Reinforcing Therapist Performance

描述（由申请人提供）：尽管有许多基于证据的实践（ebp）的发展，但在实践中传播和实施它们是一个有充分记录的挑战。事实上，卫生服务研究蓝带小组最近强调，需要进行研究，以确定提供高质量治疗的最有效方法。医学研究所（IOM）为改善保健质量而建议的一种方法是奖励提供者的绩效（即按绩效付费）。本研究的具体目的是评估强化治疗师作为一种改善ebp实施的方法的有效性和成本效益。一个名为“自信的青少年和家庭治疗”（AAFT; RFA TI-06-007）的药物滥用治疗中心（CSAT）倡议提供了一个独特的机会，将NIH的研究资金和SAMHSA的3000多万美元资金结合起来，以实现这些目标。CSAT每年向每个AAFT受助人提供大约30万美元（为期三年），以及一个全面的培训和技术援助模式，以促进青少年社区强化方法（a - cra； Godley等人，2001年）的实施。来自32个AAFT受助机构的90名治疗师将为大约3 000名青少年提供治疗，他们将在A-CRA中接受同样的全面培训和技术援助。在实验中，治疗师将被随机分配到控制组或强化组。后一组的治疗师将获得金钱奖励(a)他们的每位青少年客户接受经验推导的a - cra目标水平（即，在8次或更多的a - cra会话中进行12次或更多的a - cra程序）；以及(b)每月随机选择一段录音达到或超过a - cra认证所需的能力水平。随机化和倾向评分调整将用于控制治疗师水平和客户水平变量的差异。有效性分析将侧重于强化方法在多大程度上增加以下可能性：(a)青少年接受a - cra治疗的目标水平；(b)治疗师表现出每月的能力；(c)青少年在服药后12个月处于康复期（在社区生活时没有酒精或其他药物使用、滥用或依赖症状）。成本分析将关注于治疗师激励所增加的成本是否可以被这三种结果的改善所抵消。

DESCRIPTION (provided by applicant): Despite the development of numerous evidence-based practices (EBPs), disseminating and implementing them in practice is a well-documented challenge. Indeed, a blue ribbon panel on health services research recently highlighted the need for research to identify the most effective ways to deliver high-quality treatment. One approach recommended by the Institute of Medicine (IOM) to improve the quality of health care is to reward provider performance (i.e., pay-for-performance). The specific aims of the proposed study are to evaluate the effectiveness and cost-effectiveness of reinforcing therapists as a method to improve implementation of EBPs. A Center for Substance Abuse Treatment (CSAT) initiative called Assertive Adolescent and Family Treatment (AAFT; RFA TI-06-007) provides a unique opportunity to braid NIH research dollars and over $30 million of SAMHSA funding to address these aims. CSAT is providing each AAFT grantee with approximately $300,000 per year (for three years), as well as a comprehensive training and technical assistance model to facilitate the implementation of the Adolescent Community Reinforcement Approach (A-CRA; Godley et al., 2001). Ninety therapists from 32 AAFT grantees, who will provide treatment to approximately 3,000 adolescents, will receive the same comprehensive training and technical assistance in A-CRA. In the proposed experiment, therapists will be randomly assigned by site to be in either the control or in the reinforcement group. Therapists in the latter group will receive monetary incentives for (a) each of their adolescent clients who receive an empirically derived target level of A-CRA (i.e., 12 or more A-CRA procedures over eight or more A-CRA sessions); and (b) each month that a randomly selected session recording is rated at or above the competence level required for A-CRA certification. Urn randomization and propensity score adjustments will be used to control for differences in both therapist-level and client-level variables. Effectiveness analyses will focus on the extent to which the reinforcement approach increases the likelihood that (a) adolescents receive the target level of A-CRA treatment; (b) therapists demonstrate monthly competence; and (c) adolescents are in recovery (no alcohol or other drug use, abuse, or dependence symptoms while living in the community) 12 months after intake. Cost analyses will focus on whether the increased costs of therapist incentives can be offset by improvements in these three outcomes.