Testing a System-level Implementation Intervention to Improve the Quality of Family-Based Services for Adolescent Substance Use

测试系统级实施干预措施，以提高针对青少年药物使用的家庭服务质量

• 批准号: 9402180
• 负责人: Aaron Hogue
• 金额: $ 25.73万
• 依托单位: PARTNERSHIP TO END ADDICTION
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-15 至 2020-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9402180
• 关键词: Achievement; Adolescent; Adopted; Adoption; Alcohol or Other Drugs use; Behavioral; Characteristics; Client; Clinic; Cluster randomized trial; Complement; Data; Data Quality; Data Reporting; Development; Diffusion of Innovation; Educational Curriculum; Effectiveness; Elements; Ensure; Family; Family Process; Family member; Family psychotherapy; Feedback; Focus Groups; Fostering; Goals; Government; Guidelines; Hour; Intervention; Lead; Maps; Measurement; Measures; Methods; National Institute of Drug Abuse; New York; Outcome; Outpatients; Participant; Patient Self-Report; Phase; Policies; Positioning Attribute; Procedures; Randomized; Reporting; Research; Research Personnel; Resources; Services; Site; Strategic Planning; Supervision; System; Techniques; Testing; Therapeutic; TimeLine; Training; Training Activity; adolescent substance use; base; care systems; design; evidence base; family support; follow-up; implementation science; improved; innovation; meetings; public health priorities; public health relevance; quality assurance; reduced substance use; routine care; theories; treatment as usual; treatment site; uptake; virtual

Abstract This R34 study will first develop treatment quality assurance procedures designed to increase the adoption and quality of empirically supported family-based services (FBS) for adolescent substance use (ASU) in usual care, and then test two system-level implementation strategies for installing the new quality procedures in ASU treatment sites. FBS have achieved the strongest evidence base for treating ASU and are a prime candidate for upgrading the quality of ASU services in various systems of care. FBS comprise both family participation in services, the systemic parameters wherein family members are included in assessment and treatment activities; and family therapy techniques, the specific interventions that clinicians use to directly target family members and family functioning for change. For FBS to fulfill their potential to enhance ASU treatment systems, FBS implementation must be supported by effective quality assurance (QA) procedures designed to ensure that FBS are delivered with fidelity. To advance this effort, the proposed study will leverage a strong research-government partnership between the applicant organization and the New York single-state agency for SU services. The study will first develop innovative QA procedures (Aim 1) that use existing FBS quality metrics to promote high-fidelity FBS: Measurement Feedback System for Implementation (MFS-I), a pragmatic evidence-based method for increasing FBS quality by providing monthly feedback on therapist-reported FBS delivery along with brief online FBS training modules. The study will then experimentally compare two system- level implementation strategies designed to foster MFS-I utilization in usual care for ASU. Core Training Only will contain two 3-hour training sessions: Mapping existing FBS and identifying site goals for FBS improvement; and Installing and sustaining the MFS-I. Core + Facilitation is an additive strategy that will begin with the Core Training sessions and then continue with monthly facilitation meetings for one year to promote MFS-I use and progress toward FBS improvement. The study will feature a three-group cluster randomized trial testing Core Training Only versus Core + Facilitation versus no-intervention Control in 15 representative ASU clinics across New York State. MFS-I utilization data will be collected from Core Training and Core + Facilitation sites for one-year follow-up (after initial Core Training); FBS quality data on family participation and family therapy technique use will be collected from all sites over one-year follow-up; and client outcome data for all sites will be retrieved from administrative data warehouses over one-year baseline and one-year follow-up. These data will enable between-condition comparisons of FBS delivery (Aim 2: MFS-I utilization, family participation, family therapy technique use) and client outcomes (Aim 3: therapeutic goal achievement, substance use change). If study aims are achieved, investigators would be positioned to mount a fully powered RCT to test the effectiveness of these FBS quality improvement procedures at scale.

抽象的 这项R34研究将首先制定旨在增加采用的治疗质量保证程序 和凭经验支持的家庭服务（FBS）的质量以及通常的青少年药物使用（ASU） 护理，然后测试两个系统级实施策略，用于在ASU中安装新的质量程序 治疗部位。 FBS已经获得了治疗ASU的最有力的证据基础，并且是主要候选人 用于升级各种护理系统中的ASU服务质量。 FBS包括两个家庭参与 在服务中，将家庭成员包括在评估和治疗中的系统参数 活动;和家庭疗法技术，这是临床医生直接针对家庭的特定干预措施 成员和家庭工作以进行变革。 FB满足其增强ASU治疗的潜力 系统，FBS实施必须由有效的质量保证（QA）程序支持 确保FBS以保真度传递。为了促进这项努力，拟议的研究将利用强大的 申请组织与纽约单州机构之间的研究政府合作伙伴关系 SU服务。该研究将首先开发创新的质量检查程序（AIM 1），以使用现有的FBS质量 促进高保真FBS的指标：实施的测量反馈系统（MFS-I），务实 通过提供治疗师报告的FBS的每月反馈来提高FBS质量的循证方法 交付以及简短的在线FBS培训模块。然后，该研究将通过实验比较两个系统 旨在促进MFS-I在ASU通常护理中利用MFS-I的水平实施策略。仅核心培训 将包含两个3小时的培训课程：映射现有的FBS并确定FBS的现场目标 改进;并安装和维持MFS-I。核心 +促进是一种添加策略，将 从核心培训课程开始，然后继续每月举行一次便利会议，为期一年 促进MFS-I使用并进步FBS改进。该研究将以三组集群为特征 在15 纽约州的代表ASU诊所。 MFS-I使用数据将从核心培训中收集 和Core +促进站点为期一年的随访（在初步核心培训之后）； FBS家庭质量数据 在一年的随访中，将收集参与和家庭疗法技术的使用；和客户 所有站点的结果数据将从一年基准的行政数据仓库中检索到 一年的随访。这些数据将实现FBS传递的条件比较（AI​​M 2：MFS-I 利用，家庭参与，家庭治疗技术的使用）和客户结果（AIM 3：治疗目标 成就，药物使用变化）。如果实现了学习目标，则将调查人员放置 完全动力的RCT可以大规模测试这些FBS质量改进程序的有效性。