Increasing accuracy and efficiency of fidelity measurement in CBT

 描述(由申请人提供)：拟议项目的目标是通过确定可用于研究和实践的保真度测量方法来加强心理社会干预对公共健康的影响。到目前为止，保真度一直是一个棘手的测量困境，因为几乎没有可靠、有效和有效的保真度测量方法。衡量对心理社会干预的忠诚度的黄金标准--直接观察治疗师的行为--需要广泛的资源。在社区中衡量保真度时，最常用且资源消耗最少的方法是自我报告。不幸的是，观察和自我报告之间的一致性很低。迫切需要确定和评估准确的(即，测量其意图的)和具有成本效益的保真度测量方法。我们在这个测量方案中的目标是比较自我报告(照常进行保真度测量)和两种创新方法(图表刺激回忆和行为彩排)在评估认知行为疗法(一种既定的循证实践)忠诚度方面的准确性和成本效益。我们将把135名接受过认知行为治疗培训的治疗师随机分成3种情况：自我报告(N=45)、图表刺激回忆(N=45)和行为排练(N=45)。所有条件将包括使用治疗过程观察编码系统作为金标准比较的直接观察。在目标1中，我们将确定最准确的保真度测量方法。在目标2中，我们将评估建议的保真度测量方法的经济成本和成本效益。在目标3中，我们将比较利益相关者使用每种方法的意愿，并确定他们感觉到的使用每种方法的障碍和促进者。拟议的工作符合NIMH战略计划，特别是目标4，即加强NIMH支持的研究对公共卫生的影响。这项研究将产生重大的积极影响，产生忠诚度测量方法，然后可供实施科学家用于研究和社区心理健康诊所，以监测治疗师的忠诚度，这是治疗质量的指标。

 DESCRIPTION (provided by applicant): The goal of proposed project is to strengthen the public health impact of psychosocial interventions by identifying fidelity measurement methods that can be used for research and practice. To date, fidelity has posed a thorny measurement quandary because few reliable, valid, and efficient fidelity measurement methods exist. The gold standard for measuring fidelity to psychosocial interventions, direct observation of therapist behavior, requires extensive resources. When fidelity is measured in the community, the most commonly used and least resource intensive method is self-report. Unfortunately, concordance between observation and self-report is low. There is a critical need to identify and evaluate methods of fidelity measurement that are accurate (i.e., measure what they intend) and cost-effective. Our objective in this measurement proposal is to compare the accuracy and cost-effectiveness of self-report (fidelity measurement- as-usual) and two innovative methods (chart stimulated recall and behavioral rehearsal) in assessing fidelity to cognitive-behavioral therapy, an established evidence-based practice. We will randomize 135 therapists, trained in cognitive-behavioral therapy through an initiative to implement evidence-based practices in the City of Philadelphia, to 3 conditions: self-report (N = 45), chart stimulated recall (N = 45), and behavioral rehearsal (N = 45). All conditions will include direct observation using the Therapy Process Observational Coding System as the gold-standard comparison. In Aim 1, we will identify the most accurate fidelity measurement method. In Aim 2, we will estimate the economic costs and cost-effectiveness of the proposed fidelity measurement methods. In Aim 3, we will compare stakeholders' willingness to use each method, as well as identify their perceived barriers and facilitators to use of each method. The proposed work is consistent with the NIMH strategic plan, specifically Objective 4, to strengthen the public health impact of NIMH-supported research. This study will have a significant positive impact by producing fidelity measurement methods that can then be used by implementation scientists for research and community mental health clinics to monitor therapist fidelity, an indicator of therapy quality.