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

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.

项目概要/摘要 确保儿童获得最高质量的精神卫生保健是国家的首要任务。然而，护理质量是首要任务。 传统的服务环境仍然存在很大的变化，需要新颖的、可扩展的解决方案来解决。 为此，以可持续的方式修改护理质量指标。 参与度是临床结果和干预的实际目标的关键相关性。 通过技术解决这两个问题的机会 儿童教育研究表明，互动游戏、触摸- 屏幕学习和演示视频可增强参与度、知识、动机和学习。 好处也可能延伸到治疗环境，其中基于技术的活动的战略整合 可以促进儿童的学习，加强治疗联盟，并让提供者遵守协议。 在 NIMH R34 的最后阶段，我们试行了基于患者和提供者知情的基于平板电脑的工具包 旨在促进以创伤为中心的认知行为疗法（TF-CBT）的实施——一种治疗方法 被选中是因为它使用其他治疗方法共享的技术来解决广泛的症状 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、绘图应用程序），旨在以某种方式促进提供者与患者的互动 提高儿童的参与度并支持对治疗模式的坚持 基于平板电脑的工具包。 在我们的试点工作中，所有基准均受到儿童、护理人员和服务提供者的好评。 我们的 NIMH R34 申请中概述的可行性已达到或超过，我们现在建议进行一次。 混合有效性实施试验，以检查片剂干预可以改善的程度 我们将进行一项随机对照试验。 120 名心理健康服务提供者和 360 个家庭与卡罗来纳州和佛罗里达州的数十家诊所合作。 提供者将被随机分配到平板电脑辅助的 8-16 岁青少年和标准 TF-CBT 组。 将招募基线和基线后 3、6、9 和 12 个月的 PTSD 临床症状。 评估将由独立的盲评估员进行，会议将被录像。 我们还将对研究假设视而不见的独立评估者对参与度和忠诚度进行观察编码。 检查成本并对家庭、提供者、主管和机构进行半结构化访谈 领导者为未来的传播和实施举措提供信息。 可扩展、易于使用且专为有效融入日常实践而设计，可能会在全国范围内持续发展 这些举措的投资回报最终将取决于其改善传播的潜力。 最佳实践治疗以及向有需要的儿童提供治疗的质量。

项目成果

A Comparison of the Readiness of Youth Service Agencies to Implement a Technology-Based Toolkit to Support Treatment Delivery.

青年服务机构实施基于技术的工具包以支持治疗提供的准备情况比较。

• DOI: 10.1007/s10597-023-01099-w
• 发表时间: 2023
• 期刊: Community mental health journal
• 影响因子: 2.7
• 作者: Shanholtz,CarolineE;Ridings,LeighE;Espeleta,HannahC;Anton,MargaretT;Hanson,RochelleF;Saunders,Benjamin;Ruggiero,Kenneth;Davidson,Tatiana
• 通讯作者: Davidson,Tatiana

Leveraging Technology to Address the Quality Chasm in Children's Evidence-Based Psychotherapy.

利用技术解决儿童循证心理治疗中的质量鸿沟。

• DOI: 10.1176/appi.ps.201600548
• 发表时间: 2017
• 期刊: Psychiatric services (Washington, D.C.)
• 作者: Ruggiero,KennethJ;Saunders,BenjaminE;Davidson,TatianaM;LewskyCook,Danna;Hanson,Rochelle
• 通讯作者: Hanson,Rochelle