Evidence-Based Practices and Service Outcomes in Usual Care for ASA

描述（由申请人提供）：拟议的研究的最终目标是检查的保真度和有效性的循证实践（EBP）的青少年药物滥用时，由社区治疗师在日常护理。尽管临床医生和治疗方案拥护各种EBP，并且很大一部分报告在常规实践中使用手动治疗，但关于在社区环境中实际提供的治疗成分的可靠知识很少。为了支持采用和培训工作，了解EBP在最终用户手中是否保持其完整性和效力至关重要。拟议的研究将是第一个使用严格的观察方法，在自然服务条件下检查阿萨的EBP实施效果。该研究将利用CASALEAP的资源，CASALEAP是一项正在进行的随机试验，旨在测试四个临床站点现有阿萨治疗服务的有效性。每家临床试验机构至少认可以下两种EBP作为阿萨的主要治疗方法：认知行为治疗（CBT）、家庭治疗（FT）、12步药物咨询（DC）和动机访谈（MI）。CASALEAP试验正在收集预计N = 205名参与者的以下实施数据：三次治疗会议（2，6，10）的录像带和每次会议后EBP依从性的试点治疗师自我报告清单。以最低的成本，拟议的研究将扩大CASALEAP评估程序在两个创新的方式。首先，由经过临床培训的评估者使用所有四种EBP（CBT、FT、DC和MI）的依从性和能力的经验证观察指标对录像会话进行编码。磁带也将被评为治疗联盟与青少年和照顾者。第二，将分析已完成的治疗师报告自评量表试点版本的数据，参与的治疗师将接受培训，以可靠地完成自评量表的减项版本，并对新的简要版本进行可靠性和结构效度和标准效度测试。本研究的第一个目的是确定EBP依从性、能力和联盟是否能预测阿萨在常规护理中的服务利用率和一年的结局。第二个目标是开发和测试一个简短的，心理测量学上健全的治疗师报告措施，坚持EBP阿萨，可以包括在程序评估工具包，用于监测治疗服务的实施系统的护理。第三个目的是检查是否在社区机构的常规实施EBP方法的保真度基准设置的研究训练的治疗师在对照研究。公共卫生相关性：青少年药物滥用（阿萨）仍然是一个非常普遍的，往往危及生命，昂贵的公共卫生问题。阿萨的成本包括与治疗和预防、犯罪和生产力损失相关的成本;最近估计，仅酒精消费的ASA相关成本每年总计580亿美元。此外，阿萨与其他精神疾病的共同发生已在社区和临床样本中确立。青少年药物滥用者同时患有行为障碍，给青少年司法系统造成了沉重负担;例如，2000年有203，000多名青少年因药物滥用违法行为而被捕。由于所有这些原因，阿萨治疗是该国最紧迫的青年心理健康需求之一。然而，很少有人知道阿萨服务的性质和质量，目前在普通护理设置。这项研究将开始填补这一空白，提供一个严格的评估，实施以证据为基础的做法，阿萨在日常护理。

DESCRIPTION (provided by applicant): The ultimate objective of the proposed study is to examine the fidelity and effectiveness of evidence-based practices (EBPs) for adolescent substance abuse when implemented by community therapists in usual care. Although clinicians and treatment programs espouse allegiance to various EBPs, and a large proportion report using manualized treatments in routine practice, there is little reliable knowledge about the treatment ingredients actually delivered in community settings. To support adoption and training efforts, it is critical to know whether EBPs retain their integrity and potency in the hands of end users. The proposed study would be the first to examine implementation effects of EBPs for ASA in natural service conditions using rigorous observational methods. The study will leverage the resources of CASALEAP, an ongoing randomized trial testing the effectiveness of existing ASA treatment services in four clinical sites. Each site endorses at least two of the following EBPs as a primary treatment approach for ASA: cognitive-behavioral therapy (CBT), family therapy (FT), 12-step drug counseling (DC), and motivational interviewing (MI). The CASALEAP trial is collecting the following implementation data on a projected N = 205 participants: videotapes of three treatment sessions (2, 6,10) and a pilot therapist self-report checklist of EBP adherence after every session. At minimal cost, the proposed study will augment CASALEAP assessment procedures in two innovative ways. First, videotaped sessions will be coded by clinically trained raters using validated observational measures of adherence and competence for all four EBPs: CBT, FT, DC, and MI. Tapes will also be rated for therapeutic alliance with adolescents and caregivers. Second, data from completed pilot versions of the therapist-report checklist will be analyzed, participating therapists will be trained to reliably complete a reduced-item version of the checklist, and the new brief version will be tested for reliability and construct and criterion validity. The first aim of the study is to determine whether EBP adherence, competence, and alliance predict service utilization and one-year outcomes for ASA in usual care. The second aim is to develop and test a brief, psychometrically sound therapist-report measure of adherence to EBPs for ASA that can be included in program evaluation toolkits for monitoring treatment service implementation in systems of care. The third aim is to examine whether routine implementation of EBPs in community agencies approaches fidelity benchmarks set by research-trained therapists in controlled studies. PUBLIC HEALTH RELEVANCE: Adolescent substance abuse (ASA) continues to be a highly prevalent, often life-threatening, and costly public health problem. The costs of ASA include those associated with treatment and prevention, crime, and lost productivity; recent estimates of ASA-related costs, available for alcohol consumption only, total $58 billion dollars per year. Also, co-occurrence of ASA with other psychiatric disorders has been established in both community and clinical samples. Adolescent drug abusers with comorbid conduct disorders create a significant burden on the juvenile justice system; for example, in the year 2000 over 203,000 juveniles were arrested for drug abuse violations. For all these reasons, ASA treatment is among the most pressing youth mental health needs in the country. However little is known about the nature and quality of ASA services currently available in usual care settings. This study will begin to fill this gap by providing a rigorous evaluation of the implementation of evidence-based practices for ASA in usual care.