A Hybrid Type 2 Trial of Trauma-Focused Cognitive Behavioral Therapy and a Pragmatic Individual-Level Implementation Strategy

项目摘要 大多数经历严重创伤相关症状的年轻人没有得到指定的服务， 即使他们这样做，所得到的服务也不是以证据为基础的。教育部门负责70-80% 提供给青少年的所有心理健康服务，但有（1）有限的循证治疗菜单 （EBT）可供学校使用的创伤和（2）需要加强学校对EBT的吸收和使用 和其他社区环境中的青少年暴露于创伤。 以创伤为中心的认知行为疗法（TF-CBT）是一种有效的治疗创伤暴露的方法。 然而，目前还没有研究评估TF-CBT在学校实施的有效性。 此外，重大的实施障碍限制了成功采用、忠实交付以及 TF-CBT的持续性;特别是个体临床医生变量，如围绕核心的信念和态度 干预的组成部分（例如，恐惧的刺激）。这两个差距揭示了研究的必要性 同时检查TF-CBT在学校交付时的有效性和实施情况。 个体提供者行为改变是成功实施任何EBT的关键组成部分。甚至 当循证政策、支持性领导和有效培训等因素到位时， 执行工作最终取决于提供者的改革动机和决心。的信仰和 在学校成功实施的态度（BASIS）干预是一个便利的，基于小组的混合 实施战略BASIS是简短、实用的，旨在加强标准EBP培训， 协商程序。它的目标是从理论上推导出的与行为相关的个人层面的决定因素 使用动机和意志行为改变策略进行改变。BASIS被评为可行， 适当的SBMH临床医生，并发现增加临床医生的态度，社会规范的看法， 在一项小型（n = 24）随机试验中使用EBT的实施意图（R21 MH 108714）。 考虑到有需要研究工作队在学校的成效，以及 个人层面的战略，加强EBT培训和咨询，目前的建议是一个混合型2 使用混合方法对120名SBMH临床医生和480名学生进行了有效性实施试验。这 该项目旨在同时测试TF-CBT在学校的有效性和BASIS对 近端机制和TF-CBT实施结果。具体而言，该提案旨在通过实验 评估TF-CBT在学校与治疗照常，包括干预机制的变化，心理 健康结果和TF-CBT成本效益（目标1）;并通过实验评估BASIS与 注意力控制，包括变革的实施机制，TF-CBT实施结果，以及 成本效益基础（目标2）。TF-CBT和BASIS代表了潜在的鲁棒性和可推广性 大幅度提高受创伤青年获得服务的机会和服务质量的战略。

PROJECT ABSTRACT Most youth who experience significant trauma-related symptoms do not receive indicated services and, when they do, the services received are not evidence-based. The education sector is responsible for 70-80% of all mental health services delivered to youth, but there are (1) a limited menu of evidence-based treatments (EBTs) for trauma available for use in schools and (2) a need to enhance the uptake and use of EBT in schools and other community settings for youth exposed to trauma. Trauma-focused cognitive behavior therapy (TF-CBT) is an efficacious treatment for trauma-exposed youth, but there are no studies that have evaluated the effectiveness of TF-CBT when delivered in schools. Additionally, significant implementation barriers limit the successful adoption, delivery with fidelity, and sustainment of TF-CBT; especially individual clinician variables, such as beliefs and attitudes surrounding core components of the intervention (e.g., exposure to feared stimuli). These two gaps reveal the need for research that simultaneously examines effectiveness and implementation of TF-CBT when delivered in schools. Individual provider behavior change is a critical component of successful implementation of any EBT. Even when factors such as evidence-informed policy, supportive leadership, and effective training are in place, implementation ultimately rests with providers’ motivation and commitment to change. The Beliefs and Attitudes for Successful Implementation in Schools (BASIS) intervention is a facilitated, group-based blended implementation strategy. BASIS is brief, pragmatic, and is designed to augment standard EBP training and consultation procedures. It targets theoretically-derived individual-level determinants associated with behavior change using motivational and volitional behavior change strategies. BASIS has been rated as feasible and appropriate by SBMH clinicians, and found to increase clinicians’ attitudes, perceptions of social norms, and implementation intentions to use EBT in a small (n = 24) randomized trial (R21MH108714). Considering the need to examine the effectiveness of TF-CBT in the context of schools and the importance of individual-level strategies that augment EBT training and consultation, the current proposal is a hybrid type 2 effectiveness-implementation trial with 120 SBMH clinicians and 480 students using mixed methods. This project is designed to simultaneously test the effectiveness of TF-CBT in schools and the impact of BASIS on proximal mechanisms and TF-CBT implementation outcomes. Specifically, the proposal aims to experimentally evaluate TF-CBT in schools versus treatment as usual, including intervention mechanisms of change, mental health outcomes, and TF-CBT cost-effectiveness (Aim 1); and experimentally evaluate BASIS versus and attention control, including implementation mechanisms of change, TF-CBT implementation outcomes, and BASIS cost-effectiveness (Aim 2). TF-CBT and BASIS represent potentially robust and generalizable strategies for greatly enhancing the accessibility and quality of services for trauma-exposed youth.