Improving Measurement-Based Care in Youth Mental Health: A Comparison of Unidimensional and Multidimensional Approaches

项目摘要 数据一致表明，常规精神卫生服务和循证医学之间存在“质量鸿沟”。 实践（EBP）。一种具有巨大潜力的改善精神卫生保健的方法是测量- 基础护理（MBC），其基础是经常和系统地使用评估工具，定期跟踪 护理的过程和结果。MBC作为EBP得到了广泛的支持，特别是对于成年人。然而，MBC 实施是复杂的，MBC在不到20%的社区精神卫生服务中得到了高质量的实施。 卫生环境。医疗保健系统迫切需要指导如何集中MBC以最大限度地提高效益， 和识别必要的MBC成分已被命名为研究的关键优先事项。这些努力 由于缺乏关于百万富翁的机制的数据，这一工作受到了阻碍。这项试点研究将采用一种机制- 一种驱动的方法来比较两种模式的测量为基础的护理（MBC）在青年服务社区 心理健康设置：多维MBC，其中包括多个领域的措施，是病人- 以治疗为中心，以治疗为导向，以治疗为重点，以及一维MBC，包括症状 措施而已。多层面的MBC提供关于更广泛的进程和进展的反馈 结果可能与客户更相关，并为临床医生提供更多可操作的反馈， 应该对目标机制和客户成果产生更大的影响。然而，一维MBC是 降低患者和提供者的负担，因此可能会取得更大的实施成功。该研究将采用 第1类有效性实施混合设计，以评估这两种方法的相对有效性 在三个社区精神卫生诊所为不同的客户群体提供服务，同时收集数据， 为今后的实施提供信息。 研究的第一个目的是进行初步的开发活动，以确保两者之间的匹配 MBC方法，机制的测量和临床背景。为了实现这一目标， 利益相关者焦点小组和访谈将用于收集关于两种MBC方法的观点， 拟议的研究战略，分析现有数据将用于开发算法，以确定客户 其治疗是在轨道上（OT）或不在轨道上（NOT）的积极治疗结果，以及一个小的预试点 将与5名临床医生和20名青少年客户进行研究程序。 本研究的第二个目的是进行一项初步随机对照试验，比较两种MBC 接近。本研究将作为标准治疗在参与研究的诊所（N = 900）在整个项目范围内进行 由22名临床医生治疗的年轻人），400名年轻人及其照顾者的子集完成了额外的研究 措施同时，将收集数据，以解决第三个研究目标，即进行混合- 方法对多维度和单维度MBC实施相关因素进行分析。如果成功， 这项研究将支持未来的完全有效的试验，该试验将提供有关MBC机制的重要数据 有效的MBC战略，以及成功的MBC实施战略。

Project Summary Data consistently point to a “quality chasm” between routine mental health services and evidence-based practices (EBPs). One approach to improving mental healthcare that holds great potential is measurement- based care (MBC), which is grounded in frequent and systematic use of assessment tools to regularly track the processes and outcomes of care. MBC has broad support as an EBP, particularly for adults. However, MBC implementation is complex and MBC is implemented with high quality in fewer than 20% of community mental health settings. Healthcare systems are in dire need of guidance on how to focus MBC to maximize benefit, and identification of essential MBC components has been named as a key priority for research. These efforts have been hampered by a lack of data on the mechanisms of MBC. This pilot study will use a mechanism- driven approach to compare two models of measurement-based care (MBC) in youth-serving community mental health settings: Multidimensional MBC, which includes measures of multiple domains that are patient- centered, treatment-driven, and symptom-focused, and Unidimensional MBC, which includes symptom measures only. Multidimensional MBC provides feedback on a broader array of process and progress outcomes that may be more relevant to clients and provide more actionable feedback to clinicians, and thus should have a stronger impact on target mechanisms and client outcomes. However, unidimensional MBC is lower burden for patients and providers, so might have more implementation success. The study will employ a Type 1 Effectiveness Implementation Hybrid design to assess the comparative effectiveness of these two approaches in three community mental health clinics serving a diverse client population while gathering data to inform future implementation. The first aim of the study is to conduct preliminary development activities to ensure fit between the two MBC approaches, the measurement of mechanisms, and the clinical context. To accomplish this aim, stakeholder focus groups and interviews will be used to gather perspectives on the two MBC approaches and the proposed research strategies, analyses of existing data will be used to develop algorithms to identify clients whose treatment is on-track (OT) or not-on-track (NOT) for positive treatment outcomes, and a small pre-pilot of study procedures will be conducted with 5 clinicians and 20 adolescent clients. The second aim of the study is to conduct a pilot randomized controlled trial comparing the two MBC approaches. The study will be conducted program-wide as standard care at the participating clinics (N = 900 youth treated by 22 clinicians), with a subset of 400 youth and their caregivers completing additional research measures. Simultaneously, data will be gathered to address the third study aim, which is to conduct a mixed- methods analysis of implementation factors related to multidimensional and unidimensional MBC. If successful, this study will support a future, fully-powered trial that will provide important data regarding MBC mechanisms of action, effective MBC strategies, and successful MBC implementation strategies.