Local Quality Assurance Tool for Family Therapy in Usual Care for Adolescent Substance Use

青少年药物使用日常护理家庭治疗的本地质量保证工具

• 批准号: 8818838
• 负责人: Aaron Hogue
• 金额: $ 43.69万
• 依托单位: PARTNERSHIP TO END ADDICTION
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-02-15 至 2019-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8818838
• 关键词: Accountability; Adherence; Adolescent; Adopted; Adoption; Archives; Area; Behavior; Behavior Therapy; Behavioral; Caring; Certification; Child Welfare; Childhood; Client; Clinical; Clinical Management; Code; Communities; Competence; Consensus; Continuity of Patient Care; Contracts; Data; Data Analyses; Databases; Development; Dimensions; Discrimination; Disease; Elements; Evaluation; Family; Family psychotherapy; Gold; Guidelines; Healthcare; High Prevalence; Intervention; Justice; Licensing; Manuals; Measures; Mental Health; Methods; Modeling; Monitor; Names; Outcome; Outcomes Research; Parents; Performance; Policies; Procedures; Process; Property; Provider; Quality Indicator; Research; Resources; Review Literature; Sampling; Services; Structure; Supervision; Symptoms; System; Techniques; Testing; Time; Training; Training Technics; Youth; addiction; adolescent substance use; alternative treatment; base; control trial; cost; evidence base; follow-up; innovation; medical specialties; meetings; probation; public health priorities; public health relevance; quality assurance; response; routine care; skills; success; theories; tool; treatment as usual; treatment planning

DESCRIPTION (provided by applicant): Ecological family therapy (EFT) has by far the largest base of empirical support for treating adolescent substance use (ASU). Manualized EFT models have proven consistently superior to every type of alternative treatment in controlled trials. Yet, EFT has not been widely adopted within ASU treatment systems nationwide. A primary barrier to adoption is the mismatch between the purveyor-driven methods used by manualized EFTs and the needs of the provider community. There are several EFT brands and each has a proprietary set of expensive and highly structured training, supervision, and fidelity control guidelines. These quality assurance (QA) procedures are too costly, inflexible, and externally controlled to meet all needs of a diverse workforce. This study will empirically distill the core techniques of manualized EFTs to produce a non-proprietary, freely available, psychometrically valid EFT QA toolkit (fidelity tool, training/implementation supports) that can be locally sustaine with intramural resources. This toolkit will promote high-fidelity delivery of EFT in routine care or ASU. The timing is perfect for developing this resource: The Affordable Care Act and related policy changes have ushered in unprecedented opportunities to increase adoption of evidence-based approaches in behavioral healthcare via training and certification requirements built into provider contracts. As a result, valid QA procedures and measures for behavioral treatments are in enormous demand. Unfortunately, existing QA procedures do not contain implementation fidelity guidelines: what specific interventions to deliver, and how to do them well. This is currently true for the ASU treatment system, which has promulgated "best practices" consisting of broad principles of client engagement and continuity-of-care rather than specific techniques. The proposed study will synthesize core techniques from three EFT models to construct a QA toolkit for supporting EFT fidelity in routine care. The study will conduct observational fidelity analyses on two pools of recorded sessions: (a) 300 gold-standard EFT sessions from controlled trials of Functional Family Therapy (FFT), Multidimensional Family Therapy (MDFT), and Brief Strategic Family Therapy (BSFT); and (b) 300 front-line EFT sessions from three implementation studies with ASU samples conducted in in routine settings. A new EFT QA measure will be derived from coding these two session pools using well-validated observational fidelity measures associated with FFT, MDFT, and BSFT respectively. As is true for the parent measures, the new QA tool will assess four fidelity dimensions: adherence to core EFT techniques, global EFT competence, therapist-family alliance, and ecological foci. Specific items for the EFT QA tool will be synthesized from gold- standard sessions (Aim 1), verified on front-line sessions (Aim 2), and validated on front-line fidelity ratings and client outcomes (Aim 3). We anticipate success in synthesizing core EFT techniques based on pilot data collected using the same samples, observational fidelity measures, and coding methods described in this proposal. Our pilot data reveal strong correlations among similar items representing four EFT treatment components projected to emerge during data analysis: family engagement, relational reframing, family restructuring, and family skill building. All study analyses and QA toolkit products (fideliy tool and coding manual, description of EFT techniques, training and implementation resources) will be vetted during a collaborative toolkit development process by an Expert Review Panel containing experts in EFT clinical theory and research, distillation of the core elements of manualized treatment models for various childhood disorders, and EFT fidelity-outcome research, along with front-line family therapists who treat ASU. Developing a psychometrically valid EFT QA toolkit from existing manualized resources would create a new QA resource that could be used to assess a wide spectrum of EFT implementation activities in behavioral care: evaluation of EFT training outcomes, data-based treatment planning for ASU and related disorders, administrative and regulatory review of treatment practices, and provider certification, to name a few. Most importantly, the new EFT QA toolkit could accelerate the adoption of EFT in routine care for ASU because providers will be inclined to select an approach that is both highly effective and meets regulatory demands for quality standards in a cost-efficient manner. The proposed toolkit will be available in two ways: (1) Cost-free to any licensed provider for incorporation into their existing intramural procedures for training and monitoring staff clinician; or (2) Packaged as one treatment module within a larger QA and clinical management system. The proposed study is innovative in several ways. It would develop the first QA tool capable of defining universal quality standards for EFT. Existing EFT tools define performance standards only for the given brand- name model and have limited value outside the purveyor's sphere of influence. The study will also produce a roadmap for developing empirical methods for distilling core QA tools based on validated fidelity measures; this innovation has broad applicability to other treatment approaches with multiple manualized versions (e.g., CBT for SUD) and will advance a vital new research area for behavioral healthcare. Finally, study methods will accelerate the pace of identifying quality indicators of EBPs for youth disorders. Current efforts rely on coordinated efforts from multiple research centers to identify quality metrics based on extended periods of literature review and consensus building. In contrast, this study will use empirical distillation methods and vet study data and products with a purposively convened expert panel.

描述（由申请人提供）：生态家庭治疗（EFT）迄今为止是治疗青少年药物使用（ASU）的最大经验支持基础。在对照试验中，手动的EFT模型已被证明始终优于每种类型的替代处理。然而， 在全国范围内的ASU治疗系统中，EFT尚未被广泛采用。采用的主要障碍是手动EFT使用的供应商驱动方法与提供商社区的需求之间的不匹配。有几个EFT品牌，每个品牌都有一套专有的昂贵且结构高度的培训，监督和忠实控制指南。这些质量保证（QA）程序过于昂贵，僵化和外部控制，无法满足各种劳动力的所有需求。这项研究将在经验上提炼手动EFT的核心技术，以生产非专有的，自由的，心理有效的EFT QA Toolkit（Fidelity Tool，培训/实施支持），可以在本地提供具有内部资源的本地可持续性。该工具包将在常规护理或ASU中促进EFT的高保真输送。时间安排非常适合开发此资源：《平价医疗法案》和相关政策变更迎来了前所未有的机会，可以通过培训和提供者合同中的培训和认证要求来增加对行为医疗保健行为医疗保健中基于证据的方法的采用。结果，有效的质量检查程序和行为治疗的措施是巨大的需求。不幸的是，现有的质量检查程序不包含实施忠实指南：提供哪些特定干预措施以及如何做得好。目前，ASU治疗系统是正确的，ASU治疗系统颁布了“最佳实践”，包括广泛的客户参与和保健连续性的原则，而不是特定的技术。拟议的研究将从三个EFT模型中综合核心技术，以构建一个质量保护工具包，以支持常规护理中的EFT保真度。该研究将对两个记录的会议池进行观察性保真度分析：（a）来自功能性家庭治疗对照试验（FFT），多维家庭疗法（MDFT）的300个金标准的EFT会议，以及简短的战略家庭治疗（BSFT）； （b）来自三项实施研究的300个前线EFT会议，并在常规环境中进行了ASU样本。通过分别使用与FFT，MDFT和BSFT相关的经过良好的观察性忠诚度度量来编码这两个会话池，将得出一个新的EFT QA度量。按照父母的措施，新的质量保证工具将评估四个保真度维度：遵守核心EFT技术，全球EFT能力，治疗师 - 家庭联盟和生态重点。 EFT QA工具的特定项目将从金标准会话（AIM 1）中合成，在前线会话（AIM 2）进行验证，并在前线保真度等级和客户结果（AIM 3）上进行验证。我们 预计基于使用相同样本，观察性保真度度量以及本提案中描述的编码方法收集的试验数据，预期成功的核心EFT技术。我们的飞行员数据显示，在数据分析期间预计将出现的四个EFT治疗组件之间的类似项目之间的相关性很强：家庭参与，关系重新定义，家庭重组和家庭技能建设。所有研究分析和QA工具包产品（Fideliy工具和编码手册，EFT技术的描述，培训和实施资源的描述）都将在协作工具包开发过程中审查，其中包含EFT临床理论和研究专家的专家评论小组，蒸馏各种儿童疾病的手动治疗模型以及EFT保真度结果研究的核心元素以及治疗ASU的一线家庭治疗师。从现有手动资源中开发具有心理有效的EFT QA工具包将创建一种新的质量质量资源，可用于评估行为护理中的EFT实施活动的广泛范围：评估EFT培训结果，基于数据的ASU和相关疾病的基于数据的治疗计划，治疗惯例的行政和监管审查以及提供者认证， 仅举几例。最重要的是，新的EFT QA工具包可以加速对ASU的日常护理中EFT的采用，因为提供者将倾向于选择一种非常有效的方法，并且以成本效益的方式满足了对质量标准的监管要求。拟议的工具包将以两种方式提供：（1）任何有执照的提供商将其纳入其现有的室内程序中的培训和监测员工临床医生的成本；或（2）在较大的质量检查和临床管理系统中包装为一个治疗模块。拟议的研究在几种方面具有创新性。它将开发第一个能够定义EFT通用质量标准的质量保证工具。现有的EFT工具仅针对给定的品牌模型定义性能标准，并且在供应商的影响范围之外的价值有限。该研究还将产生一个路线图，用于开发基于经过验证的保真度措施的经验方法来提炼核心质量检查工具；这项创新对具有多个手动版本的其他治疗方法（例如，SUD的CBT）具有广泛的适用性，并将推进至关重要的行为医疗研究领域。最后，研究方法将加快确定青年疾病EBP质量指标的速度。当前的努力依靠多个研究中心的协调努力来确定基于文献综述和共识建立的长时间的质量指标。相比之下，本研究将使用经验蒸馏方法以及兽医研究数据和产品，并有目的地召集的专家小组。