Implementation Support for Prevention Program Delivery by College Peer Educators

摘要 针对心理健康问题的几种干预措施是有效的，但很少有常规的， 大学生，占年轻人的59%。这是令人遗憾的，因为大学生在高 心理健康问题的风险（例如，抑郁症，药物滥用，饮食失调），和大学咨询 中心缺乏足够的临床医生为所有患病学生提供个性化治疗， 提供预防方案。这种服务短缺的一个解决方案是让同伴教育者提供脚本 以团体为基础的预防计划，可以更有效地减少精神疾病的负担， 个别治疗以大学生为目标是提供预防方案的一种具有成本效益的策略， 因为85%的大学都有同伴教育计划，所以有巨大的潜在影响力。同伴教育者有 有效地提供了几个预防方案，有时产生更大的影响比临床医生， 该案件是一项基于群体的预防计划的初步审判，证据基础特别强。 在Wandersman等人（2012）的指导下，我们建议评估3个级别的实施支持（培训， 技术援助和质量保证/改进），以实施预防方案。我们将 随机选择45所大学：（1）培训条件，专家提供密集的离散2天初始 培训培训员讲习班，同时培训同伴教育者提供干预措施和校园 指导员培训和支持未来的同伴教育者，加上辅导员指南和辅导员支持网站; (2)培训+技术援助条件，增加为期半天的实施培训，以明确目标， 需求、领导结构、采用方案、招聘策略和沟通;或（3）培训+ 技术援助+质量保证/质量改进条件增加1年技术 协助、辅导和质量保证，以提高执行技能和可持续性。我们将测试 更大的实施支持是否与忠诚度和能力的分级增加有关， 提供脚本预防方案（目标1），学生参加干预和有效性 与实施前收集的常规护理数据相比， (Aim 2），以及方案的覆盖面和可持续性（目标3）。我们将测试《综合框架》 实施研究（CFIR）指数的感知干预特征，外部和内部设置 因素，同伴教育者属性，和过程因素后，初步培训与忠诚，能力， 在实施期间的出勤率、有效性、覆盖范围和可持续性，并测试是否在最后 在最初的1年实施期内，3种条件在相关CFIR指数和进展方面存在差异 和实施时间（目标4）。我们将在3个条件下评估预防计划的交付成本 以及每种情况在实现干预保真度，能力， 就诊率、有效性、覆盖范围和可持续性，以及诊所的一般成本节约（目标5）。

ABSTRACT Several interventions for mental health problems are efficacious and effective, but few are routinely offered to college students, who represent 59% of young adults. This is regrettable because college students are at high risk for mental health problems (e.g., depression, substance abuse, eating disorders), and college counseling centers lack sufficient clinicians to offer individual therapy to all afflicted students and are not well positioned to deliver prevention programs. One solution for this service shortfall is to have peer educators deliver scripted group-based prevention programs, which can more efficiently reduce the burden of mental illness than individual therapy. Targeting college students is a cost-effective tactic for delivering prevention programs and has vast potential reach because 85% of colleges have peer educator programs. Peer educators have effectively delivered several prevention programs, sometimes producing larger effects than clinicians, as was the case in a preliminary trial of a group-based prevention program with a particularly strong evidence-base. Guided by Wandersman et al. (2012), we propose to evaluate 3 levels of implementation support (training, technical assistance, and quality assurance/improvement) for the delivery of a prevention program. We will randomize 45 colleges to: (1) a Training condition where experts provide an intensive discrete 2-day initial train-the-trainer workshop that simultaneously trains peer educators to deliver the intervention and campus supervisors to train and support future peer educators, plus the facilitator guide and facilitator support website; (2) a Training + Technical Assistance condition, adding a ½ day implementation training to articulate goals, needs, leadership structure, adoption options, recruitment strategies, and communication; or (3) a Training + Technical Assistance + Quality Assurance/Quality Improvement condition adding 1 year of technical assistance, coaching, and quality assurance to enhance implementation skills and sustainability. We will test whether greater implementation support is associated with graded increases in fidelity and competence in delivering the scripted prevention program (Aim 1), student attendance of the intervention and effectiveness of the program on pre-to-post changes in outcomes compared to usual care data collected before implementation (Aim 2), and reach and sustainability of the program (Aim 3). We will test whether Consolidated Framework for Implementation Research (CFIR) indices of perceived intervention characteristics, outer and inner setting factors, peer educator attributes, and process factors after the initial training correlate with fidelity, competence, attendance, effectiveness, reach, and sustainability over the implementation period and test whether at the end of the initial 1-year implementation period the 3 conditions differ on relevant CFIR indices and on the progress and timing of implementation (Aim 4). We will evaluate the prevention program delivery cost in the 3 conditions and the relative cost-effectiveness of each condition in terms of attaining intervention fidelity, competence, attendance, effectiveness, reach, and sustainability, as well as general cost-savings at the clinics (Aim 5).