Implementing Feedback Interventions to Improve Outcomes

描述(申请人提供)：我们建议研究理论驱动和基于经验的反馈干预的效果，以影响为青少年提供居家心理健康服务的咨询师的认知和行为。对咨询师的反馈将基于客户对治疗联盟的评级。据预测，改善治疗关系将对年轻人的心理健康产生积极影响。改善心理健康结果的主要方法是将有效的治疗传播和实施到“现实世界”中。该提案提供了一种改进服务结果的方法，该方法对组织环境很敏感。在许多学科的数千项研究中，对绩效的反馈已经被证明可以改善绩效。然而，在一项研究的试验中，反馈导致了表现的下降。要理解反馈效果的异质性，就必须从理论上理解反馈。通过对认知、社会、组织心理学和管理学的基础和应用研究的回顾，我们建立了一个理论模型，旨在阐明和优化反馈对心理健康服务提供者绩效的影响。我们建议以联合治疗(TA)为目标，因为它是与积极的临床结果相关的最公认的常见治疗因素。我们将对将青少年助教评分反馈给辅导员的效果进行2x2随机析因研究。在研究1中，辅导员将被随机分配到站点，要么被分配到“反馈”状态，要么被随机分配到“没有反馈”的状态。网站还将被随机分配到“高参与度”或“低参与度”状态，在这种情况下，他们的主管会或不会收到客户生成的反馈。我们的模型预测了这两个因素之间的交互作用，这两个因素应该会在辅导员的认知和行为方面产生最大的变化，并在症状和功能方面产生最大的改善。研究2将使用相同的设计来测试除了反馈之外的教育部分(助教辅导员手册)是否会对助教的客户评级和随后的治疗结果产生更大的积极影响。我们认为，这项研究既有理论基础，又与精神健康提供者高度相关。它为改善精神健康服务提供了一种创新的方法。

DESCRIPTION (provided by applicant): We propose to study the effects of a theory-driven and empirically-based feedback intervention to influence the cognition and behavior of counselors who provide in-home mental health services to adolescents. The feedback to counselors will be based on client ratings of therapeutic alliance. An improved therapeutic relationship is predicted to have a positive effect on the youth's mental health. The predominant approach to improving mental health outcomes is to disseminate and implement efficacious treatments into the "real world". This proposal offers an approach to improving outcomes of services that is sensitive to the organizational context. Feedback on performance has been shown to improve performance in thousands of studies across many disciplines. However, in a trial of the studies feedback resulted in a decrease in performance. A theoretical understanding of feedback is required to understand the heterogeneity of the effect of feedback. Through a review of basic and applied research in cognitive, social, organizational psychology, and management we have developed a theoretical model that aims to elucidate and optimize the effects of feedback on the performance of mental health service providers. We propose to target therapeutic alliance (TA), as it is the most agreed upon common treatment factor associated with positive clinical outcomes. We will conduct a 2x2 randomized factorial study of the effects of feeding back the youth's TA ratings to the counselor. In Study 1, counselors will be randomly assigned by site to either a "feedback" or a "no feedback" condition. Sites will also be randomly assigned to a "high involvement" or "low involvement" condition in which their supervisor does or does not receive the client-generated feedback. Our model predicts an interaction effect between these two factors that should produce the largest change in counselor cognitions and behavior and the greatest improvement in symptoms and functioning. Study 2 will utilize the same design to test whether an educational component (TA counselor's manual) in addition to feedback will have an even greater positive effect on client ratings of TA and subsequent treatment outcomes. We believe that this research is both theory-based and highly relevant to mental health providers. It offers an innovative approach to improving mental health services.