Improving Quality of Care in Child Mental Health Service Settings

提高儿童心理健康服务机构的护理质量

• 批准号: 9980712
• 负责人: Kenneth J Ruggiero
• 金额: $ 74.78万
• 依托单位: MEDICAL UNIVERSITY OF SOUTH CAROLINA
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-01 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9980712
• 关键词: Address; Adherence; Behavior Disorders; Behavioral; Benchmarking; Caregivers; Child; Child Mental Health; Clinic; Clinical; Code; Cognitive Therapy; Community Practice; Complement; Cost Savings; Data; Development; Disease; Education; Effectiveness; Emotional disorder; Family; Feedback; Florida; Focus Groups; Future; Health Personnel; Healthcare; Intervention; Interview; Investments; Knowledge; Learning; Libraries; Maintenance; Mediating; Mediation; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Modeling; Motivation; National Institute of Mental Health; Online Systems; Outcome; Parents; Patients; Phase; Pilot Projects; Post-Traumatic Stress Disorders; Process; Protocols documentation; Provider; Psychiatric Hospitals; Quality of Care; Randomized; Randomized Controlled Trials; Reaction; Recommendation; Resources; Rest; Rural; Sampling; Series; Service setting; Structure; Symptoms; Tablets; Techniques; Technology; Testing; Therapeutic; Time; Training; Trauma; Treatment Protocols; United States National Institutes of Health; Video Recording; Work; Youth; aged; base; blind; child mental health service; community based service; cost; cost effectiveness; cost estimate; design; effectiveness implementation study; effectiveness implementation trial; experience; externalizing behavior; feasibility trial; health care delivery; improved; informant; innovation; novel; practice setting; programs; recruit; touchscreen; urban setting; usability; Address; Adherence; Behavior Disorders; Behavioral; Benchmarking; Caregivers; Child; Child Mental Health; Clinic; Clinical; Code; Cognitive Therapy; Community Practice; Complement; Cost Savings; Data; Development; Disease; Education; Effectiveness; Emotional disorder; Family; Feedback; Florida; Focus Groups; Future; Health Personnel; Healthcare; Intervention; Interview; Investments; Knowledge; Learning; Libraries; Maintenance; Mediating; Mediation; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Modeling; Motivation; National Institute of Mental Health; Online Systems; Outcome; Parents; Patients; Phase; Pilot Projects; Post-Traumatic Stress Disorders; Process; Protocols documentation; Provider; Psychiatric Hospitals; Quality of Care; Randomized; Randomized Controlled Trials; Reaction; Recommendation; Resources; Rest; Rural; Sampling; Series; Service setting; Structure; Symptoms; Tablets; Techniques; Technology; Testing; Therapeutic; Time; Training; Trauma; Treatment Protocols; United States National Institutes of Health; Video Recording; Work; Youth; aged; base; blind; child mental health service; community based service; cost; cost effectiveness; cost estimate; design; effectiveness implementation study; effectiveness implementation trial; experience; externalizing behavior; feasibility trial; health care delivery; improved; informant; innovation; novel; practice setting; programs; recruit; touchscreen; urban setting; usability

PROJECT SUMMARY/ABSTRACT Assuring children access to the highest quality mental health care is a top national priority. Yet, quality of care continues to be highly variable in traditional service settings. Novel, scalable solutions are needed to address modifiable quality-of-care indicators in sustainable ways. To this end, provider fidelity and children's engagement are key correlates of clinical outcome and practical targets for intervention. There is tremendous opportunity to address both through technology. Studies in child education show that interactive games, touch- screen learning, and demonstration videos enhance engagement, knowledge, motivation, and learning. These benefits also may extend to the therapeutic context, where strategic integration of technology-based activities may enhance children's learning, strengthen the therapeutic alliance, and keep providers on protocol. We are in the final stages of an NIMH R34 in which we piloted a patient- and provider-informed tablet-based toolkit designed to facilitate delivery of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) – a treatment that was selected because it addresses a wide range of symptoms using techniques shared by other treatments for emotional and behavioral disorders. The tablet-based toolkit consists of numerous components (e.g., videos, interactive games, drawing applications) that are designed to facilitate provider-patient interactions in a way that enhances children's engagement and supports adherence to the treatment model. The tablet-based toolkit was very well received by children, caregivers, and providers in our pilot work. Moreover, all benchmarks for feasibility outlined in our NIMH R34 application were met or exceeded. We now propose to conduct a hybrid effectiveness-implementation trial to examine the extent to which the tablet intervention may improve fidelity, engagement, and children's mental health outcomes. We will conduct a randomized controlled trial with 120 mental health providers and 360 families in partnership with dozens of clinics in the Carolinas and Florida. Providers will be assigned randomly to tablet-facilitated vs. standard TF-CBT. Youth aged 8-16 years with clinically elevated symptoms of PTSD will be recruited. Baseline and 3-, 6-, 9-, and 12-month post-baseline assessments will be conducted by independent, blind evaluators. Sessions will be videorecorded for observational coding of engagement and fidelity by independent raters blind to study hypotheses. We will also examine costs and conduct semi-structured interviews with families, providers, supervisors, and agency leaders to inform future dissemination and implementation initiatives. Technology-based resources that are scalable, easy to use, and designed for efficient integration into everyday practice may have sustained national impact. The return on investment of these initiatives will ultimately rest on their potential to improve the spread of best-practice treatments and the quality with which they are delivered to the children who need them.

项目摘要/摘要 确保儿童获得最高质量的精神卫生保健是全国重中之重。但是，护理质量 在传统的服务环境中，仍然是高度可变的。需要新颖的可扩展解决方案来解决 可持续方式修改的护理质量指标。为此，提供者保真度和儿童 参与是临床结果和干预实践目标的关键相关性。有很多 通过技术解决这两者的机会。儿童教育研究表明，互动游戏，触摸 - 筛选学习和演示视频可以增强参与，知识，动机和学习。这些 收益也可能扩展到治疗环境，在此基于技术活动的战略整合 可能会增强儿童的学习，增强治疗联盟，并使提供者遵守协议。我们是 在NIMH R34的最后阶段，我们试行了一个基于病人和提供商的平板电脑工具包 旨在促进以创伤为重点的认知行为疗法（TF-CBT）的送达 - 一种治疗方法 之所以选择，是因为它使用其他治疗方法共享的技术解决了广泛的症状 情绪和行为障碍。基于平板电脑的工具包由许多组件组成（例如，视频， 互动游戏，绘制应用程序），旨在以某种方式促进提供者的互动 这可以增强儿童的参与度并支持遵守治疗模型。基于平板电脑的工具包 在我们的飞行员工作中，儿童，看护人和提供者受到了很好的欢迎。而且，所有基准 在我们的NIMH R34申请中概述的可行性被满足或超过。我们现在建议进行 混合有效性实施试验，以检查片剂干预的程度 忠诚，敬业度和儿童心理健康成果。我们将与 120个心理健康提供者和360个家庭与卡罗来纳州和佛罗里达州的数十个诊所合作。 提供商将被随机分配给平板电脑易和标准TF-CBT。年龄8-16岁的青年 将招募PTSD的临床症状升高。基线和3-，6-，9-和12个月的基线 评估将由独立的盲目评估者进行。会议将进行视频记录 独立评估者对研究假设视而不见的参与和忠诚的观察编码。我们也会 检查成本并与家庭，提供者，主管和代理商进行半结构化访谈 领导者为未来的传播和实施计划提供信息。基于技术的资源 可扩展，易于使用并设计用于有效整合到每天的练习中可能会持续国家 影响。这些举措的投资回报最终将取决于他们改善利差的潜力 最佳练习治疗及其质量交付给需要他们的孩子。