Evidence-Based Practices and Service Outcomes in Usual Care for ASA

描述（由申请人提供）：拟议研究的最终目的是检查社区治疗师在常规护理中实施青少年药物滥用的循证实践（ebp）的保真度和有效性。尽管临床医生和治疗方案拥护各种ebp，并且很大比例的报告在常规实践中使用了手动治疗，但关于在社区环境中实际提供的治疗成分的可靠知识很少。为了支持采用和培训工作，了解ebp是否在最终用户手中保留其完整性和效力是至关重要的。该研究将首次使用严格的观察方法来检查ebp在自然服务条件下对ASA的实施效果。该研究将利用casalap的资源，casalap是一项正在进行的随机试验，在四个临床地点测试现有ASA治疗服务的有效性。每个网站至少认可以下两种ebp作为ASA的主要治疗方法：认知行为治疗（CBT），家庭治疗（FT）， 12步药物咨询（DC）和动机访谈（MI）。CASALEAP试验在205名参与者中收集了以下实施数据：三次治疗（2、6、10）的录像带，以及每次治疗后试点治疗师对EBP依从性的自我报告清单。以最低的成本，拟议的研究将以两种创新的方式增加casalap的评估程序。首先，录像会议将由经过临床培训的评分员使用所有四种EBPs （CBT， FT， DC和MI）的依从性和能力的有效观察措施进行编码。录像带还将对青少年和照顾者的治疗联盟进行评分。其次，将分析已完成的治疗师报告核对表试点版本的数据，参与的治疗师将接受培训，以可靠地完成核对表的减少项目版本，并对新的简短版本进行信度、结构和标准效度测试。本研究的第一个目的是确定EBP依从性、能力和联盟是否能预测常规护理中ASA的服务利用率和一年的结果。第二个目标是开发和测试一种简短的，心理测量学上合理的治疗师报告方法，用于ASA的ebp依从性，该方法可以包含在项目评估工具包中，用于监测护理系统中治疗服务的实施。第三个目的是检验在社区机构中常规实施的ebp是否接近研究训练的治疗师在对照研究中设定的忠诚基准。公共卫生相关性：青少年药物滥用（ASA）仍然是一个非常普遍的、经常危及生命的、代价高昂的公共卫生问题。ASA的费用包括与治疗和预防、犯罪和生产力损失有关的费用；据最近估计，美国食品和药物管理局相关的费用（仅用于酒精消费）每年总计580亿美元。此外，ASA在社区和临床样本中均与其他精神疾病共发。患有共病性行为障碍的青少年药物滥用者给少年司法系统造成了重大负担；例如，2000年有20.3万多名青少年因滥用药物而被捕。由于所有这些原因，ASA治疗是该国最紧迫的青少年心理健康需求之一。然而，人们对目前在常规护理环境中提供的ASA服务的性质和质量知之甚少。本研究将通过对ASA在常规护理中循证实践的实施进行严格评估来填补这一空白。

DESCRIPTION (provided by applicant): The ultimate objective of the proposed study is to examine the fidelity and effectiveness of evidence-based practices (EBPs) for adolescent substance abuse when implemented by community therapists in usual care. Although clinicians and treatment programs espouse allegiance to various EBPs, and a large proportion report using manualized treatments in routine practice, there is little reliable knowledge about the treatment ingredients actually delivered in community settings. To support adoption and training efforts, it is critical to know whether EBPs retain their integrity and potency in the hands of end users. The proposed study would be the first to examine implementation effects of EBPs for ASA in natural service conditions using rigorous observational methods. The study will leverage the resources of CASALEAP, an ongoing randomized trial testing the effectiveness of existing ASA treatment services in four clinical sites. Each site endorses at least two of the following EBPs as a primary treatment approach for ASA: cognitive-behavioral therapy (CBT), family therapy (FT), 12-step drug counseling (DC), and motivational interviewing (MI). The CASALEAP trial is collecting the following implementation data on a projected N = 205 participants: videotapes of three treatment sessions (2, 6,10) and a pilot therapist self-report checklist of EBP adherence after every session. At minimal cost, the proposed study will augment CASALEAP assessment procedures in two innovative ways. First, videotaped sessions will be coded by clinically trained raters using validated observational measures of adherence and competence for all four EBPs: CBT, FT, DC, and MI. Tapes will also be rated for therapeutic alliance with adolescents and caregivers. Second, data from completed pilot versions of the therapist-report checklist will be analyzed, participating therapists will be trained to reliably complete a reduced-item version of the checklist, and the new brief version will be tested for reliability and construct and criterion validity. The first aim of the study is to determine whether EBP adherence, competence, and alliance predict service utilization and one-year outcomes for ASA in usual care. The second aim is to develop and test a brief, psychometrically sound therapist-report measure of adherence to EBPs for ASA that can be included in program evaluation toolkits for monitoring treatment service implementation in systems of care. The third aim is to examine whether routine implementation of EBPs in community agencies approaches fidelity benchmarks set by research-trained therapists in controlled studies. PUBLIC HEALTH RELEVANCE: Adolescent substance abuse (ASA) continues to be a highly prevalent, often life-threatening, and costly public health problem. The costs of ASA include those associated with treatment and prevention, crime, and lost productivity; recent estimates of ASA-related costs, available for alcohol consumption only, total $58 billion dollars per year. Also, co-occurrence of ASA with other psychiatric disorders has been established in both community and clinical samples. Adolescent drug abusers with comorbid conduct disorders create a significant burden on the juvenile justice system; for example, in the year 2000 over 203,000 juveniles were arrested for drug abuse violations. For all these reasons, ASA treatment is among the most pressing youth mental health needs in the country. However little is known about the nature and quality of ASA services currently available in usual care settings. This study will begin to fill this gap by providing a rigorous evaluation of the implementation of evidence-based practices for ASA in usual care.