Finalizing and Testing an Online Therapist Training and Assistance Program to Facilitate Implementation of Comprehensive Behavioral Intervention for Tic Disorders (CBIT-Trainer)

最终确定并测试在线治疗师培训和援助计划，以促进抽动障碍综合行为干预的实施（CBIT-Trainer）

• 批准号: 10679070
• 负责人: Michael B Himle
• 金额: $ 88.34万
• 依托单位: PSYC TECH, LTD
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-16 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10679070
• 关键词: Address; Adopted; Adoption; Affect; Aftercare; Attitude; Behavior Disorders; Behavior Therapy; Behavioral tic; Benchmarking; Childhood; Clinical; Collection; Computers; Consultations; Continuing Education; Data; Development; Distress; Effectiveness; Enrollment; Evaluation; Evidence based intervention; Evidence based practice; Evidence based treatment; Feedback; Gilles de la Tourette syndrome; Happiness; Impairment; Individual; International; Intervention; Letters; Measures; Modality; Motor; Neurodevelopmental Disorder; Outcome; Patient-Focused Outcomes; Patients; Persons; Pharmacotherapy; Phase; Population; Process; Protocols documentation; Provider; Qualitative Methods; Quality of life; Randomized, Controlled Trials; Recommendation; Reporting; Research; Research Methodology; Risk; Self Administration; Self Efficacy; Severities; Small Business Innovation Research Grant; Speed; Techniques; Technology; Testing; Tic disorder; Training; Training Programs; Treatment outcome; Vocal Tic Disorders; blind; disability; effectiveness/implementation design; effectiveness/implementation hybrid; follow-up; health care model; human capital; implementation facilitation; implementation framework; implementation process; impression; improved; innovation; neuropsychiatric disorder; nondrug therapy; optimism; patient response; peer support; phase 1 study; phase 1 testing; pilot test; preference; prevent; primary outcome; programs; psychoeducation; psychoeducational; repetitive behavior; satisfaction; side effect; skills; social; technology development; treatment response; trial comparing

Project Summary/Abstract Tic disorders (TD) are a class of childhood-onset neuropsychiatric disorders that occur in 1-3% of the population and often cause significant impairment in physical, social, academic, and interpersonal functioning and reduce quality of life. There is currently no cure for TD, however large-scale randomized controlled trials have shown that a non-drug treatment known as Comprehensive Behavioral Intervention for Tics (CBIT) can reduce tics without the adverse side effects associated with pharmacotherapy. Although CBIT is now recommended as a first-line intervention for TD, most patients cannot get CBIT due to a lack of trained therapists. Given the need and desire for CBIT among individuals with TD, high demand for therapist trainings, and the lack of therapists adequately trained in CBIT, there is a clear need for innovative ways to train more providers in this evidence-based treatment. The current proposal partners two of the primary developers of CBIT with PsycTech, a company that specializes in developing effective computer-based products for repetitive behavior disorders. In the proposed project, we will first finalize development of an innovative online program for training therapists to deliver CBIT (called CBIT-Trainer). Throughout the development process, we will engage multiple stakeholders in order to identify provider- and organizational-level factors shown to influence adoption and implementation of adapted interventions in other health-care models and settings. Upon completion, CBIT-Trainer will be tested against an intensive in-person therapist training program in a randomized controlled trial. This Phase II project will accomplish five aims: (1) to use a stakeholder-informed feedback process to complete the development of CBIT-Trainer, (2) to compare CBIT-Trainer to traditional in- person training on therapists’ ability to administer CBIT, (3) to compare CBIT-Trainer to in-person training on patient outcomes when they are treated by a CBIT-trained therapist, (4) to identify and address therapist factors that will improve (or limit) adoption and use of CBIT-Trainer, and (5) to identify therapist factors likely to influence therapists’ continued use of CBIT in their practice after training. To test these aims, we utilize an effectiveness-implementation hybrid design to conduct a randomized controlled trial comparing CBIT-Trainer to the Tourette Association of America’s Behavior Therapy Training Institute (BTI), which is the current gold- standard for training CBIT therapists. We plan to enroll 234 CBIT-naïve therapist-patient dyads to participate in the study. Our primary therapist outcomes will be therapist skill in delivering CBIT, which will be assessed at post-training (Week 0), after administering CBIT with a patient (Week 10), and at 6-month follow-up (Week 34). Our primary patient outcomes will be overall clinical improvement assessed at pre-treatment (Week 0), post- treatment (Week 10), and 6-month follow up (Week 34). As a secondary aim, we will also assess therapist- level facilitators and barriers to adopting CBIT-Trainer, as well as implementing and sustaining CBIT in their practice, after training. If CBIT-Trainer is effective for training therapists to deliver CBIT with fidelity, it has the potential to increase the number of therapists available to treat TD. In addition, the technology itself could be leveraged easily to advance the technological development and testing of similar training programs for other evidence-based interventions (EBIs), thereby speeding dissemination and availability of EBIs for other clinical problems. Moreover, CBIT-Trainer is proposing a unique research methodology that could be readily applied to similar projects seeking to expand the evaluation of training and treatment outcomes for EBIs that have historically relied too heavily on a human-capital intensive training approach.

项目摘要/摘要 TIC疾病（TD）是一类儿童期神经精神疾病，发生在1-3％ 人口，经常在身体，社会，学术和人际功能中造成重大损害 并降低生活质量。目前尚无TD治疗，但是大规模随机对照试验 已经表明，一种被称为TICS（CBIT）综合行为干预的非药物治疗可以 减少没有与药物治疗相关的不良副作用的抽动。虽然CBIT现在是 推荐作为TD的一线干预，大多数患者由于缺乏训练而无法获得CBIT 治疗师。鉴于有TD的人对CBIT的需求和渴望，对治疗师培训的需求很高， 而且缺乏接受CBIT培训的治疗师，显然需要创新的方法来培训更多 提供者在这种基于证据的治疗中。当前的提案合作伙伴的两个主要开发商 CBIT与Psyctech，一家专门开发有效的基于计算机产品的公司 重复行为障碍。在拟议的项目中，我们将首先最终确定创新的在线开发 培训治疗师提供CBIT的计划（称为CBIT培训者）。通过开发过程，我们 将吸引多个利益相关者，以确定提供者和组织级别的因素 影响采用和实施其他医疗保健模型和环境中改编的干预措施。之上 完成，CBIT培训者将针对一个密集的面对面治疗师培训计划进行测试 随机对照试验。该第二阶段项目将实现五个目标：（1）使用利益相关者的信息 完成CBIT培训的反馈过程，（2）将CBIT培训剂与传统的内部培训进行比较 治疗师管理CBIT能力的人培训，（3）将CBIT培训者与面对面培训进行比较 患者的结果是由CBIT训练的治疗师治疗的（4）以识别和解决治疗师 可以改善（或限制）采用和使用CBIT培训的因素，以及（5）确定可能的治疗师因素 影响治疗师在培训后继续使用CBIT的实践。为了测试这些目标，我们利用 有效性实施混合设计，以进行随机对照试验，将CBIT训练器与 美国电视协会的行为疗法培训研究所（BTI），这是当前的黄金 培训CBIT治疗师的标准。我们计划注册234个没有CBIT的治疗师患者二元组参加 研究。我们的主要治疗师成果将是提供CBIT的治疗师技能，将在 训练后（第0周），使用患者进行CBIT（第10周）和6个月的随访（第34周）。 我们的主要患者结局将是在治疗前（第0周），以后评估的总体临床改进。 治疗（第10周）和6个月的随访（第34周）。作为次要目标，我们还将评估治疗师 - 水平的促进者和采用CBIT培训者的障碍，以及在其中实施和维持CBIT 练习，训练后。如果CBIT培训者对培训治疗师以忠诚提供CBIT有效，则具有 增加可用于治疗TD的治疗师数量的潜力。此外，技术本身可能是 轻松利用以推进技术发展和测试其他类似培训计划 基于证据的干预措施（EBIS），从而加快了其他临床的EBIS的传播和可用性 问题。此外，CBIT培训者提出了一种独特的研究方法，可以很容易地应用 试图扩大对EBI的培训和治疗结果的类似项目 从历史上看，在人力资本密集型培训方法上过于重大救助。