Combining an Evidenced Based Treatment with a Measurement Feedback System

将循证治疗与测量反馈系统相结合

• 批准号: 7984463
• 负责人: Leonard Bickman
• 金额: $ 62.76万
• 依托单位: VANDERBILT UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-01 至 2015-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7984463
• 关键词: Address; Adherence; Adolescent; Affect; Attention; Attitude; Behavior; Behavioral; Belief; Caregivers; Characteristics; Client; Clinic; Clinical; Clinical Treatment; Clinical Trials; Communities; Computer Simulation; Data; Development; Educational Intervention; Evidence based treatment; Experimental Designs; Family; Family psychotherapy; Feedback; Foundations; Funding; Goals; Grant; Health system; Healthcare; Indiana; Intervention; Justice; Lead; Licensing; Life; Measurement; Measures; Mediator of activation protein; Mental Health; Mental Health Services; Modeling; National Institute of Mental Health; Outcome; Population; Process; Protocols documentation; Provider; Quasi-experiment; Randomized; Research; Research Personnel; Self Efficacy; Services; Site; Staff Attitudes; Stress; Supervision; System; Testing; Therapeutic; Universities; Work; Youth; base; clinical application; clinical decision-making; community setting; computerized; cost; evidence base; experience; falls; improved; information processing; innovation; operation; public health relevance; standardize measure; theories; treatment adherence; treatment as usual

DESCRIPTION (provided by applicant): The recent, poor meta-analytic results of evidence-based treatment (EBT) represent a crisis in youth mental health services. There is a dire need for innovative approaches to improving transportability, implementation, and outcomes of services. Model adherence (EBT fidelity) is a necessary but not sufficient mechanism for improving outcomes in community settings. Real-world mental health treatment requires attention to the complexities inherent in the interaction between unique settings, therapists, and clients. As such, therapists implementing EBTs need better support for clinical decision making that may lead to adaptations of the EBT in the service of tailoring treatment. A measurement feedback system (MFS) provides the ongoing treatment progress and process information necessary to assist the therapist in making treatment decisions. As a benefit to the MFS, the EBT provides an essential framework for integration of systematic data into logistical, clinical, and supervisory operations. The synergy of the combination of an MFS and an EBT should improve transportability of EBT, implementation of MFS, and youth and family outcomes. We will integrate an existing EBT [and an existing MFS. The EBT is Functional Family Therapy (FFT), an empirically supported intervention for youths in the juvenile justice and mental health systems. Model-specific data on treatment adherence and progress are provided in the FFT Q-system, a computerized model-specific quality improvement system. The MFS is Contextualized Feedback Intervention and Training (CFIT), which provides computerized feedback on treatment progress and process upon weekly completion of brief standardized measures administered to youths, caregivers, and therapists.] We will determine if this innovative combination has the desired synergistic effect on the provider organizations, therapist behavior, and youth/family outcomes in a community mental health agency with 4 sites where 102 therapists will serve over 4000 youths during the life of the study. A current foundation grant is supporting the development and testing of a computerized system that integrates both existing feedback systems. That work will be complete[d in January 2010]. Therapists will be randomly assigned to one of two groups: (1) Basic FFT (FFT only) or (2) Enhanced FFT (FFT + CFIT). Feedback for the Basic FFT condition includes adherence only, consistent with the typical FFT supervision protocol. For the Enhanced FFT condition, feedback also includes information on youth treatment progress and process This study will address the changes in therapist behavior and youth/family outcomes that may result from providing two different types of therapist feedback in community mental health agencies. The proposed project also includes a low-cost quasi-experimental design comparing implementation of CFIT in this study with a current NIMH study where CFIT is implemented in the absence of an EBT. PUBLIC HEALTH RELEVANCE: Evidence-based treatments (EBTs) have not reached their potential to improve the outcomes for clients in community mental health treatment settings. There is a crisis in youth mental health services demanding innovative approaches for improving transportability, implementation, and outcomes of clinical treatments. The proposed study tests whether adding a measurement feedback system (MFS) that provides feedback on the therapeutic process and outcomes, to an existing EBT that only measures model adherence, improves therapist behavior and ultimately youth/family outcomes.

描述（由申请人提供）：最近循证治疗（EBT）的荟萃分析结果不佳，代表了青少年心理健康服务的危机。迫切需要创新方法来改善服务的可运输性、实施和结果。模型依从性（EBT 保真度）是改善社区环境结果的必要但不充分的机制。现实世界的心理健康治疗需要关注独特环境、治疗师和客户之间相互作用所固有的复杂性。因此，实施 EBT 的治疗师需要为临床决策提供更好的支持，这可能会导致 EBT 的调整以服务于定制治疗。测量反馈系统（MFS）提供持续的治疗进展和协助治疗师做出治疗决策所需的过程信息。作为 MFS 的一项优势，EBT 提供了一个重要框架，用于将系统数据集成到后勤、临床和监督操作中。 MFS 和 EBT 相结合的协同作用应可改善 EBT 的可转移性、MFS 的实施以及青年和家庭的成果。我们将整合现有的 EBT [和现有的 MFS。 EBT 是功能性家庭治疗 (FFT)，是一种在少年司法和心理健康系统中针对青少年的实证支持干预措施。 FFT Q 系统提供了有关治疗依从性和进展的特定模型数据，这是一种计算机化的特定模型质量改进系统。 MFS 是情境化反馈干预和培训 (CFIT)，每周完成对青少年、护理人员和治疗师实施的简短标准化措施后，提供有关治疗进展和过程的计算机化反馈。] 我们将确定这种创新组合是否具有预期的协同效应社区心理健康机构设有 4 个站点，在研究期间将有 102 名治疗师为 4000 多名青少年提供服务。目前的基金会拨款用于支持集成现有反馈系统的计算机化系统的开发和测试。这项工作将于 2010 年 1 月完成。治疗师将被随机分配到两组中的一组：(1) 基本 FFT（仅 FFT）或 (2) 增强 FFT（FFT + CFIT）。基本 FFT 条件的反馈仅包括遵守情况，与典型的 FFT 监控协议一致。对于增强型 FFT 情况，反馈还包括有关青少年治疗进展和过程的信息。这项研究将解决治疗师行为和青少年/家庭结果的变化，这些变化可能是由于在社区心理健康机构提供两种不同类型的治疗师反馈而导致的。拟议的项目还包括一个低成本的准实验设计，将本研究中 CFIT 的实施与当前 NIMH 研究（其中 CFIT 在没有 EBT 的情况下实施）进行比较。 公共卫生相关性：循证治疗 (EBT) 尚未发挥其改善社区心理健康治疗环境中客户治疗结果的潜力。青少年心理健康服务面临危机，需要创新方法来改善临床治疗的可转移性、实施和结果。拟议的研究测试是否在现有的仅测量模型依从性的 EBT 中添加一个提供治疗过程和结果反馈的测量反馈系统 (MFS)，改善治疗师的行为并最终改善青少年/家庭的结果。