A Hybrid Effectiveness-Implementation Trial of Group CBT in Urban Schools

 描述（由申请人提供）：低收入城市社区的学校为实施心理社会循证实践（EBP）提供了一个具有巨大潜力的背景。认知行为疗法（CBT）是一种EBP，已被发现在各种社区环境（包括学校）中治疗焦虑非常有效。Friends for Life（Friends for Life）是一种有效的团体CBT协议。不幸的是，针对焦虑症的EBP很少在资源不足的城市学校使用，因为治疗方案不是根据背景或人群量身定制的，现有的行为健康工作人员没有接受足够的培训或支持，使他们能够忠实地实施治疗，而且学区没有资源与外部提供者或顾问签订合同。在我们之前的工作中，我们开发了一种更具文化敏感性，专注性和可行性的CBT焦虑协议（适应朋友）。修改后的方案（aFRIENDS）解决了实施的主要障碍之一（干预背景适应）。在学校提供服务的社区精神卫生机构治疗师通常会接受一些EBP培训，但通常无法获得足够的支持，例如临床监督，这是保持治疗忠诚度所必需的。关于EBP的传播和实施（D&I）的两个重要问题是：a）城市学校的公共资助的心理健康治疗师在自己的机构支持下能否成功实施EBP，或者成功实施需要外部专家的支持？B）这两种不同实施战略的相对成本效益如何？这项为期五年的研究的目的是在18所K-8学校进行一项3臂、平行组、2型混合有效性试验。治疗师和主管将被随机分配到三个条件之一：a）与培训师培训实施策略的朋友（即，硕士级主管接受专家关于开展监督的培训）; B）采用“教员培训”战略的FRIENDS; c）采用“教员培训+”战略的FRIENDS（即，监督员接受专家关于进行监督的培训和咨询）。我们还将评估成本效益和调解人和主持人的忠诚实施战略。90名治疗师（每组30名）、18名机构主管（每组6名）和360名儿童（每组120名）将参加。我们的指导框架是传播和实施的交互式系统框架。治疗师和主管将使用GoToMeeting和SIMULATIONiQ咨询TM，这是一个基于云的，符合HIPAA的系统，用于培训心理健康工作者。

 DESCRIPTION (provided by applicant): Schools in low-income urban communities present a context with great potential for the implementation of psychosocial evidence-based practices (EBPs). Cognitive-behavioral therapy (CBT) is an EBP that has been found to be very effective in treating anxiety in various community settings, including schools. Friends for Life (FRIENDS) are an efficacious group CBT protocol for anxiety. Unfortunately, EBPs for anxiety are seldom employed in under-resourced urban schools, because treatment protocols are not tailored to the context or the population, existing behavioral health staff does not receive adequate training or support to allow them to implement the treatment with fidelity, and school districts do not have the resources to contract outside providers or consultants. In our prior work, we developed a more culturally sensitive, focused, and feasible CBT for anxiety protocol (adapted FRIENDS). The adapted protocol (aFRIENDS) addresses one of the major barriers to implementation (intervention context fit). Community mental health agency therapists who provide services in schools usually receive some training in EBPs but typically lack access to adequate support, such as clinical supervision, which is necessary for maintaining treatment fidelity. Two important questions regarding dissemination and implementation (D&I) of EBPs are: a) Can publicly funded mental health therapists in urban schools successfully implement EBPs when supported by their own agencies or does successful implementation require external, expert support? b) What is the comparative cost effectiveness of these two different implementation strategies? The aim of this five-year study is to conduct a 3-arm, parallel group, Type 2 hybrid effectiveness- implementation trial in 18 K-8 schools. Therapists and supervisors will be randomly assigned to one of three conditions: a) FRIENDS with Train-the-Trainer implementation strategy (i.e., Masters-level supervisors receive training from experts on conducting supervision); b) aFRIENDS with Train-the-Trainer strategy; c) aFRIENDS with Train-the-Trainer Plus strategy (i.e., supervisors receive training and consultation from experts on conducting supervision). We will also assess cost-effectiveness and mediators and moderators of implementation strategies on fidelity. Ninety therapists (30 per arm), 18 agency supervisors (6 per arm) and 360 children (120 per arm) will participate. Our guiding framework is the Interactive Systems Framework for Dissemination and Implementation. Therapists and supervisors will use GoToMeeting and SIMULATIONiQ Counseling TM, a cloud-based, HIPAA- compliant system for training mental health workers.