Implementing Feedback Interventions to Improve Outcomes

实施反馈干预措施以改善结果

• 批准号: 6780165
• 负责人: Leonard Bickman
• 金额: $ 56.16万
• 依托单位: VANDERBILT UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-08-10 至 2009-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6780165
• 关键词: adolescence (12-20); clinical research; health care quality; health care service evaluation; health services research tag; home health care; human subject; human therapy evaluation; mental health; mental health counseling; mental health services; outcomes research; patient oriented research; performance; psychotherapy

DESCRIPTION (provided by applicant): We propose to study the effects of a theory-driven and empirically-based feedback intervention to influence the cognition and behavior of counselors who provide in-home mental health services to adolescents. The feedback to counselors will be based on client ratings of therapeutic alliance. An improved therapeutic relationship is predicted to have a positive effect on the youth's mental health. The predominant approach to improving mental health outcomes is to disseminate and implement efficacious treatments into the "real world". This proposal offers an approach to improving outcomes of services that is sensitive to the organizational context. Feedback on performance has been shown to improve performance in thousands of studies across many disciplines. However, in a trial of the studies feedback resulted in a decrease in performance. A theoretical understanding of feedback is required to understand the heterogeneity of the effect of feedback. Through a review of basic and applied research in cognitive, social, organizational psychology, and management we have developed a theoretical model that aims to elucidate and optimize the effects of feedback on the performance of mental health service providers. We propose to target therapeutic alliance (TA), as it is the most agreed upon common treatment factor associated with positive clinical outcomes. We will conduct a 2x2 randomized factorial study of the effects of feeding back the youth's TA ratings to the counselor. In Study 1, counselors will be randomly assigned by site to either a "feedback" or a "no feedback" condition. Sites will also be randomly assigned to a "high involvement" or "low involvement" condition in which their supervisor does or does not receive the client-generated feedback. Our model predicts an interaction effect between these two factors that should produce the largest change in counselor cognitions and behavior and the greatest improvement in symptoms and functioning. Study 2 will utilize the same design to test whether an educational component (TA counselor's manual) in addition to feedback will have an even greater positive effect on client ratings of TA and subsequent treatment outcomes. We believe that this research is both theory-based and highly relevant to mental health providers. It offers an innovative approach to improving mental health services.

描述（由申请人提供）：我们建议研究理论驱动和基于经验的反馈干预的效果，以影响为青少年提供家庭心理健康服务的咨询师的认知和行为。 给咨询师的反馈将基于客户对治疗联盟的评分。 预计改善的治疗关系将对青少年的心理健康产生积极影响。 改善心理健康结果的主要方法是在“现实世界”传播和实施有效的治疗方法。 该提案提供了一种改善对组织环境敏感的服务结果的方法。 许多学科的数千项研究表明，对绩效的反馈可以提高绩效。然而，在研究试验中，反馈导致了性能下降。 要理解反馈效果的异质性，需要对反馈有理论上的理解。 通过回顾认知、社会、组织心理学和管理方面的基础和应用研究，我们开发了一个理论模型，旨在阐明和优化反馈对心理健康服务提供者绩效的影响。 我们建议以治疗联盟（TA）为目标，因为它是与积极临床结果相关的最受认可的常见治疗因素。 我们将进行一项 2x2 随机因子研究，研究将青少年的 TA 评分反馈给辅导员的效果。 在研究 1 中，辅导员将按地点随机分配至“反馈”或“无反馈”状态。 站点还将被随机分配到“高参与度”或“低参与度”条件，其中其主管是否收到客户生成的反馈。 我们的模型预测这两个因素之间的相互作用，应该会产生咨询师认知和行为的最大变化以及症状和功能的最大改善。 研究 2 将利用相同的设计来测试除了反馈之外的教育成分（TA 辅导员手册）是否会对客户对 TA 的评分和后续治疗结果产生更大的积极影响。 我们相信这项研究既以理论为基础，又与心理健康提供者高度相关。 它提供了一种改善心理健康服务的创新方法。