Advancing Sustainability of Evidence-Based Treatments in Community Mental Health

项目总结/摘要 太多的病人没有接受基于证据的治疗（EBT）的心理健康问题。在答复中， 实施科学已经迅速发展，将EBT带到常规实践环境中，从而提高了 患者结局。不幸的是，关于EBT可持续性的研究仍然非常有限。这是 鉴于EBT活动和福利在实施后经常下降，这一点令人担忧。防止这些 下降，迫切需要对可持续性进行研究。根据NIMH的战略计划4.2，F32将推进 关于可持续性的研究-即可持续性（a）成果、（B）预测因素和（c）机制， 利用正在进行的父R 01（R 01 MH 120147）。R 01的重点是在10个国家实施EBT， 加州的社区精神健康中心（CMHC）。具体而言，CMHC与R 01团队合作 实施睡眠和昼夜节律功能障碍的跨诊断干预（Transdiagnosis Intervention for Sleep and Circadian Dysfunction，TransS-C） 患有严重的精神疾病此外，R 01设计用于测试操作TransS-C是否“适合” CMHC环境将通过随机分配CMHC以提供标准TransS-C来改善实施结果 或适配的Trans-C。因此，R 01的基础设施允许F32测试三个主要目标。符合 Shediac-Rizkallah和Bone的可持续性框架，目标1将评估定性和定量 TransS-C的可持续性成果，涉及持续的（a）活动、（B）效益和（c）能力。目的2 将使用分层线性建模来评估是否操纵治疗适合背景预测 可持续性成果。目标3将使用结构方程模型来测试可能的介质-具体来说， 提供者对配合的感知（即，可接受性、适当性和可行性）之间的关系 操纵治疗适应性和可持续性结果。为了实现这些目标，申请人将获得 培训：（1）EBT的可持续性，（2）高级定量分析，（3）机械研究设计，以及 (4)定性和混合方法。这所提供的研究和培训机会 奖学金将得到加州大学伯克利分校蓬勃发展的研究环境的支持， 来自申请人的赞助商（博士艾莉森哈维）和专家顾问（博士香农Wiltsey指导 Stirman，Cara刘易斯，and Sophia Rabe-Hesketh）.总的来说，这个F32奖学金将支持申请人的 职业目标成为一个独立的调查员在实施科学与研究计划 评估预测因素，机制，实施结果和EBT的可持续性， 社区设置。

Project Summary/Abstract Too many patients do not receive evidence-based treatments (EBTs) for mental health problems. In response, implementation science has rapidly advanced to bring EBTs to routine practice settings, and thereby improve patient outcomes. Unfortunately, research on sustainability of EBTs remains alarmingly limited. This is concerning, given that EBT activities and benefits regularly decline post-implementation. To prevent these declines, research on sustainability is urgently needed. Per NIMH’s Strategic Plan 4.2, this F32 will advance research on sustainability – namely, sustainability (a) outcomes, (b) predictors, and (c) mechanisms – by leveraging an ongoing, parent R01 (R01MH120147). The R01 focuses on implementation of an EBT in 10 of California’s community mental health centers (CMHCs). Specifically, the CMHCs partnered with the R01 team to implement the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) for individuals with serious mental illness. Additionally, the R01 was designed to test whether manipulating TranS-C to “fit” the CMHC context would improve implementation outcomes by randomizing CMHCs to deliver Standard TranS-C or Adapted TranS-C. Thus, the R01’s infrastructure allows this F32 to test three primary aims. Consistent with Shediac-Rizkallah and Bone’s sustainability framework, Aim 1 will evaluate qualitative and quantitative sustainability outcomes of TranS-C, with respect to continued (a) activities, (b) benefits, and (c) capacity. Aim 2 will use hierarchical linear modeling to evaluate whether manipulating treatment fit to context predicts sustainability outcomes. Aim 3 will use structural equation modeling to test possible mediators – specifically, provider perceptions of fit (i.e., acceptability, appropriateness, and feasibility) – of the relation between manipulated treatment fit and sustainability outcomes. To accomplish these aims, the applicant will receive training in: (1) sustainability of EBTs, (2) advanced quantitative analysis, (3) mechanistic research design, and (4) qualitative and mixed methods approaches. The research and training opportunities offered by this fellowship will be supported by the thriving research environment of University of California, Berkeley and mentorship from the applicant’s Sponsor (Dr. Allison Harvey) and expert Consultants (Drs. Shannon Wiltsey Stirman, Cara Lewis, and Sophia Rabe-Hesketh). Collectively, this F32 fellowship will support the applicant’s career goals of becoming an independent investigator in implementation science with a program of research that evaluates the predictors, mechanisms, and outcomes of implementation and sustainability of EBTs in community settings.