Finalizing and Testing an Online Therapist Training and Assistance Program to Facilitate Implementation of Comprehensive Behavioral Intervention for Tic Disorders (CBIT-Trainer)

项目总结/摘要 抽动障碍（TD）是一类儿童期发作的神经精神障碍，发生在1-3%的儿童中。 人口，并经常导致身体，社会，学术和人际功能的重大损害 降低生活质量。目前还没有治愈TD的方法，但是大规模的随机对照试验 已经表明，一种被称为抽动综合行为干预（CBIT）的非药物治疗可以 减少抽搐，而没有与药物治疗相关的不良副作用。虽然CBIT现在 作为TD的一线干预措施，大多数患者由于缺乏训练有素的 心理医生鉴于TD患者对CBIT的需求和愿望，对治疗师培训的高需求， 以及缺乏经过CBIT充分培训的治疗师，显然需要创新的方法来培训更多的治疗师。 提供者在这种基于证据的治疗。目前的提案与两个主要开发商合作， CBIT与PsycTech合作，PsycTech是一家专门开发有效的基于计算机的产品的公司， 重复性行为障碍在拟议的项目中，我们将首先完成一个创新的在线开发， 培训治疗师提供CBIT的计划（称为CBIT培训师）。在整个开发过程中，我们 将与多个利益相关者合作，以确定供应商和组织层面的因素， 影响在其他保健模式和环境中采用和实施经调整的干预措施。后 完成后，CBIT培训师将在一个密集的面对面治疗师培训计划中进行测试。 随机对照试验。第二阶段计划将达致五个目标：（1）使用一个拥有知识产权的 反馈过程完成CBIT-Trainer的开发;（2）将CBIT-Trainer与传统的 对治疗师进行CBIT管理能力的个人培训，（3）比较CBIT培训师与 当他们接受CBIT培训的治疗师治疗时，患者的结果，（4）识别和解决治疗师 将改善（或限制）CBIT培训师的采用和使用的因素，以及（5）确定可能 影响治疗师在培训后的实践中继续使用CBIT。为了测试这些目标，我们利用一个 有效性-实施混合设计，进行随机对照试验，比较CBIT-Trainer与 美国行为治疗训练研究所（BTI）的妥瑞症协会，这是目前的黄金- 培训CBIT治疗师的标准。我们计划招募234名CBIT初治治疗师-患者配对参与 书房我们的主要治疗结果将是治疗师在提供CBIT方面的技能，这将在 培训后（第0周）、患者接受CBIT后（第10周）和6个月随访时（第34周）。 我们的主要患者结局将是治疗前（第0周）、治疗后（第2周）和治疗后（第3周）评估的总体临床改善。 治疗（第10周）和6个月随访（第34周）。作为次要目标，我们还将评估治疗师- 水平的促进者和障碍，采用CBIT培训师，以及实施和维持CBIT在他们的 练习，训练后。如果CBIT-Trainer对于训练治疗师忠实地提供CBIT是有效的，那么它具有 增加治疗TD的治疗师数量的潜力。此外，这项技术本身也可以 容易利用，以推进技术开发和测试类似的培训计划，为其他 循证干预措施（EBI），从而加速EBI的传播和其他临床应用 问题此外，CBIT-Trainer还提出了一种独特的研究方法，可以随时应用 类似的项目寻求扩大对EBI的培训和治疗结果的评估， 在历史上过于依赖人力资本密集型培训方法。

Project Summary/Abstract Tic disorders (TD) are a class of childhood-onset neuropsychiatric disorders that occur in 1-3% of the population and often cause significant impairment in physical, social, academic, and interpersonal functioning and reduce quality of life. There is currently no cure for TD, however large-scale randomized controlled trials have shown that a non-drug treatment known as Comprehensive Behavioral Intervention for Tics (CBIT) can reduce tics without the adverse side effects associated with pharmacotherapy. Although CBIT is now recommended as a first-line intervention for TD, most patients cannot get CBIT due to a lack of trained therapists. Given the need and desire for CBIT among individuals with TD, high demand for therapist trainings, and the lack of therapists adequately trained in CBIT, there is a clear need for innovative ways to train more providers in this evidence-based treatment. The current proposal partners two of the primary developers of CBIT with PsycTech, a company that specializes in developing effective computer-based products for repetitive behavior disorders. In the proposed project, we will first finalize development of an innovative online program for training therapists to deliver CBIT (called CBIT-Trainer). Throughout the development process, we will engage multiple stakeholders in order to identify provider- and organizational-level factors shown to influence adoption and implementation of adapted interventions in other health-care models and settings. Upon completion, CBIT-Trainer will be tested against an intensive in-person therapist training program in a randomized controlled trial. This Phase II project will accomplish five aims: (1) to use a stakeholder-informed feedback process to complete the development of CBIT-Trainer, (2) to compare CBIT-Trainer to traditional in- person training on therapists’ ability to administer CBIT, (3) to compare CBIT-Trainer to in-person training on patient outcomes when they are treated by a CBIT-trained therapist, (4) to identify and address therapist factors that will improve (or limit) adoption and use of CBIT-Trainer, and (5) to identify therapist factors likely to influence therapists’ continued use of CBIT in their practice after training. To test these aims, we utilize an effectiveness-implementation hybrid design to conduct a randomized controlled trial comparing CBIT-Trainer to the Tourette Association of America’s Behavior Therapy Training Institute (BTI), which is the current gold- standard for training CBIT therapists. We plan to enroll 234 CBIT-naïve therapist-patient dyads to participate in the study. Our primary therapist outcomes will be therapist skill in delivering CBIT, which will be assessed at post-training (Week 0), after administering CBIT with a patient (Week 10), and at 6-month follow-up (Week 34). Our primary patient outcomes will be overall clinical improvement assessed at pre-treatment (Week 0), post- treatment (Week 10), and 6-month follow up (Week 34). As a secondary aim, we will also assess therapist- level facilitators and barriers to adopting CBIT-Trainer, as well as implementing and sustaining CBIT in their practice, after training. If CBIT-Trainer is effective for training therapists to deliver CBIT with fidelity, it has the potential to increase the number of therapists available to treat TD. In addition, the technology itself could be leveraged easily to advance the technological development and testing of similar training programs for other evidence-based interventions (EBIs), thereby speeding dissemination and availability of EBIs for other clinical problems. Moreover, CBIT-Trainer is proposing a unique research methodology that could be readily applied to similar projects seeking to expand the evaluation of training and treatment outcomes for EBIs that have historically relied too heavily on a human-capital intensive training approach.