Quality Assessment in Exposure Therapy

项目摘要/摘要 没有经验支持的行为疗法就不能有效地传播 了解关键质量要素。机制知情的质量措施有 消除不必要的因素和提高实用主义的非凡潜力 针对多个问题和人群，通过检测来增强预测价值 治疗早期的机制接合。社区精神卫生机构(CMHA)， 然而，由于负担和负担，往往缺乏使用这种治疗质量衡量标准的能力 有限的资源。暴露疗法治疗焦虑症是测试一种实用的、 考虑到CMHAs对公共健康的潜在影响和 明确的机理理论。暴露指南(EG)，一个简短的质量测量工具治疗师 行为和机制，是基于微分析编码数据开发的，显示出强大的 暴露治疗的三个随机对照试验中治疗师行为和患者结果之间的联系 青春年华。使用这些RCT数据对EG进行的初步心理测量显示出可靠性， 构建效度和预测效度，试点数据表明它可能是可以接受的 在社区环境中可行。在这些发现的基础上，我们建议测试这部小说 社区环境中暴露质量的测量，包括其可靠性和效度，其 实用主义，以及哪些社区最终用户可以成为可靠和有效的记者。 当地一家大型CMHA(N=40)的治疗师治疗焦虑的年轻人和5-21岁的年轻人 (n=300)将参与这项研究。专家组将由1)机构主管完成 每月，每期2名治疗师，3)每期患者/家庭，以及4)每期研究评分员 会议。这项研究的结果将建立一个衡量治疗效果的创新模型 触发现实世界治疗中的变化机制并为未来使用提供信息的要素 例如，作为一种培训工具，以提高社区环境中的暴露质量。

Project Summary/Abstract Empirically supported behavioral treatments cannot be effectively disseminated without understanding key quality components. Mechanism-informed quality measures have extraordinary potential to enhance pragmatism by eliminating unnecessary elements and targeting multiple problems and populations, and to enhance predictive value by detecting mechanism engagement early in treatment. Community Mental Health Agencies (CMHAs), however, are often ill-equipped to use such measures of treatment quality due to burden and limited resources. Exposure therapy for anxiety is an ideal prototype for testing a practical, mechanism-informed quality measure in CMHAs given its potential for public health impact and clear theory of mechanism. The Exposure Guide (EG), a brief quality tool measuring therapist behaviors and mechanism, was developed based on microanalytic coded data showing a strong link between therapist behavior and patient outcome across three RCTs of exposure therapy in youth. Initial psychometrics for the EG using these RCT data are promising showing reliability, construct validity, and predictive validity, and pilot data suggests it may be acceptable and feasible in a community setting. Building upon these findings, we propose to test this novel measure of exposure quality, EG, in a community setting including its reliability and validity, its pragmatism, and which community end-users can become reliable and valid reporters. Therapists at a large local CMHA (N = 40) treating anxious youth and young adults ages 5-21 (N = 300) will participate in this study. The EG will be completed by 1) agency supervisors monthly, 2) therapists per session, 3) patient/families per session, and 4) study raters per session. Results from this study will establish an innovative model for measuring therapeutic elements that trigger mechanism of change in real-world therapy as well as inform future use of EG as a training tool to improve exposure quality in community settings.