Implementation of a Measurement Feedback System in School Mental Health

描述(由申请者提供)：这个指导职业发展奖(K08)旨在提供强化培训，制定一个强有力的研究计划，调查健康信息技术在学校环境中的适应和实施，以增加为服务不足的青少年和家庭提供高质量心理健康干预的机会。最近出现了一个实施科学领域，以解决用于治疗青少年心理健康问题的循证做法(EBP)的激增与其在常规护理治疗环境中的使用之间的重大差距。这种差距在任何地方都比不上学校更加明显。学校提供了大部分青年心理健康服务(70%)，并有效地减少了按族裔和社会经济地位获得服务的差距。然而，侧重于学校背景的实施研究一直不成比例地有限。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，在教育环境中促进精神卫生提供者使用EBP。精神症状的标准化评估(SA)是所有EBP的基石，与治疗相关结果的改善密切相关。然而，SA很少被基于学校的提供者利用，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，候选人的当务之急是增加临床医生对SA工具的管理，并通过开发专门为学校设计的MFS和随之而来的情景适应过程，将SA反馈纳入常规实践。目前的K08奖将使候选人在推进这一研究议程方面具有独特的地位。他的背景包括儿童临床心理学的专门培训、循证评估和干预方法、校本心理健康研究、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的和最佳的心理健康护理之间的差距，他试图将他的培训扩展到：(1)设计用户友好且适合具体情况的医疗保健技术，(2)拥有支持学校创新吸收/实施的理论和方法经验，(3)先进的统计和研究方法，以及(4)先进的学术写作。华盛顿大学是参与实现这些培训目标所需的跨学科培训的杰出环境。候选人的主要导师--Dr。伊丽莎白·麦考利和于尔根·乌努策结合了以下方面的专业知识：青少年精神病理学的评估和治疗、与以学校为基础的提供者的培训、开发计算机产品以支持循证服务的提供、实施科学，以及开发和传播用于客户进度监测的测量反馈工具。更多的当地和本国顾问将在以下方面提供专门知识：青年/家庭服务的执行研究、以用户为中心的设计、以学校为基础的精神健康、社区服务的提供、青年治疗提供者的决策支持工具、文化多样性和精神健康保健、精神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业知识，通过一系列定性、定量和混合方法的研究目标，开发和评估适应背景的、基于网络的MFS，用于校本卫生中心(SBHC)。华盛顿大学护理管理跟踪系统是由Unutzer博士开发的MFS，以前发现它可以改善患者的护理，减少症状，增加患者的功能。目前的研究建议使用SBHC临床医生焦点小组和直接临床医生反馈来调整该MFS以供SBHC临床医生使用。候选人之前的研究表明，SBHC提供商很少使用SA措施，但支持使用结构化、计算机化的方法来增加SA管理的可行性。来自SBHC临床医生(n=20)和青年(n=，Aim 3)的样本将参与该项目，以推进以下研究目标：(1)评估SBHC背景以告知MFS适应情况；(2)评估适应背景下的有效性；(3)评估该系统对临床医生行为和青年结果的影响；以及(4)评估向学校临床医生提供学术数据以用于进度监测的额外效用。SBHC临床医生将就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年轻人的结果。目标1和目标2将在适用时使用现有基准进行描述性评估。AIM 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(及其工作量的子集)将被随机分配到以下两种情况之一：(A)使用学校MFS使用SA监测进展情况；或(B)照常进行评估。AIM 4将使用MFS进行测试，将青年随机分为两种情况：(A)临床医生从MFS收到SA结果和学生的出勤率数据；或(B)数据仅包括SA结果。根据这项工作的结果，将提交一份R01补助金申请，以调查学校MFS的更大规模实施情况和一系列学校服务提供模式中的情景适应过程，以便更彻底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.