Project 1

项目1

• 批准号: 10664995
• 负责人: BRYAN J. WEINER
• 金额: $ 18万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10664995
• 关键词: Address; Back; Caring; Chronic; Client; Clinic; Clinical; Collection; Communities; Community Mental Health Centers; Community Practice; Data; Deterioration; Development; Diagnostic; Disparity; Educational workshop; Effectiveness; Elements; Ensure; Ethnography; Evaluation; Evidence based practice; Feedback; Foundations; Goals; Group Processes; Hour; Intervention; Journals; Knowledge; Latinx population; Maps; Measurement; Measures; Mental Health; Mental Health Services; Methods; Modeling; Monitor; Outcome; Participant; Pathway interactions; Process; Provider; Recommendation; Reporting; Research Personnel; Site Visit; Structure; Symptoms; System; Testing; Therapeutic; Washington; Work; Youth; clinical implementation; community setting; comorbidity; dashboard; design; experience; implementation/effectiveness; improved; post implementation; preference; social; symptomatic improvement; treatment planning; treatment response; user centered design

PROJECT 1 SUMMARY For youth receiving care in community mental health centers (CMHCs), comorbidities are the rule rather than the exception.1,2 Using measurement-based care (MBC) as the foundation of treatment for youth with comorbid problems significantly improves the therapeutic impact as it can help define the treatment focus. MBC is the systematic, routine evaluation of symptoms to inform care decisions. Especially in youth, MBC increases the rate of symptom improvement,3 detects clients who would otherwise deteriorate,4 and alerts clinicians to non- responders.4,5 Implementing MBC with fidelity requires 3 elements: (a) routine administration of measures for symptoms, outcomes, and processes before therapy sessions, (b) therapist and client score review, and (c) collaborative reevaluation of the treatment plan. But MBC is rarely implemented with fidelity; less than 15% of providers report using MBC per recommendations.6 Previous efforts to support MBC implementation have yielded suboptimal outcomes because CMHC leaders are challenged to identify and prioritize barriers and select strategies to overcome them. New methods are needed for identifying and prioritizing determinants, and matching strategies to determinants, to optimize MBC implementation and treatment quality to improve youth mental health outcomes in community settings. Project 1's optimization goals are to increase impact of MBC and align methods with preferences of practice partners. IMPACT Center methods will be piloted in six diverse CMHC clinics (three of six serve primarily Latinx populations). IMPACT methods we focus on include (a) rapid evidence reviews to uncover empirical data regarding MBC determinants; (b) rapid ethnography to identify and describe local determinants and situate them in specific organizational, social, and task contexts; and (c) design probes (e.g., kits with disposable camera, journals, maps) to allow practice partners and youth to capture and reflect on aspects of their context that are salient for MBC. These activities will result in a list of determinants that will be rated by partners from each clinic for criticality, chronicity, and ubiquity to generate priority scores. Subsequently, we will use facilitated group processes to develop causal pathway diagrams to match strategies to the top three determinants and clarify their preconditions, moderators, mechanisms, and proximal and outcomes (definitions in Methods Core) at each of the six clinics to yield a plan to optimize MBC implementation (Aim 1). We will check back with clinic-specific implementation teams to track strategy deployment for six months. We will then compare MBC treatment quality for another six months post implementation with data from two years of historical controls (Aim 2). Finally, we will co-design toolkits for each of the five IMPACT Methods for the practice and scientific communities (Aim 3). Results from Aims 1 & 2 will support an R01 testing practice partner-led efforts, using the IMPACT toolkits (developed in Aim 3), to optimize MBC fidelity in CMHCs. Optimizing MBC implementation in CMHCs could transform youth mental health care by ensuring the most pressing symptoms are targeted early in treatment.

项目1摘要 对于在社区心理健康中心（CMHC）接受护理的青年，合并症是规则而不是 例外。1,2使用基于测量的护理（MBC）作为合并症青年的治疗的基础 问题可显着改善治疗影响，因为它可以帮助定义治疗重点。 MBC是 系统的常规评估症状，以告知护理决定。特别是在青年中，MBC增加了 症状改善率，有3个发现否则会恶化的客户，其中4名向临床医生提醒非 - 响应者。4,5用忠诚实施MBC需要3个要素：（a）常规管理措施 治疗前的症状，结果和过程，（b）治疗师和客户得分审查，以及（c） 治疗计划的协作重新评估。但是MBC很少以忠诚而实施。少于15％ 提供者报告使用MBC根据建议。6以前支持MBC实施的努力 产生次优的结果，因为CMHC领导人面临挑战以识别和优先级障碍并选择 克服它们的策略。需要新的方法来识别和优先考虑决定因素，并且 匹配决定因素的策略，优化MBC实施和治疗质量以提高青年 社区环境中的心理健康成果。项目1的优化目标是增加MBC和 将方法与实践伙伴的偏好相结合。影响中心方法将在六种不同的CMHC中进行试验 诊所（六个主要是拉丁人种群中的三个）。我们关注的影响方法包括（a）快速证据 审查以发现有关MBC决定因素的经验数据； （b）识别和描述的快速民族志 本地决定因素并将其置于特定的组织，社会和任务环境中； （c）设计探针 （例如，带有一次性相机，期刊，地图的套件），允许实践伙伴和青年捕捉和反思 其上下文的各个方面是MBC的重要性。这些活动将导致决定因素的清单 由每个诊所的合作伙伴对关键，慢性和普遍存在以产生优先级分数的评分。随后， 我们将使用促进的小组流程来开发因果途径图，以将策略与前三名相匹配 决定因素并阐明其先决条件，主持人，机制以及近端和结果（定义 方法核心）在六个诊所中的每个诊所中的每一个，以制定优化MBC实施的计划（AIM 1）。我们将检查 返回特定于诊所的实施团队，以跟踪六个月的战略部署。然后我们将比较 实施后六个月的MBC治疗质量以及两年历史控制的数据 （目标2）。最后，我们将针对该实践和科学的五种影响方法共同设计工具包 社区（目标3）。 AIMS 1和2的结果将支持R01测试实践合作伙伴主导的努力，并使用 影响工具包（在AIM 3中开发），以优化CMHC中的MBC保真度。优化MBC实施 CMHC可以通过确保最紧迫的症状成为针对性的最初针对的青年心理卫生保健 治疗。