Combining an Evidenced Based Treatment with a Measurement Feedback System

描述（由申请人提供）：最近，基于证据的治疗（EBT）的meta分析结果很差，这代表了青少年心理健康服务的危机。迫切需要创新方法来改善服务的可运输性、实施和结果。模型依从性（EBT保真度）是改善社区环境结果的必要但不充分的机制。现实世界的心理健康治疗需要关注独特环境、治疗师和来访者之间内在互动的复杂性。因此，实施EBT的治疗师需要更好的临床决策支持，这可能导致EBT在定制治疗服务中的适应性。测量反馈系统（MFS）提供正在进行的治疗进展和过程信息，以帮助治疗师做出治疗决策。作为MFS的一个好处，EBT为将系统数据整合到后勤、临床和监督操作中提供了一个基本框架。MFS和EBT结合的协同作用将改善EBT的可移植性、MFS的实施以及青年和家庭的成果。我们将整合现有的EBT[和现有的MFS]。EBT是功能性家庭治疗（FFT），是一种在青少年司法和心理健康系统中为青少年提供的经验支持干预。特定模型的治疗依从性和进展数据由FFT q系统提供，这是一个计算机化的特定模型质量改进系统。MFS是情境化反馈干预和培训（CFIT），它在每周完成对青少年、照顾者和治疗师实施的简短标准化措施后，提供有关治疗进展和过程的计算机反馈。我们将确定这种创新的组合是否对提供者组织、治疗师行为和社区心理健康机构的青少年/家庭结果产生预期的协同效应，该机构有4个站点，102名治疗师将在研究期间为4000多名青少年提供服务。一项当前的基金会奖助金正在支持一个计算机化系统的开发和测试，该系统集成了两种现有的反馈系统。这项工作将于2010年1月完成。治疗师将被随机分配到两组之一：(1)基础FFT（仅FFT）或(2)增强FFT （FFT + CFIT）。基本FFT条件的反馈仅包括依从性，与典型FFT监督协议一致。对于增强的FFT条件，反馈还包括青少年治疗进展和过程的信息。本研究将探讨在社区精神卫生机构中提供两种不同类型的治疗师反馈可能导致的治疗师行为和青少年/家庭结果的变化。拟议的项目还包括一个低成本的准实验设计，将本研究中CFIT的实施与目前在没有EBT的情况下实施CFIT的NIMH研究进行比较。

DESCRIPTION (provided by applicant): The recent, poor meta-analytic results of evidence-based treatment (EBT) represent a crisis in youth mental health services. There is a dire need for innovative approaches to improving transportability, implementation, and outcomes of services. Model adherence (EBT fidelity) is a necessary but not sufficient mechanism for improving outcomes in community settings. Real-world mental health treatment requires attention to the complexities inherent in the interaction between unique settings, therapists, and clients. As such, therapists implementing EBTs need better support for clinical decision making that may lead to adaptations of the EBT in the service of tailoring treatment. A measurement feedback system (MFS) provides the ongoing treatment progress and process information necessary to assist the therapist in making treatment decisions. As a benefit to the MFS, the EBT provides an essential framework for integration of systematic data into logistical, clinical, and supervisory operations. The synergy of the combination of an MFS and an EBT should improve transportability of EBT, implementation of MFS, and youth and family outcomes. We will integrate an existing EBT [and an existing MFS. The EBT is Functional Family Therapy (FFT), an empirically supported intervention for youths in the juvenile justice and mental health systems. Model-specific data on treatment adherence and progress are provided in the FFT Q-system, a computerized model-specific quality improvement system. The MFS is Contextualized Feedback Intervention and Training (CFIT), which provides computerized feedback on treatment progress and process upon weekly completion of brief standardized measures administered to youths, caregivers, and therapists.] We will determine if this innovative combination has the desired synergistic effect on the provider organizations, therapist behavior, and youth/family outcomes in a community mental health agency with 4 sites where 102 therapists will serve over 4000 youths during the life of the study. A current foundation grant is supporting the development and testing of a computerized system that integrates both existing feedback systems. That work will be complete[d in January 2010]. Therapists will be randomly assigned to one of two groups: (1) Basic FFT (FFT only) or (2) Enhanced FFT (FFT + CFIT). Feedback for the Basic FFT condition includes adherence only, consistent with the typical FFT supervision protocol. For the Enhanced FFT condition, feedback also includes information on youth treatment progress and process This study will address the changes in therapist behavior and youth/family outcomes that may result from providing two different types of therapist feedback in community mental health agencies. The proposed project also includes a low-cost quasi-experimental design comparing implementation of CFIT in this study with a current NIMH study where CFIT is implemented in the absence of an EBT. PUBLIC HEALTH RELEVANCE: Evidence-based treatments (EBTs) have not reached their potential to improve the outcomes for clients in community mental health treatment settings. There is a crisis in youth mental health services demanding innovative approaches for improving transportability, implementation, and outcomes of clinical treatments. The proposed study tests whether adding a measurement feedback system (MFS) that provides feedback on the therapeutic process and outcomes, to an existing EBT that only measures model adherence, improves therapist behavior and ultimately youth/family outcomes.