Developing a tool to assess, provide feedback, and facilitate discussion of mechanisms of change in frontline addiction treatment

 描述（由申请人提供）：对行为改变机制（MOBC）的研究已经确定了几个过程，这些过程似乎有助于酒精使用障碍（AUD）治疗中的成功饮酒结果。通常，不同的循证治疗似乎通过类似的机制起作用，这表明诸如拒绝饮酒的自我效能、渴望、对戒酒的社会支持和其他MOBC等结构是应该评估的关键变量，在治疗中有针对性，并监测变化。虽然对MOBC的研究基础继续扩大，但需要更多的工作来了解如何在现实世界的实践环境中利用MOBC。在非AUD背景下，基于测量的护理研究表明，如果对心理健康症状进行常规评估、向患者介绍并与临床医生讨论，则这些症状改善得更快，程度更大。然而，对MOBC采取类似方法的影响-即，评估、提供反馈和讨论MOBC作为治疗过程中的常规实践-尚未经过测试。此外，在现实世界的实践中，评估，反馈和讨论MOBC的具体方式可以促进还没有探索。基于MOBC的评估工具可能对一线临床医生特别有吸引力，因为（1）理论方法通常因临床医生而异， 基本的MOBC通常是相似的，以及（2）向基于结果的绩效测量和医疗保健改革的发展将需要增加相关治疗目标的测量和记录。 拟议的K 01职业发展奖提供培训，以支持研究职业生涯，重点是开发和测试工具，帮助一线临床医生，提高他们的服务质量。精心设计的培训计划将提供以下方面的培训：（1）成瘾治疗的实施科学，（2）用户 以技术为中心的设计，以及（3）跨学科合作，研究传播和资助写作。这些目标将通过多种方式实现，包括专家指导，课程，临床培训和实践经验。 拟议的研究项目通过开发一种基于计算机的临床支持工具来补充这些培训目标，该工具以实施为重点，并帮助一线临床医生在治疗过程中评估和审查患者MOBC数据。该项目将包括以下阶段：（1）评估利益相关者围绕开发此类临床支持工具的意见、需求和愿望;（2）迭代测试和修改软件原型，以增加使用工具的易用性并了解其反馈;以及（3）测试工具的可行性、可接受性和对临床医生会话内行为的影响。该研究将在公共资助的治疗环境中与一线临床医生和患者一起进行。该奖项将通过提供涉及跨学科研究伙伴关系，以用户为中心的设计和以实施为重点的研究的新领域的培训，补充候选人在MOBC研究方面的现有优势。

 DESCRIPTION (provided by applicant): Research on mechanisms of behavior change (MOBCs) has identified several processes that appear to facilitate successful drinking outcomes in alcohol use disorder (AUD) treatments. Often, different evidence- based treatments appear work through similar mechanisms, suggesting that constructs such as drink-refusal self-efficacy, craving, social support for abstinence, and other MOBCs are key variables that should be assessed, targeted in treatment, and monitored for change. Although the research base on MOBCs continues to expand, more work is needed to understand how to utilize MOBCs in real-world practice settings. In non- AUD contexts, measurement-based care research has shown that mental health symptoms improve more quickly and to a greater degree if they are routinely assessed, presented to patients, and discussed with clinicians. However, the impact of a similar approach for MOBCs - i.e., assessing, providing feedback, and discussing MOBCs as routine practice during treatment sessions- has not been tested. Moreover, the specific manner in which assessment, feedback, and discussion of MOBCs could be facilitated in real-world practice has not been explored. MOBC-based assessment tools could be particularly appealing to frontline clinicians given that (1) theoretical approaches often vary between clinicians despite the underlying MOBCs often being similar and (2) movement toward outcome-based performance measures and healthcare reform will require increased measurement and documentation of relevant treatment targets. The proposed K01 career development award provides training to support a research career focused on developing and testing tools that assist frontline clinicians and enhance the quality of their service delivery. Carefully devised training plans will provide training in (1) implementation science in addiction treatment, (2) user centered technology design, and (3) cross-disciplinary collaboration, research dissemination, and grant writing. These goals will be achieved through several means including mentorship from experts, coursework, clinical training, and hands-on experience. The proposed research project complements these training aims by developing a computer-based clinical support tool that is implementation-focused and helps frontline clinicians assess and review patient MOBC data during their treatment sessions. The project will include phases to (1) assess opinions, needs, and desires of stakeholders around developing such a clinical support tool, (2) iteratively test and modify a software prototype to increase the ease of using the tool and understanding its feedback, and (3) test the tool's feasibility, acceptability, and impact on clinicians' within-session behavior. The research will take place at a publicly-funded treatment setting with frontline clinicians and patients. The award will complement the candidate's existing strengths in MOBC research by providing training in new domains involving cross- disciplinary research partnerships, user-centered design, and implementation-focused research.