Improving Measurement-Based Care in Youth Mental Health: A Comparison of Unidimensional and Multidimensional Approaches

项目摘要 数据一直指向常规精神健康服务和循证服务之间的“质量鸿沟” 实践(EBPS)。改善精神卫生保健的一个具有巨大潜力的方法是测量- 基于护理(MBC)，其基础是频繁和系统地使用评估工具来定期跟踪 护理的过程和结果。MBC作为一种EBP得到了广泛的支持，特别是对成年人。然而，MBC 实施很复杂，只有不到20%的社区成员高质量地实施了MBC 运行状况设置。医疗保健系统迫切需要指导如何专注于MBC以实现利益最大化， 而鉴定MBC的基本成分已被列为研究的关键优先事项。这些努力 由于缺乏关于MBC机制的数据，一直受到阻碍。这项初步研究将使用一种机制-- 在青年服务社区中比较两种基于测量的护理模式的驱动型方法 心理健康设置：多维MBC，包括对患者的多个领域的测量- 以治疗为中心，以症状为重点，包括症状的单维MBC 仅限措施。多维MBC提供对更广泛的流程和进度的反馈 结果可能与客户更相关，并向临床医生提供更具可操作性的反馈，因此 应该对目标机制和客户结果产生更大的影响。然而，一维MBC是 患者和提供者的负担更低，因此可能会有更大的实施成功。这项研究将采用一种 第1类有效性实施评估这两种方法的比较有效性的混合设计 三家社区精神卫生诊所为不同的服务对象提供服务的方法，同时收集数据以 通知未来的实施。 这项研究的第一个目标是进行初步开发活动，以确保两者之间的匹配 MBC方法、机制的测量和临床背景。为了实现这一目标， 将利用利益相关者焦点小组和访谈来收集对两种MBC方法和 建议的研究策略、对现有数据的分析将用于开发识别客户的算法 谁的治疗是在轨道上(OT)或不在轨道上(NOT)以获得积极的治疗结果，以及小规模的预试 将与5名临床医生和20名青少年客户一起进行研究程序。 这项研究的第二个目的是进行一项试点随机对照试验，比较两种MBC 接近了。这项研究将在参与的诊所(N=900)作为标准护理在整个计划范围内进行 由22名临床医生治疗的青年)，400名青年及其照顾者的子集完成了额外的研究 措施。同时，将收集数据以解决第三个研究目标，即进行混合- 方法对多维和一维MBC的实施因素进行分析。如果成功， 这项研究将支持未来的全功率试验，提供有关MBC机制的重要数据 有效的管理成本战略和成功的管理成本实施战略。

Project Summary Data consistently point to a “quality chasm” between routine mental health services and evidence-based practices (EBPs). One approach to improving mental healthcare that holds great potential is measurement- based care (MBC), which is grounded in frequent and systematic use of assessment tools to regularly track the processes and outcomes of care. MBC has broad support as an EBP, particularly for adults. However, MBC implementation is complex and MBC is implemented with high quality in fewer than 20% of community mental health settings. Healthcare systems are in dire need of guidance on how to focus MBC to maximize benefit, and identification of essential MBC components has been named as a key priority for research. These efforts have been hampered by a lack of data on the mechanisms of MBC. This pilot study will use a mechanism- driven approach to compare two models of measurement-based care (MBC) in youth-serving community mental health settings: Multidimensional MBC, which includes measures of multiple domains that are patient- centered, treatment-driven, and symptom-focused, and Unidimensional MBC, which includes symptom measures only. Multidimensional MBC provides feedback on a broader array of process and progress outcomes that may be more relevant to clients and provide more actionable feedback to clinicians, and thus should have a stronger impact on target mechanisms and client outcomes. However, unidimensional MBC is lower burden for patients and providers, so might have more implementation success. The study will employ a Type 1 Effectiveness Implementation Hybrid design to assess the comparative effectiveness of these two approaches in three community mental health clinics serving a diverse client population while gathering data to inform future implementation. The first aim of the study is to conduct preliminary development activities to ensure fit between the two MBC approaches, the measurement of mechanisms, and the clinical context. To accomplish this aim, stakeholder focus groups and interviews will be used to gather perspectives on the two MBC approaches and the proposed research strategies, analyses of existing data will be used to develop algorithms to identify clients whose treatment is on-track (OT) or not-on-track (NOT) for positive treatment outcomes, and a small pre-pilot of study procedures will be conducted with 5 clinicians and 20 adolescent clients. The second aim of the study is to conduct a pilot randomized controlled trial comparing the two MBC approaches. The study will be conducted program-wide as standard care at the participating clinics (N = 900 youth treated by 22 clinicians), with a subset of 400 youth and their caregivers completing additional research measures. Simultaneously, data will be gathered to address the third study aim, which is to conduct a mixed- methods analysis of implementation factors related to multidimensional and unidimensional MBC. If successful, this study will support a future, fully-powered trial that will provide important data regarding MBC mechanisms of action, effective MBC strategies, and successful MBC implementation strategies.