Standardized versus Tailored Implementation of Measurement Based Care for Depression

描述(申请人提供)：抑郁症仍然是美国十大慢性病之一，每年花费超过800亿美元。抑郁症被称为精神疾病的“感冒”，但它具有严重的发病和死亡风险。现在有许多基于证据的治疗抑郁症的做法，但不幸的是，这些做法在很大程度上仍然不适用于在社区精神健康中心接受服务的客户。基于测量的护理(MBC)是一种相对简单的循证干预框架。根据定义，MBC是使用症状测量为精神卫生保健提供信息的做法。当治疗目标是高血压时，医生会定期测量患者的血压，这证明了MBC的医学推论。当MBC用于成人抑郁症的治疗时，已被证明通过识别没有进展的客户并降低客户在治疗过程中恶化的可能性来改善结果。然而，尽管MBC已证明有效，但大多数社区精神健康顾问(即临床医生)并不定期评估目标问题症状，以指导他们在治疗过程中的工作。据我们所知，到目前为止，还没有研究集中在社区精神卫生环境中实施MBC的过程。这项研究项目的长期目标是就促进社区精神卫生中心MBC使用和忠诚度的实施方法提供可概括和实用的建议。具体地说，这项研究将测试在美国最大的非营利性行为健康服务提供商之一实施MBC的标准化和定制方法。尽管被吹捧为优秀的，但定制的实现很少被与标准化方法相比较。此外，最近的研究表明，显然有必要调整以证据为基础的做法，以适应实施这些做法的具体背景，特别是如果它们是 要持续下去。这一提议反映了执行科学领域的一项运动，即正在测试有计划的适应，并将其与标准化版本进行比较。这项拟议的研究是一项三阶段的混合方法(定量/定性)研究，旨在调查这两种不同的MBC实施方法对临床医生级(例如，MBC保真度)和客户级(抑郁症症状变化)结果的影响。我们将重点关注背景因素(例如，态度、资源、流程等)。这可能会影响到 实施过程，目的是确定一种可推广和实用的方式，将MBC引入社区精神卫生中心，治疗成年抑郁症患者。

DESCRIPTION (provided by applicant): Depression remains among the nation's top 10 chronic illnesses, costing over $80 billion annually. Depression has been called the "Common Cold" of mental illness, but one with serious risk of morbidity and mortality. There are now many evidence-based practices for the treatment of depression, but unfortunately these practices remain largely unavailable to clients receiving services in community mental health centers. Measurement Based Care (MBC) is a relatively simple evidence-based intervention framework. MBC, by definition, is the practice of using symptom measurement to inform mental health care. Physicians who routinely measure the patient's blood pressure when the treatment target is high blood pressure demonstrate the medical corollary of MBC. When MBC is used in the treatment of depressed adults, it has been shown to improve outcomes by identifying clients who are not making progress and reducing the likelihood that clients will deteriorate in treatment. However, despite the demonstrated effectiveness of MBC, the majority of community mental health counselors (i.e., clinicians) do not regularly assess target problem symptoms to guide their work over the course of treatment. To our knowledge, no studies to date have focused on the process of implementing MBC in community mental health settings. The long-term goal of this research project is to provide generalizable and practical recommendations about implementation approaches that promote MBC use and fidelity in community mental health centers. Specifically, this study will test a standardized versus a tailored approach to implementing MBC in one of the nation's largest not-for-profit providers of behavioral health services. Although touted as superior, tailored implementations have rarely been compared to standardized approaches. Moreover, recent research has demonstrated an apparent need to adapt evidence- based practices to fit the specific context in which they are being implemented, particularly if they are to be sustained. This proposal reflects a movement in the field of implementation science in which planned adaptations are being tested and compared to standardized versions. The proposed research is a three-phase, mixed methods (quantitative/qualitative) study to investigate the effect of these two different approaches to MBC implementation on both clinician-level (e.g., MBC fidelity) and client-level (depression symptom change) outcomes. We will focus on contextual factors (e.g., attitudes, resources, process, etc.) that may influence the implementation process with the goal of identifying a generalizable and practical way of bringing MBC to community mental health centers treating depressed adults.