TRANSPORTABILITY OF NEW TREATMENTS: MST AS A TEST CASE

这项研究考察了与有效地将复杂的以家庭为基础的心理健康治疗--多系统治疗(MST)--转移到社区环境相关的因素。因此，这项研究直接解决了临床(心理治疗)和精神卫生服务研究中有关将有效的治疗转化为有效的精神卫生服务的主要差距。在青少年经历严重临床问题的随机试验中，MST已被证明在改善儿童行为和家庭功能方面有效。在对暴力和慢性青少年罪犯进行的三项随机试验中，MST降低了再次被捕和离家安置的长期比率，并改善了儿童行为和家庭功能。早期的随机试验表明，MST在治疗虐待/忽视儿童和青少年性犯罪者方面前景光明，一项正在进行的研究正在评估其作为精神科住院替代方案的有效性。为了响应政策制定者和提供者发展MST项目的需求，在8个州和加拿大建立了27个项目，每年为1500名青年和家庭服务。最近关于MST的研究表明，临床医生遵守MST治疗方案与对年轻人有利的结果之间存在显著关联。因此，将模型及其有利结果转移到常规护理环境中的首要挑战是确定支持MST干预措施保真度的组织和组织外条件。具体地说，这项研究将检查26个项目中临床医生提供的与MST相关的儿童和结果。参与者将是2550名参加MST计划的青年和家庭，以及这些计划雇用的临床医生和管理人员。一个多方法、多来源的测量组合将被用来检查被认为支持对MST及其伴随的儿童结果的忠诚度的组织和非组织因素。本研究的目的是：1)。记录临床医生对特定治疗模式的依从性与通常护理环境中儿童结局之间的关系；2)检查组织内变量对临床医生依从性的影响；3)。考察与运输能力相关的组织变量受选定的组织外因素影响的程度；考察临床医生变量对依从性的影响；检验一个治疗效果的中介模型，在该模型中，组织内外因素和个体临床医生变量对结果的影响是通过临床医生的依从性来中介的。

This study examines the factors associated with the effective transport of a complex family-based mental health treatment, Multisystemic Therapy (MST), to community settings. As such, the study directly addresses major gaps in both clinical (psychotherapy) and mental health services research pertaining to the translation of efficacious treatments to effective mental health services. MST has proven effective in improving child behavior and family functioning in randomized trials with youth experiencing serious clinical problems. In three randomized trials with violent and chronic juvenile offenders, MST reduced long-term rates of rearrest and out-of-home placement and improved child behavior and family functioning. Earlier randomized trials demonstrated the promise of MST in treating child abuse/neglect and juvenile sex offenders, and an ongoing study is evaluating its effectiveness as an alternative to psychiatric hospitalization. In response to demand from policy makers and providers to develop MST programs, 27 programs serving 1500 youth and families annually have been established in 8 states and Canada. Recent research on MST has demonstrated a significant association between clinicians' adherence to the MST treatment protocol and favorable outcomes for youth. Thus, the foremost challenge in transporting the model and its favorable outcomes to usual care settings is determining the organizational and extra- organizational conditions that support the fidelity of MST interventions. Specifically, this study will examine the child and outcomes associated with MST as delivered by clinicians in 26 programs. Participants will be 2550 youth and families referred to MST programs and the clinicians and administrators employed by those programs. A multi-method multi-source measurement battery will be used to examine the organizational and extra-organizational factors thought to support fidelity to MST and concomitant child outcomes. The aims of this study are to: 1). Document the relationship between clinician adherence to a specific treatment model and child outcomes in usual care settings; 2). Examine the impact of intra-organizational variables on clinician adherence; 3). Examine the extent to which organizational variables relevant to transportability are influenced by selected extra-organizational factors; 4). Examine the influence of clinician variables on adherence; 5). Test a mediation model of treatment effectiveness in which the impact of intra- and extra-organizational factors and individual clinician variables on outcomes is mediated by clinician adherence.