Internet-based Fidelity Enhancement of MTFC

描述（由申请人提供）：拟议的项目建立在第一阶段“概念验证”的基础上，其中创建了基于互联网的治疗保真度监测系统（ITFMS）的基本组成部分，以帮助MTFC顾问和实施机构通过更有效地推进和保持项目实施的保真度来改善临床结果。ITFMS对社区机构、寄养父母和项目顾问使用的可行性也进行了检查（请参阅第一阶段报告）。第二阶段的目标是完成ITFMS系统，并对最终系统的有效性进行随机对照试验。在我们的有效性检查中，我们将重点关注与提高MTFC机构和项目顾问效率有关的结果，以实现实施保真度标准。ITFMS系统的完成目标包括：1)根据审稿人和第一阶段测试人员的要求，改进和增强现有的ITFMS基础系统组件，以便实施机构可以远程、更有效地输入和查看满足MTFC保真度标准和认证要求所需的全套现场数据；2)增加一个集成的系统组件，该组件将在每个实施站点中收集日常数据，并自动集成和显示这些数据，使站点、项目顾问和开发人员能够更正式地了解机构向MTFC保真度的移动，并在他们的反馈和讨论中更积极地支持站点实施中的积极变化；3)增加一个专业的沟通系统，不仅在项目顾问和站点之间，而且在实施站点之间，允许项目想法和实施信息的自由流动，这样问题、问题和支持就可以以一种持续的、富有成效的和有意义的方式获得；4)具有资源和适度点对点支持的父支持组件。一旦ITFMS系统开发完成，它将首先提供给目前活跃的MTFC站点进行beta测试和对整个系统的反馈。来自这些站点的反馈将被整合到ITFMS系统中，然后将征求新的和正在开发的实施站点参与随机对照试验。该试验将涉及随机分配站点，以标准或基于互联网的MTFC顾问支持的实施服务。由于ITFMS旨在促进社区机构对MTFC保真度的实施，因此将评估从保真度管理和有效性研究中得出的重要保真度领域，包括实施过程、实施效率和实施有效性的结果指标。据推测，与传统的MTFC计划相比，ITFMS机构将在每个实施保真度域中报告更高的水平。我们还将评估反映ITFMS使用情况和执行机构对系统满意度的商业化指标。

DESCRIPTION (provided by applicant): The proposed project builds upon Phase I "proof of concept" efforts wherein the basic foundational components of an Internet-based Treatment Fidelity Monitoring System, the ITFMS, were created to assist MTFC consultants and implementing agencies to improve clinical outcomes by moving more efficiently towards and maintaining fidelity of program implementation. ITFMS feasibility for community agency, foster parent, and program consultant use was also examined (please see Phase I report). The Phase II aims involve the completion of the ITFMS system and a randomized controlled trial of the effectiveness of the final system. Within our effectiveness examination, we will focus on outcomes related to increasing MTFC agency and program consultant efficiency in moving towards criteria for implementation fidelity. Completion objectives for the ITFMS system will involve: 1) refinement and enhancement of the existing ITFMS foundational system components, in response to both reviewers and Phase I beta testers, such that the full set of site data necessary to fulfill MTFC fidelity criteria and certification requirements can be remotely and more efficiently entered and viewed by implementing agencies; 2) addition of an integrated system component that will take the day-to-day data collected within each implementation site and automatically integrate and display it in a manner that will allow sites, program consultants, and developers to be more formatively aware of agency movement towards MTFC fidelity and more proactive in their feedback and discussions relative to supporting positive changes in site implementation; 3) addition of a professional communication system that will allow for the free-flow of program ideas and implementation information not only between program consultants and sites, but also between implementation sites such that issues, problems and support can be garnered in an on- going, productive, and meaningful manner; and 4) a parent support component with resources and moderated peer-to-peer support. Once ITFMS system development is completed, it will first be offered to currently active MTFC sites for beta-testing and feedback on the entire system. Feedback from these sites will be integrated into the ITFMS system and then new and developing implementation sites will be solicited to participate in the randomized-controlled trial. The trial will involve randomly assigning sites to either a standard or internet-based MTFC consultant-supported implementation service. Because ITFMS is meant to facilitate movement towards MTFC fidelity implementation by community agencies, important fidelity domains derived from the fidelity management and effectiveness research will be assessed, including outcome indicants of implementation process, implementation efficiency, and implementation effectiveness. It is hypothesized that ITFMS agencies will report greater levels within each of these implementation fidelity domains when compared to the traditionally-implemented MTFC program. We will also assess commercialization indicants reflecting ITFMS usage and system satisfaction within implementing agencies. PUBLIC HEALTH RELEVANCE: Mental health, child welfare, and juvenile justice agencies are jointly faced with the challenge of reducing the prevalence of adolescent antisocial behavior, but sadly, even though empirically-validated programs are available and widely disseminated, replication of research results in community settings remains slow and problematic. A critical contributor to unsuccessful dissemination efforts is the prohibitive need for intensive monitoring by intervention developers/consultants; a difficulty exacerbated as the distance increases between these individuals and community agencies attempting to achieve and maintain implementation fidelity. The current project proposes one possible solution to this problem by developing an Internet-based fidelity feedback mechanism for program consultants, clinical supervisors and interventionists as part of an empirically-validated program's data collection and reporting functions; mechanisms that would link local clinical programs and nationally-based dissemination teams through direct, immediate, high quality data and make it more likely that local service organizations can implement services at the highest possible level of fidelity and achieve stronger community-based intervention outcomes.