Standardized versus Tailored Implementation of Measurement Based Care for Depression

描述（由申请人提供）：抑郁症仍然是美国十大慢性疾病之一，每年花费超过800亿美元。抑郁症被称为精神疾病中的“普通感冒”，但具有严重的发病率和死亡率风险。现在有许多基于证据的治疗抑郁症的做法，但不幸的是，这些做法在很大程度上仍然无法获得社区精神卫生中心接受服务的客户。基于测量的护理（MBC）是一个相对简单的循证干预框架。根据定义，MBC是使用症状测量来告知心理健康护理的实践。当治疗目标是高血压时，常规测量患者血压的医生证明了MBC的医学推论。当MBC用于治疗抑郁症的成年人时，它已被证明可以通过识别没有取得进展的客户并减少客户在治疗中恶化的可能性来改善结果。然而，尽管MBC的有效性得到了证明，但大多数社区心理健康顾问（即，临床医生）不定期评估目标问题症状以指导他们在治疗过程中的工作。据我们所知，迄今为止还没有研究集中在社区精神卫生环境中实施MBC的过程中。本研究项目的长期目标是提供有关促进社区精神卫生中心MBC使用和忠诚的实施方法的可推广和实用的建议。具体来说，这项研究将测试一个标准化与定制的方法来实施MBC在全国最大的非营利行为健康服务提供商之一。尽管被吹捧为上级，但定制的实现很少与标准化方法进行比较。此外，最近的研究表明，显然需要调整基于证据的做法，以适应他们正在实施的具体情况，特别是如果他们是 维持下去这一提议反映了执行科学领域的一项运动，其中计划的调整正在进行测试并与标准化版本进行比较。拟议的研究是一项三阶段混合方法（定量/定性）研究，以调查这两种不同的MBC实施方法对临床医生水平（例如，MBC保真度）和客户水平（抑郁症状变化）的结果。我们将重点关注上下文因素（例如，态度、资源、过程等）可能影响 实施过程的目标是确定一个推广和实用的方式，使MBC社区精神卫生中心治疗抑郁症的成年人。

DESCRIPTION (provided by applicant): Depression remains among the nation's top 10 chronic illnesses, costing over $80 billion annually. Depression has been called the "Common Cold" of mental illness, but one with serious risk of morbidity and mortality. There are now many evidence-based practices for the treatment of depression, but unfortunately these practices remain largely unavailable to clients receiving services in community mental health centers. Measurement Based Care (MBC) is a relatively simple evidence-based intervention framework. MBC, by definition, is the practice of using symptom measurement to inform mental health care. Physicians who routinely measure the patient's blood pressure when the treatment target is high blood pressure demonstrate the medical corollary of MBC. When MBC is used in the treatment of depressed adults, it has been shown to improve outcomes by identifying clients who are not making progress and reducing the likelihood that clients will deteriorate in treatment. However, despite the demonstrated effectiveness of MBC, the majority of community mental health counselors (i.e., clinicians) do not regularly assess target problem symptoms to guide their work over the course of treatment. To our knowledge, no studies to date have focused on the process of implementing MBC in community mental health settings. The long-term goal of this research project is to provide generalizable and practical recommendations about implementation approaches that promote MBC use and fidelity in community mental health centers. Specifically, this study will test a standardized versus a tailored approach to implementing MBC in one of the nation's largest not-for-profit providers of behavioral health services. Although touted as superior, tailored implementations have rarely been compared to standardized approaches. Moreover, recent research has demonstrated an apparent need to adapt evidence- based practices to fit the specific context in which they are being implemented, particularly if they are to be sustained. This proposal reflects a movement in the field of implementation science in which planned adaptations are being tested and compared to standardized versions. The proposed research is a three-phase, mixed methods (quantitative/qualitative) study to investigate the effect of these two different approaches to MBC implementation on both clinician-level (e.g., MBC fidelity) and client-level (depression symptom change) outcomes. We will focus on contextual factors (e.g., attitudes, resources, process, etc.) that may influence the implementation process with the goal of identifying a generalizable and practical way of bringing MBC to community mental health centers treating depressed adults.