Implementation of evidence-based treatments for on-campus eating disorders

对校园饮食失调实施循证治疗

• 批准号: 8217893
• 负责人: WILLIAM Stewart AGRAS
• 金额: $ 77.17万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-04-05 至 2017-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8217893
• 关键词: Adoption; Adult; Affect; Anorexia Nervosa; Binge Eating; Binge eating disorder; Bulimia; Client; Cognitive Therapy; Collaborations; Communities; Consultations; Cost Analysis; Counseling; Data Coordinating Center; Development; Disease; Eating Disorders; Educational workshop; Effectiveness; Ensure; Environment; Evaluation; Evidence based intervention; Evidence based treatment; Faculty; Future; Goals; Health; High Prevalence; Individual; Intervention; Learning; Life; Manuals; Mediator of activation protein; Mental Depression; Mental Health; Mental Health Services; Methods; Modeling; Monitor; Mood Disorders; Obesity; Outcome; Overweight; Patients; Population; Procedures; Process; Provider; Psychopathology; Psychotherapy; Quality Control; Randomized; Research Personnel; Resources; Services; Site; Students; Symptoms; Syndrome; Testing; Training; Universities; Washington; aged; college; community setting; cost; design; discounting; dissemination research; early adolescence; evidence base; falls; follow-up; implementation research; improved; member; primary outcome; purge; response; skills; theories; university student

DESCRIPTION (provided by applicant): This proposal is a response to PAR-10-038 "Dissemination and Implementation Research in Health." Despite major advances in developing evidence-based psychotherapies, the adoption of such treatments by community therapists has been slow. Hence, it is important to develop and test different methods to effectively train therapists to implement evidence-based psychotherapies in community settings. College campuses have a relatively high prevalence of eating disorders (EDs) and therefore present an efficient environment to test the implementation of strategies to treat these disorders. We propose to train therapists to implement interpersonal psychotherapy (IPT), evidence-based treatments for EDs. Therapists usually learn about new therapies via a workshop and treatment manual. However, it has been shown that this method does not effectively increase therapist skills, nor does it sustain utilization of these interventions. Hence, in this study we will compare two implementation strategies designed to improve upon this approach. The first is a low intensity strategy with the addition of external expert consultation following the workshop. The second is a theoretically-grounded high intensity approach focused on building internal expertise. In this strategy, a staff member from the counseling center will be trained in IPT and coached to train other staff members within the site to implement IPT. This strategy includes quality-control procedures designed to improve implementation and to ensure treatment fidelity. Twenty-six college counseling centers with approximately 230 therapists will be allocated at random to one of the two implementation strategies. Three centers: Washington University (Implementation and Cost Analysis Center), Rutgers University (Fidelity Monitoring Center), and Stanford University (Data Coordinating Center) will conduct the study. The primary aim is to compare therapist fidelity to IPT for the two training strategies and its consequent impact on client outcome. A secondary aim is to examine the generalization of use of IPT for depression. We hypothesize that the high intensity approach will prove significantly more effective than the low intensity strategy, particularly in sustainability. Exploratory moderator and mediator analyses will illuminate the institutional and therapist variables that affect implementation and client outcomes. Because the two approaches differ in resources, the implementation and service costs for each of the training methods will be determined. Implementation will proceed over a twenty month period with a 12-month follow-up to test sustainability, during which period consultation from Washington University will have ceased. This project continues a long-standing collaboration among the three PIs and centers that have focused in the past on understanding factors underlying eating disorders and on the development of evidence- based psychotherapies. To extend our expertise on implementation theory and procedures, we have established collaborations with faculty from the Dissemination and Implementation Core at Washington University, including Drs. Proctor and Raghavan who are co-investigators on this project. PUBLIC HEALTH RELEVANCE: Eating disorders occur most frequently in late adolescence and early adult life, and therefore constitute, along with mood disorders, a serious and prevalent mental health problem for college students. Although evidence-based treatments such as interpersonal psychotherapy (IPT) have been shown to be effective for both of these disorders, few community therapists use such treatments. Hence, the present study will involve partnering with college counseling centers to determine the most effective method to implement IPT for eating and mood disorders in these settings, and will establish a platform for future large-scale dissemination of evidence-based interventions to mental health service providers.

描述（由申请人提供）：该提案是对“健康的传播和实施研究” PAR-10-038的回应。尽管在发展基于证据的心理治疗方面取得了重大进展，但社区治疗师对这种治疗的采用却很慢。因此，重要的是开发和测试不同的方法，以有效地培训治疗师在社区环境中实施基于证据的心理治疗。大学校园的饮食失调患病率相对较高（EDS），因此提出了一个有效的环境，以测试治疗这些疾病的策略的实施。我们建议培训治疗师，以实施人际心理治疗（IPT），基于循证的ED疗法。治疗师通常通过研讨会和治疗手册了解新疗法。但是，已经表明，这种方法并不能有效地提高治疗师的技能，也不能维持对这些干预措施的利用。因此，在这项研究中，我们将比较旨在改进这种方法的两种实施策略。首先是一个低强度策略，在研讨会之后增加了外部专家咨询。第二个是一种理论上的高强度方法，重点是建立内部专业知识。在此策略中，咨询中心的工作人员将接受IPT培训，并经过教练，培训现场内的其他工作人员以实施IPT。该策略包括旨在改善实施并确保治疗保真度的质量控制程序。有大约230名治疗师的26个大学咨询中心将随机分配给两种实施策略之一。三个中心：华盛顿大学（实施和成本分析中心），罗格斯大学（富达监测中心）和斯坦福大学（数据协调中心）将进行研究。主要目的是将治疗师的保真度与IPT进行两种培训策略及其对客户结果的影响。第二个目的是检查使用IPT用于抑郁症的概括。我们假设高强度方法将比低强度策略，尤其是在可持续性方面更有效。探索性主持人和调解员分析将阐明影响实施和客户结果的机构和治疗师变量。由于两种方法的资源不同，因此将确定每种培训方法的实施和服务成本。实施将在20个月内进行，并进行了为期12个月的随访，以测试可持续性，在此期间，华盛顿大学的咨询将停止。该项目继续在三个PI和中心之间进行了长期的合作，这些PI和中心一直集中在了解饮食失调和基于证据的心理疗法的发展的因素上。为了扩展我们在实施理论和程序方面的专业知识，我们已经与华盛顿大学的传播和实施核心的教师建立了合作，包括博士。 Proctor和Raghavan是该项目的共同投资者。 公共卫生相关性：饮食失调最常发生在青春期和成年早期的早期生活中，因此构成了情绪障碍，这对大学生来说是一个严重而普遍的心理健康问题。尽管诸如人际心理治疗（IPT）之类的循证治疗已被证明对这两种疾病都是有效的，但很少有社区治疗师使用这种治疗方法。因此，本研究将涉及与大学咨询中心合作，以确定在这些环境中实施IPT和情绪障碍的最有效方法，并将建立一个平台，以使未来对精神卫生服务提供者进行基于证据的干预措施的大规模传播。