Leveraging Routine Clinical Materials and Mobile Technology to Assess CBT Quality

项目摘要：认知行为疗法（CBT）已被证明是有效的许多 出现问题，包括抑郁、焦虑和创伤后应激障碍（PTSD）。几家大型 精神卫生系统已经投入了大量的资金来培训他们的临床医生进行CBT，但相对较少 在培训结束后，注意监测或促进CBT的质量。识别 这样做的战略可以促进研究和培训，对于确保消费者获得高质量的服务至关重要。 高质量的循证治疗缺乏可扩展、有效和高效的质量监控方法 是努力促进高质量执行的一个主要障碍。自我报告忠诚度评估增加 临床医生和消费者的负担，可能无法准确反映临床医生的技能或强度， 采取干预措施。观察和专家评级需要大量时间和资源， 在大型系统中可行或负担得起。一旦生效，尽可能广泛执行 制定了质量监控战略，这些战略必须是可行的， 常规护理环境，利用在常规护理期间收集的信息。迄今为止，很少有监测战略 不涉及观察，客户/护理人员报告，或临床医生自我报告已经过测试。解决 这一关键的实施挑战，我们建议完善和评估监测质量的方法， 基于对会话中完成的CBT测试的评估。因为他们 开发用于实施核心认知和行为元素，并嵌入到跨诊断的CBT中 类别，它们可用于阐明临床医生通过CBT干预指导客户的能力， 上网时段初步研究表明，这项措施之间的高度相关性， 观察者对临床医生能力的评价，与随后症状变化的相关性，以及高度一致性 对认知行为疗法熟悉程度不同的评估者之间的差异。根据评分完成评分 仅需要会话观察和评级所需的一小部分时间。该项目将比较 这一新的策略，观察员评级和遵守检查表，嵌入在临床笔记。 此外，它还将比较移动的应用程序收集的工作表数据与纸质表格的准确性 并评估这些策略的可行性和可接受性。因为认知行为疗法的核心要素 和它的重复性在许多CBT中是常见的，这项研究对监控保真度具有广泛的意义。 在各种心理健康和医疗保健系统和环境中的CBT。这项研究将由 一组在CBT、培训、实施、心理治疗过程和结果方面具有专业知识的调查人员 研究、心理测量学、纵向数据分析、移动的技术和医疗保健经济学， 社区合作伙伴和最终用户。由此产生的产品有可能显着改善 努力监测和确保在常规护理环境中持续高质量地实施CBT。

Project Abstract: Cognitive Behavioral Therapy (CBT) has been demonstrated to be effective for numerous presenting problems, including depression, anxiety, and post-traumatic stress disorder (PTSD). Several large mental health systems have invested heavily in programs to train their clinicians in CBTs, but relatively little attention has been devoted to the monitoring or promotion of CBT quality after training is complete. Identifying strategies to do so can facilitate research and training, and is critical to ensuring consumer access to high quality, evidence-based treatments. The lack of a scalable, effective, and efficient method of monitoring quality is a key barrier to efforts to promote high-quality implementation. Self-report fidelity assessments increase clinician and consumer burden and may not accurately reflect clinician skill or the intensity with which CBT interventions are delivered. Observation and expert ratings are time and resource intensive and unlikely to be feasible or affordable in large systems. To maximize the likelihood of broad implementation once effective strategies to monitor quality are established, it is essential that these strategies are feasible and acceptable in routine care contexts, leveraging information collected during routine care. To date, few monitoring strategies that do not involve observation, client/caregiver reports, or clinician self-reports have been tested. To address this critical implementation challenge, we propose to refine and evaluate a method of monitoring quality that is based on an evaluation of CBT worksheets that are completed in session. Because the worksheets were developed to implement core cognitive and behavioral elements and are embedded in CBTs across diagnostic categories, they may be used to elucidate the clinician’s ability to guide the client through CBT interventions in session. Preliminary research with this measure demonstrated high correlations between the measure and observer ratings of clinician competence, associations with subsequent symptom change, and high agreement between raters with differing levels of familiarity with CBT. Completion of the ratings based on worksheets requires only a small fraction of time required for session observation and ratings. This project will compare this novel strategy to observer ratings and adherence checklists that are embedded in clinical notes. Furthermore, it will compare the accuracy of worksheet data collected by mobile app to paper-form worksheets, and assess the feasibility and acceptability of these strategies. Because the core elements of CBT and its worksheets are common across many CBTs, this research has broad implications for monitoring fidelity to CBTs in a variety of mental health and healthcare systems and settings. This research will be conducted by a team of investigators with expertise in CBT, training, implementation, psychotherapy process and outcome research, psychometrics, longitudinal data analysis, mobile technologies and healthcare economics, with input from community partners and end-users. The resulting products have the potential to significantly improve efforts to monitor and ensure ongoing high quality implementation of CBT in routine care settings.