 40.02万
• 依托单位: PARTNERSHIP TO END ADDICTION
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-02-15 至 2019-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9012070
• 关键词: Accountability; Adherence; Adolescent; Adopted; Adoption; Affordable Care Act; Archives; Area; Behavior; Behavior Therapy; Behavioral; Caring; Certification; Child Welfare; Childhood; Client; Clinical; Clinical Management; Code; Communities; Competence; Consensus; Continuity of Patient Care; Contracts; Data; Data Analyses; Databases; Development; Dimensions; Discrimination; Disease; Diverse Workforce; Elements; Evaluation; Family; Family psychotherapy; Gold; Guidelines; Health; Healthcare; High Prevalence; Intervention; Justice; Licensing; Manuals; Measures; Mental Health; Methods; Modeling; Monitor; Names; Outcome; Outcomes Research; Parents; Performance; Policies; Procedures; Process; Property; Provider; Quality Indicator; Research; Resources; Review Literature; Sampling; Services; Structure; Supervision; Symptoms; System; Techniques; Testing; Time; Training; Training Technics; Youth; addiction; adolescent substance use; alternative treatment; base; control trial; cost; cost efficient; evidence base; follow-up; innovation; medical specialties; meetings; probation; public health priorities; quality assurance; response; routine care; skills; success; theories; tool; treatment as usual; treatment planning

DESCRIPTION (provided by applicant): Ecological family therapy (EFT) has by far the largest base of empirical support for treating adolescent substance use (ASU). Manualized EFT models have proven consistently superior to every type of alternative treatment in controlled trials. Yet, EFT has not been widely adopted within ASU treatment systems nationwide. A primary barrier to adoption is the mismatch between the purveyor-driven methods used by manualized EFTs and the needs of the provider community. There are several EFT brands and each has a proprietary set of expensive and highly structured training, supervision, and fidelity control guidelines. These quality assurance (QA) procedures are too costly, inflexible, and externally controlled to meet all needs of a diverse workforce. This study will empirically distill the core techniques of manualized EFTs to produce a non-proprietary, freely available, psychometrically valid EFT QA toolkit (fidelity tool, training/implementation supports) that can be locally sustaine with intramural resources. This toolkit will promote high-fidelity delivery of EFT in routine care or ASU. The timing is perfect for developing this resource: The Affordable Care Act and related policy changes have ushered in unprecedented opportunities to increase adoption of evidence-based approaches in behavioral healthcare via training and certification requirements built into provider contracts. As a result, valid QA procedures and measures for behavioral treatments are in enormous demand. Unfortunately, existing QA procedures do not contain implementation fidelity guidelines: what specific interventions to deliver, and how to do them well. This is currently true for the ASU treatment system, which has promulgated "best practices" consisting of broad principles of client engagement and continuity-of-care rather than specific techniques. The proposed study will synthesize core techniques from three EFT models to construct a QA toolkit for supporting EFT fidelity in routine care. The study will conduct observational fidelity analyses on two pools of recorded sessions: (a) 300 gold-standard EFT sessions from controlled trials of Functional Family Therapy (FFT), Multidimensional Family Therapy (MDFT), and Brief Strategic Family Therapy (BSFT); and (b) 300 front-line EFT sessions from three implementation studies with ASU samples conducted in in routine settings. A new EFT QA measure will be derived from coding these two session pools using well-validated observational fidelity measures associated with FFT, MDFT, and BSFT respectively. As is true for the parent measures, the new QA tool will assess four fidelity dimensions: adherence to core EFT techniques, global EFT competence, therapist-family alliance, and ecological foci. Specific items for the EFT QA tool will be synthesized from gold- standard sessions (Aim 1), verified on front-line sessions (Aim 2), and validated on front-line fidelity ratings and client outcomes (Aim 3). We anticipate success in synthesizing core EFT techniques based on pilot data collected using the same samples, observational fidelity measures, and coding methods described in this proposal. Our pilot data reveal strong correlations among similar items representing four EFT treatment components projected to emerge during data analysis: family engagement, relational reframing, family restructuring, and family skill building. All study analyses and QA toolkit products (fideliy tool and coding manual, description of EFT techniques, training and implementation resources) will be vetted during a collaborative toolkit development process by an Expert Review Panel containing experts in EFT clinical theory and research, distillation of the core elements of manualized treatment models for various childhood disorders, and EFT fidelity-outcome research, along with front-line family therapists who treat ASU. Developing a psychometrically valid EFT QA toolkit from existing manualized resources would create a new QA resource that could be used to assess a wide spectrum of EFT implementation activities in behavioral care: evaluation of EFT training outcomes, data-based treatment planning for ASU and related disorders, administrative and regulatory review of treatment practices, and provider certification, to name a few. Most importantly, the new EFT QA toolkit could accelerate the adoption of EFT in routine care for ASU because providers will be inclined to select an approach that is both highly effective and meets regulatory demands for quality standards in a cost-efficient manner. The proposed toolkit will be available in two ways: (1) Cost-free to any licensed provider for incorporation into their existing intramural procedures for training and monitoring staff clinician; or (2) Packaged as one treatment module within a larger QA and clinical management system. The proposed study is innovative in several ways. It would develop the first QA tool capable of defining universal quality standards for EFT. Existing EFT tools define performance standards only for the given brand- name model and have limited value outside the purveyor's sphere of influence. The study will also produce a roadmap for developing empirical methods for distilling core QA tools based on validated fidelity measures; this innovation has broad applicability to other treatment approaches with multiple manualized versions (e.g., CBT for SUD) and will advance a vital new research area for behavioral healthcare. Finally, study methods will accelerate the pace of identifying quality indicators of EBPs for youth disorders. Current efforts rely on coordinated efforts from multiple research centers to identify quality metrics based on extended periods of literature review and consensus building. In contrast, this study will use empirical distillation methods and vet study data and products with a purposively convened expert panel.

描述（由申请人提供）：生态家庭疗法（EFT）是迄今为止治疗青少年物质使用（ASU）的最大经验支持基础。在对照试验中，手动EFT模型已被证明始终优于每种替代治疗类型的上级。然而， EFT尚未在全国范围内的ASU处理系统中广泛采用。采用的主要障碍是手动EFT使用的供应商驱动方法与供应商社区的需求之间的不匹配。有几个EFT品牌，每个品牌都有一套专有的昂贵和高度结构化的培训，监督和保真度控制指南。这些质量保证（QA）程序成本太高，不灵活，并且受到外部控制，无法满足多样化劳动力的所有需求。本研究将经验提炼的核心技术的手动EFT产生一个非专有的，免费提供的，心理有效的EFT QA工具包（保真度工具，培训/实施支持），可以在本地维持校内资源。该工具包将促进EFT在常规护理或ASU中的高保真交付。现在正是开发这一资源的绝佳时机：《平价医疗法案》和相关政策的变化带来了前所未有的机会，通过提供者合同中的培训和认证要求，增加了行为医疗中循证方法的采用。因此，有效的QA程序和行为治疗措施的需求量很大。不幸的是，现有的QA程序不包含实现保真度指南：提供哪些具体的干预措施，以及如何做好它们。ASU治疗系统目前就是这样，它颁布了“最佳做法”，包括客户参与和持续护理的广泛原则，而不是具体的技术。建议的研究将综合核心技术，从三个EFT模型，构建一个QA工具包，支持EFT的保真度在常规护理。该研究将对两组记录的会话进行观察性保真度分析：（a）来自功能性家庭治疗（FFT）、多维家庭治疗（MDFT）和简短战略家庭治疗（BSFT）对照试验的300个金标准EFT会话;（B）来自三项实施研究的300个一线EFT会话，其中ASU样本在常规环境中进行。将使用分别与FFT、MDFT和BSFT相关的经过充分验证的观测保真度测量对这两个会话池进行编码，从而得出一个新的EFT QA测量。与父母测量一样，新的QA工具将评估四个保真度维度：坚持核心EFT技术，全球EFT能力，治疗师家庭联盟和生态焦点。EFT QA工具的具体项目将从黄金标准会话（目标1）中合成，在一线会话中验证（目标2），并在一线保真度评级和客户结果中验证（目标3）。我们 预计成功地综合核心EFT技术的基础上，试点数据收集使用相同的样本，观测保真度措施，和编码方法中所描述的这一建议。我们的试点数据显示，类似项目之间存在密切相关性，代表数据分析期间预计出现的四个EFT治疗组成部分：家庭参与、关系重构、家庭重组和家庭技能建设。所有研究分析和QA工具包产品（fideliy工具和编码手册，EFT技术的描述，培训和实施资源）将在合作工具包开发过程中由专家审查小组进行审查，该小组包括EFT临床理论和研究专家，各种儿童疾病手动治疗模型的核心要素的提炼，以及EFT可行性结果研究，沿着治疗ASU的一线家庭治疗师。从现有的手动资源开发心理测量有效的EFT QA工具包将创建一个新的QA资源，可用于评估行为护理中广泛的EFT实施活动：EFT培训结果的评估，ASU和相关疾病的基于数据的治疗计划，治疗实践的行政和监管审查，以及提供者认证， 仅举几个例子。最重要的是，新的EFT QA工具包可以加速在ASU的常规护理中采用EFT，因为供应商将倾向于选择一种既高效又符合质量标准监管要求的方法。拟议的工具包将以两种方式提供：（1）免费提供给任何持牌供应商，用于纳入其现有的内部程序，以培训和监测工作人员临床医生;或（2）作为一个治疗模块打包在一个更大的质量保证和临床管理系统。拟议的研究在几个方面具有创新性。它将开发第一个能够界定电子资金转移通用质量标准的质量保证工具。现有的EFT工具只为给定的品牌型号定义性能标准，在供应商的影响范围之外价值有限。该研究还将为开发基于经验证的保真度措施提取核心QA工具的经验方法提供路线图;这项创新对具有多个手动版本的其他治疗方法具有广泛的适用性（例如，CBT为SUD），并将推进行为医疗保健的一个重要的新研究领域。最后，研究方法将加快确定青年障碍EBP质量指标的步伐。目前的努力依赖于多个研究中心的协调努力，以确定基于长期文献综述和共识建立的质量指标。相比之下，本研究将使用经验蒸馏方法，并与有目的地召集的专家小组一起审查研究数据和产品。