Automated telephone assessment for substance abuse treatment

描述（由申请人提供）：拟议的研究源于一个突出的临床需求：对与物质使用障碍共同发生的精神疾病进行常规评估。在过去的15年里，人们更加关注共同发生的疾病，因为它们会影响治疗计划、结果和工作人员培训需求。据我们所知，这项拨款申请提供了第一个提出的模型，用于自动评估共同发生的疾病。我们的系统旨在进行初步筛选和随后的结果评估。我们选择了交互式语音应答（IVR）技术作为这个项目的平台，它比其他方法（面对面评估、网络、纸笔自我报告）有很多优势。PI和顾问团队在共同发生的疾病，IVR和药物滥用评估和治疗方面具有专业知识。我们还选择了一家技术公司，该公司在用于健康评估的IVR软件方面有着出色的记录。该项目将从一个“演示”阶段开始，在这个阶段，一个有限版本的IVR系统将由一小部分临床医生、客户和项目管理员进行评估。我们特别针对这三种类型的参与者，因为他们对IVR系统的看法都同样重要。然后，我们将构建本应用程序中提出的完整IVR系统，该系统旨在评估五种关键的共同发生的疾病（药物使用障碍，酒精使用障碍，重度抑郁症，心境恶劣和创伤后应激障碍），以及自杀水平。我们将有60名客户完成初始诊断筛选的样本，其中一半（n=30）也将进行面对面访谈，以确定IVR诊断筛选的有效性和对这些疾病的结果测量。所有的病人都将被评估他们符合最初筛查标准的任何障碍的结果，加上所有的人都将完成几个一般的结果测量。结果评估将每月进行一次，为期三个月（在对这些相同措施进行初步基线评估之后，这将作为后续变化的基准）。在本提案的研究部分，我们侧重于评估几个主要问题：每种参与者类型（临床医生、客户、项目管理员）对IVR系统的满意度；参与者特征与IVR系统满意度之间的关系（如年龄、性别、治疗环境）；结果随着时间的推移而变化（在3个月的随访期间，客户改善了多少）；综合征和症状的相互作用（共同发生的疾病如何发生和相互变化）。我们的样本将从大波士顿地区的两个主要药物滥用治疗项目中招募：我们根据彻底的文献检索选择了IVR系统的测量方法，以确定心理测量学上有效的工具，这些工具简短且用户友好。此外，我们的仪器还允许在后期的II期研究中扩展到其他共同发生的疾病，如果我们的I期结果得到保证。公共卫生相关性：在这个项目中，我们试图开发一个系统来评估共同发生的疾病（药物滥用加上额外的精神疾病）。我们计划使用电话作为一种自动化和低成本的方法。呼叫者拨打免费电话号码，然后听到自动回答的问题，然后他/她将使用电话键盘回答这些问题（例如，“按1表示是，按2表示否”）。我们亦会进行一项研究，以评估电话评估系统的满意度及相关问题。如果发现我们的系统工作良好，这个项目可以帮助更多的人获得同时发生的疾病的帮助。

DESCRIPTION (provided by applicant): The proposed study arises out of a prominent clinical need: routine assessment of psychiatric disorders that co-occur with substance use disorder. The past fifteen years have seen greater focus on co-occurring disorders as they can impact treatment planning, outcomes, and staff training needs. To our knowledge, this grant application offers the first proposed model for automated assessment of co-occurring disorders. Our system is designed to conduct both initial screening and later outcome evaluation. We have selected interactive voice response (IVR) technology as the platform for this project, which offers numerous advantages over other methods (in-person assessment, web, paper-and-pencil self-report). The PI and consultant team have expertise in co-occurring disorders, IVR, and substance abuse assessment and treatment. We have also selected a technology company with an outstanding record in IVR software for health-related assessment. This project would start with a "demonstration" phase in which a limited version of the IVR system would be evaluated by a small subsample of clinicians, clients, and program administrators. We are specifically targeting all three participant types as their views on the IVR system are all equally important. We would then construct the full IVR system proposed in this application, which is designed to assess five key co-occurring disorders (drug use disorder, alcohol use disorder, major depression, dysthymia, and PTSD), plus level of suicidality. We would have a sample of 60 clients complete the initial diagnostic screen, of which half (n=30) would also undergo an in-person interview to ascertain validity of the IVR diagnostic screening and outcome measures for these disorders. All clients would be assessed for outcomes on any of the disorders for which they met criteria on the initial screen, plus all would complete several general outcome measures. The outcome evaluations would occur monthly for three months (after initial baseline assessment on those same measures, which serves as the benchmark for subsequent change). In the research portion of this proposal, we focus on evaluation of several major questions: satisfaction with the IVR system by each participant type (clinicians, clients, program administrators); relationship between participant characteristics and satisfaction with the IVR system (e.g., age, gender, treatment setting); outcome changes over time (how much clients improve during the 3 month followup period); syndrome and symptom interplay (how co-occurring disorders occur and change in relation to each other). Our sample will be recruited from two major substance abuse treatment programs in the greater Boston area: We selected the measures for our IVR system based on a thorough literature search to identify psychometrically valid instruments that are brief and user-friendly. Moreover, our instrumentation also allows for expansion to additional co-occurring disorders on a later Phase II study, if warranted by our Phase I results. PUBLIC HEALTH RELEVANCE: In this project, we seek to develop a system to evaluate co-occurring disorders (substance abuse plus additional psychiatric conditions). We plan to use the telephone as an automated and low-cost method. A caller would dial a toll-free number, and then hear automated questions which s/he would then answer using the telephone keypad (e.g., "press 1 for yes or 2 for no"). We would also conduct a study to evaluate satisfaction with the telephone assessment system and related questions. This project could help more people obtain help for co-occurring disorders, if our system is found to work well.