Implementation Support for Prevention Program Delivery by College PeerEducators

摘要 一些针对心理健康问题的干预措施是有效和有效的，但很少有常规干预措施提供给 大学生占年轻人的59%。这是令人遗憾的，因为大学生正处于兴奋状态 精神健康问题的风险(例如，抑郁、药物滥用、饮食失调)和大学咨询 中心缺乏足够的临床医生为所有患有疾病的学生提供个体化治疗，也不能很好地 提供预防计划。解决这一服务不足的一个解决方案是让同行教育人员按脚本交付 以群体为基础的预防计划，它可以比 个体化治疗。以大学生为目标是一种成本效益高的策略，可以提供预防方案和 有巨大的潜在影响，因为85%的大学都有同伴教育者项目。同行教育者已经 有效地提供了几个预防方案，有时产生的效果比临床医生更大 该案是以群体为基础的预防计划的初审，具有特别强大的证据基础。 由Wandersman等人指导。(2012)，我们建议评估3个级别的执行支助(培训、 技术援助和质量保证/改进)，用于实施预防计划。我们会 将45所大学随机分为：(1)培训条件，即专家提供为期两天的密集离散初始培训 培训培训员研讨会，同时培训同行教育人员以提供干预和校园 主管培训和支持未来的同伴教育者，外加辅导员指南和辅导员支持网站； (2)培训+技术援助条件，增加半天的实施培训以阐明目标， 需求、领导结构、采用选项、招聘策略和沟通；或(3)培训+ 技术支持+质量保证/质量改进条件增加一年的技术支持 协助、指导和质量保证，以增强实施技能和可持续性。我们将测试 更大的实施支持是否与以下方面的忠诚度和能力的逐步提高相关 提供脚本化预防计划(目标1)，学生参加干预和有效性 关于前后结果变化与实施前收集的常规护理数据的比较方案 (目标2)，以及方案的覆盖面和可持续性(目标3)。我们将测试整合的框架是否 知觉干预特征、外部和内部环境的实施研究(CFIR)指标 初步培训后的因素、同伴教育者属性和过程因素与忠诚度、能力、 在实施期间的出席率、有效性、覆盖率和可持续性，并测试是否在结束时 在最初的一年执行期中，三个条件在相关的CFIR指标和进展方面存在差异 和实施时间(目标4)。我们将评估3种情况下的预防计划交付成本 以及在获得干预的保真度、能力、 诊所的出勤率、有效性、覆盖面和可持续性，以及总体成本节约(目标5)。

ABSTRACT Several interventions for mental health problems are efficacious and effective, but few are routinely offered to college students, who represent 59% of young adults. This is regrettable because college students are at high risk for mental health problems (e.g., depression, substance abuse, eating disorders), and college counseling centers lack sufficient clinicians to offer individual therapy to all afflicted students and are not well positioned to deliver prevention programs. One solution for this service shortfall is to have peer educators deliver scripted group-based prevention programs, which can more efficiently reduce the burden of mental illness than individual therapy. Targeting college students is a cost-effective tactic for delivering prevention programs and has vast potential reach because 85% of colleges have peer educator programs. Peer educators have effectively delivered several prevention programs, sometimes producing larger effects than clinicians, as was the case in a preliminary trial of a group-based prevention program with a particularly strong evidence-base. Guided by Wandersman et al. (2012), we propose to evaluate 3 levels of implementation support (training, technical assistance, and quality assurance/improvement) for the delivery of a prevention program. We will randomize 45 colleges to: (1) a Training condition where experts provide an intensive discrete 2-day initial train-the-trainer workshop that simultaneously trains peer educators to deliver the intervention and campus supervisors to train and support future peer educators, plus the facilitator guide and facilitator support website; (2) a Training + Technical Assistance condition, adding a ½ day implementation training to articulate goals, needs, leadership structure, adoption options, recruitment strategies, and communication; or (3) a Training + Technical Assistance + Quality Assurance/Quality Improvement condition adding 1 year of technical assistance, coaching, and quality assurance to enhance implementation skills and sustainability. We will test whether greater implementation support is associated with graded increases in fidelity and competence in delivering the scripted prevention program (Aim 1), student attendance of the intervention and effectiveness of the program on pre-to-post changes in outcomes compared to usual care data collected before implementation (Aim 2), and reach and sustainability of the program (Aim 3). We will test whether Consolidated Framework for Implementation Research (CFIR) indices of perceived intervention characteristics, outer and inner setting factors, peer educator attributes, and process factors after the initial training correlate with fidelity, competence, attendance, effectiveness, reach, and sustainability over the implementation period and test whether at the end of the initial 1-year implementation period the 3 conditions differ on relevant CFIR indices and on the progress and timing of implementation (Aim 4). We will evaluate the prevention program delivery cost in the 3 conditions and the relative cost-effectiveness of each condition in terms of attaining intervention fidelity, competence, attendance, effectiveness, reach, and sustainability, as well as general cost-savings at the clinics (Aim 5).