Reinforcing Therapist Performance

描述（由申请人提供）：尽管发展了许多循证实践（EBP），但在实践中传播和实施它们是一个有据可查的挑战。事实上，一个关于卫生服务研究的蓝带小组最近强调，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）建议的一种提高医疗保健质量的方法是奖励提供者的表现（即，按业绩计薪）。建议的研究的具体目的是评估的有效性和成本效益的强化治疗师作为一种方法，以提高实施循证医学。药物滥用治疗中心（CSAT）的一项名为“自信的青少年和家庭治疗”（AAFT; RFA TI-06-007）的倡议提供了一个独特的机会，可以编织NIH的研究资金和超过3000万美元的SAMHSA资金来实现这些目标。CSAT每年向每个AAFT受赠者提供大约30万美元（为期三年），以及一个全面的培训和技术援助模式，以促进实施青少年社区强化方法（A-CRA; Godley等人，2001年）。来自32个AAFT受赠方的90名治疗师将为大约3 000名青少年提供治疗，他们将接受A-CRA的同样全面的培训和技术援助。在拟议的实验中，治疗师将被随机分配到控制组或强化组。后一组中的治疗师将为（a）接受经验得出的A-CRA目标水平（即，在八个或更多的A-CRA课程中进行12个或更多的A-CRA程序）;以及（B）每个月，随机选择的课程记录被评定为达到或超过A-CRA认证所需的能力水平。将使用Urn随机化和倾向评分调整来控制治疗师水平和客户水平变量的差异。有效性分析将重点关注强化方法增加以下可能性的程度：（a）青少年接受目标水平的A-CRA治疗;（B）治疗师表现出每月的能力;（c）青少年在服用后12个月处于恢复期（在社区生活期间无酒精或其他药物使用、滥用或依赖症状）。成本分析的重点是治疗师激励措施增加的成本是否可以通过改善这三个结果来抵消。

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.