Improving Sustainment through Implementation Supports to Reduce Burnout in Therapists Delivering Child Trauma EBPs

项目摘要/摘要 已经开发了许多基于证据的心理健康干预措施来解决负面后果 与儿童暴露在早期逆境和创伤中有关。然而，尽管取得了这些有希望的进展， 在公共资助的精神卫生系统中接受服务的大多数儿童没有得到基于证据的 计划(EBP)。为了解决这一研究与实践的差距，几个大规模的、系统驱动的 在过去十年中，开展了多重创伤循证计划的执行工作，包括在 加利福尼亚州和阿肯色州。尽管这些系统驱动的计划通常会增加EBP在 在社区环境下，在最初的实施推动下，EBP交付的长期可持续性较低。 劳动力风险因素，如导致离职的供应商倦怠，已被确定为导致 创伤性EBPS的长期维持性差。因此，支持长期发展的一个重要步骤是- 儿童创伤EBPS的长期维持是制定针对提供者职业倦怠的实施策略 以及与服务提供商留存率下降相关的组织环境因素。 这项拟议的K23指导患者导向研究职业发展奖将制定和试点 一揽子实施战略，“支持供应商，防止资源在 创伤系统“(支持)，旨在通过解决以下问题来增加创伤循证计划的持续交付 与职业倦怠相关的提供者保留相关因素。支持的发展将被告知 通过与多EBP实施工作相关的计划进行的需求评估， 加州和阿肯色州。该项目将建立在申请者的研究和临床基础上 同时提供对申请者未来发展至关重要的专业培训。具体来说， 申请人需要接受以下方面的额外培训：1)实施科学的理论和实践，特别是 强调组织管理和科学，因为它与开发和测试 实施战略；2)先进的方法，包括定性和混合定性和 量化方法；以及3)评估实施影响的医疗保健经济技术 战略。这项培训将由申请者的主要赞助人劳伦博士指导 布鲁克曼-弗雷齐和她的联合赞助商格雷戈里·亚伦博士、托德·吉尔默、丽莎·凯斯和艾莉森·汉密尔顿。 该项目将提供试点数据，以激励后续的NIMH R01应用程序进行大规模试验 支持维持儿童创伤循证医学计划的执行战略。此外，该项目还将 为申请人提供启动独立研究所需的高级培训和技能 该计划的重点是改善对处于早期逆境和创伤中的儿童的心理保健服务。

PROJECT SUMMARY/ABSTRACT Many evidence-based mental health interventions have been developed to address the negative outcomes associated with child exposure to early adversity and trauma. Despite these promising advances, however, the majority of children served in publicly funded mental health systems do not receive evidence-based programs (EBPs). To address this research-to-practice gap, several large-scale, system-driven implementation efforts of multiple trauma EBPs have been launched over the last decade, including in the states of California and Arkansas. Though these system-driven initiatives often increase EBP delivery in community settings following the initial implementation push, long-term sustainment of EBP delivery is low. Workforce risk factors, such as provider burnout leading to turnover, have been identified as contributing to the poor long-term sustainment of trauma EBPs. Therefore, an important step to consider in supporting the long- term sustainment of child trauma EBPs is to develop implementation strategies that target provider burnout and organizational climate factors associated with decreased provider retention. This proposed K23 Mentored Patient-Oriented Research Career Development Award will develop and pilot a package of implementation strategies, “Supporting Providers & Preventing the Overwhelming of Resources in Trauma Systems” (SUPPORTS), aimed increasing the sustained delivery of trauma EBPs by addressing the factors associated with provider retention related to burnout. The development of SUPPORTS will be informed by a needs assessment conducted with programs involved with the multiple-EBP implementation efforts in California and Arkansas. This project will build upon the applicant’s foundation of research and clinical experience while also providing specialized training critical for the applicant’s future development. Specifically, the applicant requires additional training in: 1) theory and practice in implementation science with particular emphasis on organizational management and science as it pertains to the development and testing of implementation strategies; 2) advanced methodologies, including qualitative and mixed qualitative and quantitative methods; and 3) healthcare economic techniques to evaluate the impact of implementation strategies. This training will be facilitated by mentorship from the applicant’s primary sponsor, Dr. Lauren Brookman-Frazee, and her co-sponsors, Drs. Gregory Aarons, Todd Gilmer, Lisa Kath, and Allison Hamilton. This project will provide pilot data to motivate a subsequent NIMH R01 application to conduct a large-scale trial of the implementation strategies supporting the sustainment of child trauma EBPs. In addition, this project will provide the applicant with the advanced training and skills required to launch an independent research program focused on improving mental healthcare services for children exposed to early adversity and trauma.