Strengthening Quality in School Mental Health

加强学校心理健康质量

• 批准号: 8277377
• 负责人: MARK D WEIST
• 金额: $ 49.02万
• 依托单位: UNIVERSITY OF SOUTH CAROLINA AT COLUMBIA
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-08-25 至 2013-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8277377
• 关键词: Address; Adherence; Agreement; Applications Grants; Attention; Attenuated; Attitude; BLase; Behavior; Behavioral; Caregivers; Characteristics; Collection; Consultations; County; Data; Data Collection; Delaware; Demographic Factors; Development; Dimensions; Discipline; Disruptive Behavior Disorder; Distal; Dose; Educational process of instructing; Effectiveness; Emotional; Ensure; Environment; Evaluation; Evidence Based Medicine; Evidence based intervention; Evidence based practice; Evidence based treatment; Failure; Family; Feedback; Frequencies; Funding; Group Meetings; Health Services Research; Incentives; Individual; Intervention; Knowledge; Language; Lead; Learning; Literature; Maryland; Measures; Mediating; Mediation; Mental Health; Mental Health Services; Modeling; National Institute of Mental Health; Nature; Outcome; Parental Consent; Parenting behavior; Parents; Patients; Performance; Play; Positioning Attribute; Preparation; Preventive Intervention; Problem behavior; Procedures; Process; Psychiatry; Quality Indicator; Questionnaires; Randomized; Randomized Controlled Trials; Records; Relative (related person); Reporting; Research; Research Personnel; Role; Schools; Self Efficacy; Services; Site; South Carolina; Stress; Students; Supervision; Suspension substance; Suspensions; System; Techniques; Testing; Texas; Theoretical model; Time; Training; Universities; Work; Writing; Youth; absorption; base; design; empowerment; evidence base; experience; follow-up; implementation research; improved; interest; member; mental health center; organizational climate; programs; psychosocial; public health relevance; randomized trial; rehearsal; research to practice; skill acquisition; skills; skills training; theories; therapy design

DESCRIPTION (provided by applicant): This application seeks to extend findings from a previous randomized controlled trial, funded by NIMH (Enhancing Quality in Expanded School Mental Health; 1R01MH71015-01A1; 2003 -2007), which resulted in the development and refinement of a systematic and achievable strategy for promoting high quality, evidence- based services by clinicians working in school mental health (SMH) programs in Delaware, Maryland, and Texas. In the prior study, clinicians assigned to systematic Quality Assessment and Improvement (QAI) as compared to a condition focused on personal wellness were more likely to engage in evidence-based practices and to demonstrate quality indicators associated with best practice in SMH. However in this study, involving a formative evaluation, distal impacts on emotional/behavioral functioning by students being treated by clinicians were not shown. The failure to achieve student-level impacts was likely related to the formative evaluation, with study procedures enhanced but evolving from Year 1 to Year 2, and to the multi-site study, which contributed error variance. In addition, the prior study did not involve implementation support to assure that clinicians were applying learned skills in their schools. In this follow-up study, we proposed to evaluate an enhanced quality assessment and improvement (EQAI) intervention involving four components: 1) Implementation support (IS), involving on-site coaching including rehearsal, feedback, emotional support, and administrative support based on research and a theoretical model developed by the National Implementation Research Network (with leaders Dean Fixsen and Karen Blase helping to develop IS and on the study's Advisory Panel), 2) systematic QAI to ensure that clinicians are most effectively implementing learned skills in the environment of schools, 3) family engagement and empowerment (FEE) based on recent research through an NIMH Developing Center to study co-investigator, Kimberly Hoagwood and colleagues, and 4) evidence- based practice (EBP) focusing on disruptive behavioral problems through an expanded modular intervention, developed in consultation with study Advisory Panel member, Bruce Chorpita. The study will be implemented in the largest and most successful SMH program in South Carolina (SC), operating in Horry County, with 36-40 full-time clinicians randomly assigned to either EQAI or PW, with both conditions well-developed through the prior R01. The study will measure impacts on proximal outcomes of clinician demonstration of skills in EBP, quality of SMH services, and FEE, and measure distal impacts including student emotional/behavioral functioning, school behavior and performance, and parenting stress. Moderating and/or mediating influences such as clinician experience, attitudes toward evidence-based practice, working alliance with families, and clinician stress will also be explored. With expected positive findings, the study is positioned to have a transformative impact since SC is a leading state for SMH, with almost half of the schools including comprehensive services, and strong local/state support for the study and generalizing findings from it. PUBLIC HEALTH RELEVANCE: In a well established school mental health program operating in a South Carolina school district of 44 schools, will study the impact of an Enhanced Quality Assessment and Improvement (EQAI) intervention designed to improve the effectiveness of services. The EQAI intervention is based on theory and prior research and extends important research on implementing high quality mental health prevention and intervention in the real world setting of schools.

描述（由申请人提供）：本申请旨在扩展先前由 NIMH 资助的随机对照试验的结果（增强扩大学校心理健康的质量；1R01MH71015-01A1；2003 年 -2007 年），该试验导致了一项系统性且可实现的战略，旨在促进特拉华州学校心理健康 (SMH) 项目中的临床医生提供高质量、基于证据的服务，马里兰州和德克萨斯州。在之前的研究中，与专注于个人健康的情况相比，被分配进行系统质量评估和改进 (QAI) 的临床医生更有可能参与循证实践，并展示与 SMH 最佳实践相关的质量指标。然而，在这项涉及形成性评估的研究中，没有显示出接受临床医生治疗的学生对情绪/行为功能的远端影响。未能实现学生层面的影响可能与形成性评估有关，研究程序得到了加强，但从第一年到第二年不断演变，并且与多地点研究有关，这导致了误差方差。此外，之前的研究没有涉及实施支持以确保临床医生应用在学校学到的技能。在这项后续研究中，我们建议评估强化质量评估和改进（EQAI）干预，涉及四个组成部分：1）实施支持（IS），包括现场辅导，包括排练、反馈、情感支持和基于行政支持的国家实施研究网络开发的研究和理论模型（领导者 Dean Fixsen 和 Karen Blase 帮助开发 IS 以及该研究的顾问小组），2) 系统的 QAI，以确保临床医生在环境中最有效地实施学到的技能学校数量， 3) 家庭参与和赋权 (FEE) 基于 NIMH 开发中心联合研究员 Kimberly Hoagwood 及其同事的最新研究，以及 4) 循证实践 (EBP)，重点通过扩展的模块化干预来解决破坏性行为问题，与研究顾问小组成员 Bruce Chorpita 协商后制定。 该研究将在南卡罗来纳州 (SC) 最大、最成功的 SMH 项目中实施，该项目在霍里县运营，将 36-40 名全职临床医生随机分配到 EQAI 或 PW，这两种情况都通过先前的研究得到了充分发展。 R01。该研究将衡量临床医生在 EBP、SMH 服务质量和 FEE 方面的技能展示对近端结果的影响，并衡量远端影响，包括学生情绪/行为功能、学校行为和表现以及养育压力。还将探讨调节和/或调节影响，例如临床医生经验、对循证实践的态度、与家庭的工作联盟以及临床医生压力。凭借预期的积极结果，该研究有望产生变革性影响，因为南卡罗莱纳州是 SMH 的领先州，几乎一半的学校提供​​综合服务，并且地方/州对该研究和总结研究结果给予大力支持。 公共卫生相关性：在南卡罗来纳州 44 所学校组成的学区开展的一项完善的学校心理健康计划中，将研究旨在提高服务有效性的增强质量评估和改进 (EQAI) 干预措施的影响。 EQAI 干预以理论和先前研究为基础，并扩展了在学校现实环境中实施高质量心理健康预防和干预的重要研究。