Implementation of a Measurement Feedback System in School Mental Health

描述（由申请人提供）：本指导职业发展奖（K08）旨在提供强化培训，以制定强有力的研究计划，调查学校环境下健康信息技术的适应和实施，以增加对服务不足的青少年和家庭的高质量心理健康干预的可用性。最近出现了一个实施科学领域，以解决治疗青少年心理健康问题的循证实践（EBP）的扩散与其在常规护理治疗环境中的使用之间的重大差距。这种差距在学校表现得最为明显。学校提供了大部分青少年心理健康服务（70%），并有效减少了因种族和社会经济地位而造成的服务获取差异。然而，侧重于学校环境的实施研究受到了不成比例的限制。为了解决这些差距并推进实施科学，候选人的长期职业目标是开发有效的方法来促进教育环境中心理健康提供者使用EBP。精神症状的标准化评估（SA）是所有EBP的基石，并与治疗相关结果的改善显著相关。然而，以学校为基础的提供者很少使用SA，从而导致次优护理。测量反馈系统（MFS）使用SA的结果向临床医生提供有关客户进展的信息，代表了将SA引入服务系统的结构化方式，并具有支持有效的以客户为中心的护理的潜力。因此，候选人的直接重点是通过开发MFS和相应的专门为学校设计的情境化适应过程，增加临床医生对SA工具的管理，并将SA反馈纳入日常实践。目前的K08奖将独特地定位候选人推进这一研究议程。他的背景包括儿童临床心理学的专业培训、基于证据的评估和干预方法、基于学校的心理健康研究、心理健康服务研究以及与社区利益相关者的合作。为了更有效地弥合学校中典型和最佳精神卫生保健之间的差距，他寻求扩展他的培训，包括：(1)设计用户友好且适合环境的医疗保健技术，(2)提供理论和方法方面的经验，以支持学校对创新的吸收/实施，(3)高级统计和研究方法，以及(4)高级学术写作。华盛顿大学为实现这些培训目标所需要的跨学科培训提供了良好的环境。候选人的主要导师-博士。Elizabeth McCauley和Jurgen Unutzer结合了青少年精神病理学评估和治疗方面的专业知识，与学校提供者进行培训，开发计算机产品以支持基于证据的服务交付，实施科学，以及开发和传播用于客户进度监控的测量反馈工具。其他地方和国家顾问将在以下方面提供专门知识：青年/家庭服务的实施研究、以用户为中心的设计、以学校为基础的心理健康、社区服务的提供、青年治疗提供者的决策支持工具、文化多样性和心理保健、心理健康政策以及定性和混合方法研究。拟议的项目利用上述培训和专门知识，通过一系列定性、定量和混合方法的研究目标，开发和评估适合具体情况的基于网络的MFS，供校本保健中心使用。华盛顿大学护理管理跟踪系统是由Unutzer博士开发的MFS，先前发现可以改善患者的护理，减轻症状并增强功能。目前的研究建议使用shbhc临床医生焦点小组和直接临床医生反馈来调整该MFS供shbhc临床医生使用。候选人之前的研究表明，shbhc提供者很少使用SA措施，但支持使用结构化的、计算机化的方法来增加SA管理的可行性。参与该项目的临床医生样本（n = 20）和青年样本（n = 64，目标3）将推进以下研究目标：(1)评估shbhc背景，为MFS适应提供信息；(2)评估环境适应的有效性；(3)评估系统对临床医生行为和青少年结局的影响；(4)评估向学校临床医生提供学术数据用于进度监测的附加效用。shbhc的临床医生将对MFS的最佳设计提供反馈，并使用它来跟踪经历抑郁和焦虑的青少年的结果。目标1和目标2将在适用的情况下使用现有基准进行描述性评估。目标3将通过一项小规模随机试验进行实验测试，在该试验中，临床医生（及其病例量的一部分）将被随机分为两种情况：(a)使用学校MFS使用SA来监测进展，或(b)像往常一样进行评估。目标4将使用MFS进行测试，将青少年随机分为两种情况：(a)临床医生从MFS中获得SA结果和学生出勤数据，或(b)数据仅包括SA结果。基于这项工作的结果，将提交R01拨款申请，以调查学校MFS的大规模实施和一系列学校服务提供模式中的情境化适应过程，从而更全面地评估其对临床医生行为和学生功能的影响。

DESCRIPTION (provided by applicant): This Mentored Career Development Award (K08) is designed to provide intensive training in developing a strong program of research that investigates the adaptation and implementation of health information technologies within the school context to increase the availability of high-quality mental health interventions for underserved youth and families. A field of implementation science has recently emerged to address the significant gap between the proliferation of evidence-based practices (EBP) for treating youth mental health problems and their use in usual care treatment settings. Nowhere is this gap more apparent than in schools. Schools provide the bulk of youth mental health services (>70%) and effectively reduce service access disparities by ethnicity and socioeconomic status. Nevertheless, implementation research focused on the school context has been disproportionately limited. To address these gaps and advance implementation science, the candidate's long term career objective is to develop effective methods for promoting the use of EBP among mental health providers in educational settings. Standardized assessment (SA) of psychiatric symptoms is a cornerstone of all EBP and has been significantly associated with improvements in treatment- related outcome. Nevertheless, SA is infrequently utilized by school-based providers, resulting in sub-optimal care. Measurement feedback systems (MFS) use the results of SA to deliver information to clinicians about client progress, represent a structured way to introduce SA into service systems, and have the potential to support effective, client-centered care. The candidate's immediate focus is therefore to increase clinicians' administration of SA tools and incorporation of SA feedback into routine practice through the development of a MFS and an accompanying contextualized adaptation process that are designed specifically for schools. The current K08 Award will uniquely position the candidate to advance this research agenda. His background includes specialized training in child clinical psychology, evidence-based assessment and intervention approaches, research on school-based mental health, mental health services research, and collaboration with community stakeholders. To more effectively bridge the gap between typical and optimal mental health care in schools, he seeks to extend his training to include: (1) design of healthcare technologies that are user-friendly and contextually appropriate, (2) experience with theory and methods to support innovation uptake/implementation in schools, (3) advanced statistics and research methodology, and (4) advanced academic writing. The University of Washington is an outstanding environment in which to engage in the interdisciplinary training required to achieve these training goals. The candidate's primary mentors-Drs. Elizabeth McCauley and Jurgen Unutzer have combined expertise in the assessment and treatment of adolescent psychopathology, training with school-based providers, development of computer products to support evidence-based service delivery, implementation science, and the development and dissemination of measurement feedback tools for client progress monitoring. Additional local and national consultants will contribute expertise in implementation research for youth/family services, user-centered design, school-based mental health, community service provision, decision support tools for youth treatment providers, cultural diversity and mental health care, mental health policy, and qualitative and mixed methods research. The proposed project draws on the training and expertise above to develop and evaluate a contextually- adapted, web-based MFS for use in school-based health centers (SBHCs) through a series of qualitative, quantitative, and mixed methods research aims. The University of Washington Care Management Tracking System is a MFS, developed by Dr. Unutzer, previously found to result in improved care, symptom reductions, and increased functioning among patients. The current study proposes to use SBHC clinician focus groups and direct clinician feedback to adapt this MFS for use by SBHC clinicians. The candidate's prior research has revealed that SBHC providers infrequently utilize SA measures, but supports the feasibility of using structured, computerized methods to increase SA administration. A sample of SBHC clinicians (n = 20) and youth (n = 64, Aim 3) will participate in the project to advance the following Research Aims: (1) evaluate the SBHC context to inform MFS adaptation; (2) assess the adaptation's effectiveness in context; (3) evaluate the system impact on clinician behavior and youth outcomes; and (4) assess the added utility of providing academic data to school clinicians for use in progress monitoring. SBHC clinicians will provide feedback on the optimal design of the MFS and use it to track outcomes among youth experiencing depression and anxiety. Aims 1 and 2 will be evaluated descriptively, using existing benchmarks when applicable. Aim 3 will be tested experimentally via a small-scale randomized trial in which clinicians (and a subset of their caseloads) will be randomized to one of two conditions: (a) use of the school MFS to monitor progress using SA or (b) assessment as usual. Aim 4 will be tested using the MFS, with randomization of youth to two conditions: (a) clinicians receive the results of SA and students' school attendance data from the MFS or (b) data include SA results only. Based on the results of this work, a R01 grant application will be submitted to investigate the larger-scale implementation of the school MFS and contextualized adaptation process among a range of school service delivery models, allowing for more thorough evaluation of its impact on clinician behavior and student functioning. PUBLIC HEALTH RELEVANCE: Evidence-based mental health services are infrequently provided by school-based clinicians, resulting in sub- optimal outcomes for the "safety net" populations most likely to receive care in that setting (i.e., low- socioeconomic status, ethnic minority youth). By identifying innovative health technologies that systematically support the implementation of evidence-based practices and adapting them for use in schools, the proposed research and training carries considerable potential to enhance the availability of high-quality care for underserved youth, thereby more effectively alleviating symptoms and promoting functioning across domains.