Optimization of Fidelity Procedures for Pivotal Response Training in Autism

自闭症关键反应训练保真度程序的优化

• 批准号: 8287835
• 负责人: Aubyn C. Stahmer
• 金额: $ 25.06万
• 依托单位: RADY CHILDREN'S HOSPITAL - SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-01 至 2013-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8287835
• 关键词: Address; Affect; Area; Autistic Disorder; Behavior; Behavior Therapy; Behavioral; Characteristics; Child; Child Behavior; Child Mental Health; Clinical; Code; Communities; Community Mental Health Services; Community Services; Data; Data Analyses; Development; Diagnosis; Discipline; Disease; Education; Effectiveness; Environment; Evaluation; Feedback; Funding; Goals; Health Personnel; Individual; Intervention; Investigation; Knowledge; Measures; Mental Health; Mental Health Services; Methods; Modeling; Modification; National Research Council; Outcome; Parents; Population; Procedures; Process; Prospective Studies; Provider; Research; Research Personnel; Sampling; Specific qualifier value; Supervision; Techniques; Testing; Time; Trainers Training; Training; Validation; community setting; implementation science; improved; instrument; prospective; response; skills; teacher; therapy development; tool; usability

DESCRIPTION (provided by applicant): To improve the overall quality and effectiveness of mental health intervention, it is essential to identify empirically supported behavioral treatments (ESBTs) and assure the accessibility and usability of these treatments for providers in community settings. Fidelity of implementation (FI), or the degree to which an intervention is implemented as was intended, provides necessary information for training and maintaining providers' effectiveness. However, the tools and procedures used to measure FI and provide feedback to providers must be effective and efficient. Through archival data analysis and prospective assessment of individual treatment components, we aim to develop and assess an FI instrument and assessment procedures for an ESBT for children with autism. Autism is a key area of concern in the field of child mental health; Pivotal Response Training (PRT) is a naturalistic ESBT for this population (Humphries, 2003; National Standards Project, 2009). PRT is routinely used in community settings with limited data regarding treatment integrity or effectiveness (Stahmer, Collings & Palinkas, 2005). PRT fidelity of implementation (FI) measures were developed for use in research settings and have received minimal validation and adaptation for use by community therapists. The specific components of PRT have not been independently evaluated to determine how FI relates to child outcome, and the effect of ancillary factors such as therapist discipline, setting, education, affect, and the treatment environment on treatment integrity and child outcome have not been examined. The overall goal of this project is to inform strategies for enhancing fidelity of PRT in community service settings Toward this goal, there will be six specific aims: 1) Evaluate relationships between FI of PRT and within-session child skills and behavior via archival data analysis. 2) Evaluate relationships between provider characteristics and FI of PRT components via archival data analysis. 3) Individually test possible modifications to components of PRT using deconstructive evaluation. 4) Develop and evaluate a PRT FI instrument and assessment procedures in partnership with community providers. 5) Evaluate effectiveness of a PRT FI instrument and assessment procedures including (a) examining improvements to training and supervision methods using the instrument and (b) analyzing possible moderating variables affecting FI of PRT and child outcome in a prospective study. 6) Prospectively assess the relationship between provider implementation of PRT and child skills and behavior. The proposed scientific model will generate data and important products supporting ESBT use in the autism services community. This research will also serve as a general model for evaluation and improvement of FI knowledge and practice for the mental health services community and implementation science. PUBLIC HEALTH RELEVANCE: To improve the quality of mental health services in community settings, it is important to assess providers' implementation of empirically supported behavioral treatments (ESBTs). Pivotal Response Training (PRT), an ESBT for autism, is regularly used in community settings, but adequate tools for assessing providers' implementation of PRT have not been developed. This project will identify critical components of PRT, develop of a comprehensive tool for assessing implementation of these components, and evaluate the effectiveness of the tool for training and maintaining provider implementation of PRT in community settings.

描述（由申请人提供）：为了提高心理健康干预的整体质量和有效性，必须确定经验支持的行为治疗方法 (ESBT) 并确保社区环境中的提供者能够获得这些治疗方法和可用性。实施的保真度 (FI) 或干预措施按照预期实施的程度，为培训和维持提供者的有效性提供了必要的信息。然而，用于衡量 FI 并向提供商提供反馈的工具和程序必须有效且高效。通过档案数据分析和对个体治疗成分的前瞻性评估，我们的目标是开发和评估自闭症儿童 ESBT 的 FI 工具和评估程序。自闭症是儿童心理健康领域关注的一个重点领域；关键反应训练 (PRT) 是针对该人群的自然 ESBT（Humphries，2003 年；国家标准项目，2009 年）。 PRT 通常用于社区环境，但有关治疗完整性或有效性的数据有限（Stahmer、Collings & Palinkas，2005）。 PRT 实施保真度 (FI) 措施是为研究环境中使用而开发的，并已接受了最低程度的验证和调整，供社区治疗师使用。 PRT 的具体组成部分尚未经过独立评估，以确定 FI 与儿童结局的关系，并且尚未检查治疗师纪律、环境、教育、情感和治疗环境等辅助因素对治疗完整性和儿童结局的影响。该项目的总体目标是为提高社区服务环境中 PRT 的保真度提供策略依据。 为了实现这一目标，将有六个具体目标： 1) 通过档案数据分析评估 PRT 的 FI 与会话中儿童技能和行为之间的关系。 2) 通过档案数据分析评估 PRT 组件的提供商特征和 FI 之间的关系。 3) 使用解构评估单独测试对 PRT 组件的可能修改。 4) 与社区提供者合作开发和评估 PRT FI 工具和评估程序。 5) 评估 PRT FI 工具和评估程序的有效性，包括 (a) 检查使用该工具对培训和监督方法的改进，以及 (b) 在前瞻性研究中分析影响 PRT FI 和儿童结局的可能调节变量。 6) 前瞻性评估提供者实施 PRT 与儿童技能和行为之间的关系。拟议的科学模型将生成支持 ESBT 在自闭症服务社区中使用的数据和重要产品。这项研究还将作为评估和改进精神卫生服务社区和实施科学的 FI 知识和实践的通用模型。 公共卫生相关性：为了提高社区环境中心理健康服务的质量，评估提供者实施经验支持的行为治疗 (ESBT) 的情况非常重要。关键反应训练 (PRT) 是一种针对自闭症的 ESBT，经常在社区环境中使用，但尚未开发出足够的工具来评估提供者实施 PRT 的情况。该项目将确定 PRT 的关键组成部分，开发用于评估这些组成部分实施情况的综合工具，并评估该工具在社区环境中培训和维护提供者实施 PRT 的有效性。