Internet-based Fidelity Enhancement of MTFC

描述(由申请人提供)：心理健康、儿童福利和少年司法领域共同面临着减少青少年反社会行为流行率的挑战。在过去的20年里，品行障碍已经从被认为是难以治愈的困难转变为有困难但可用的解决方案。经经验验证的干预措施现在正在广泛传播，但在社区环境中复制临床试验的结果仍然存在问题。这些在研究背景下产生了令人印象深刻的效果的系统，如果没有干预开发人员对保真度的密集监控，就很难复制。密集的监控是采用的障碍，尤其是随着采用者和开发人员之间的距离增加，成本也增加了。与此同时，各州、社区和机构面临着越来越大的压力，要求它们实施那些已被证明最有效的干预服务。这一问题的一个可能解决办法是为监督者和干预者建立反馈机制，作为互联网系统的数据收集和报告职能的一部分。这样的系统可以通过直接、即时和高质量的数据将当地临床项目和全国的传播团队联系起来，并将使当地服务组织更有可能以尽可能高的保真度提供服务。由于这些经经验验证的治疗的保真度已被证明与其结果的质量有关，因此开发创新的服务提供系统至关重要，以提高这些经过验证的治疗方法的传播保真度。该项目将在提供多层面治疗寄养护理(MTFC)的机构中开发和测试增强的基于互联网的监督/保真系统的可行性和满意度。我们提议的系统将包括：(A)一个安全的网站，对数据存储、报告(包括图形和表格)的显示和动态反馈的观察具有多级访问限制；(B)以计算机为媒介的临床形式(例如，儿童行为的每日报告)以及针对参与计划量身定做的监督评级和活动(例如，治疗预约和临床会议)，包括基于互联网和基于自动电话的响应格式；以及(C)以计算机为媒介的视频观察(临床会议和个人会议)。这个拟议的系统将(通过电脑数码摄像机)记录必要的临床工作人员和寄养家长的会议，压缩和加密视频数据以通过互联网传输，并通过互联网安全传输视频数据以进行编码和报告。

DESCRIPTION (provided by applicant): The fields of mental health, child welfare, and juvenile justice are jointly faced with the challenge of reducing the prevalence of antisocial behavior among adolescents. In the last 20 years, conduct disorders have moved from being considered intractable difficulties to having difficult but available solutions. Empirically-validated interventions are now being widely disseminated, but the replication of the results from clinical trials in community settings remains problematic. The systems, which produced impressive effects in a research-context, are difficult to replicate without intensive monitoring of fidelity by the intervention developers. Intensive monitoring is a barrier toward adoption, in particular, as the distance between the adopter and developer increases so does cost. At the same time, states, communities, and agencies are under increasing pressure to implement those intervention services that have been shown to be most effective. One possible solution to this problem is to develop feedback mechanisms for supervisors and interventionists as part of the data collection and reporting functions with an Internet-based system. Such a system could link local clinical programs and nationally-based dissemination teams through direct, immediate to high quality data, and would make it more likely that local service organizations are able to implement services at the highest possible fidelity. As fidelity of these empirically-validated treatments has been shown to be related to the quality of their outcomes, it is of critical importance to develop innovative service delivery systems that increase fidelity in the dissemination of these proven treatment approaches. This project would develop and test the feasibility and satisfaction with an enhanced Internet-based supervision/fidelity system among agencies delivering Multidimensional Treatment Foster Care (MTFC). Our proposed system will include: (a) a secure website with multiple levels of access restrictions for data storage, display of reports (both graphical and tabular) and observations for dynamic feedback; (b) computer-mediated forms of clinical (e.g. daily reporting of child behavior) and supervisory ratings and activities (e.g., program tasks such as therapy appointments and clinical meetings) tailored to the participating program with both Internet-based and automated-phone-based response formats; and (c) computer-mediated video observation (clinical meetings & individual sessions). This proposed system would record (via computer digital video camera) essential clinical staff and foster parent meetings, compress and encrypt the video data for transmission via the Internet, and the secure transmission of the video data over the Internet for coding and reporting.