A Computer-Assisted Cognitive Behavioral Therapy Tool to Enhance Fidelity in CBO

计算机辅助认知行为治疗工具可增强 CBO 的保真度

• 批准号: 10016120
• 负责人: Michael Anthony Cucciare
• 金额: --
• 依托单位: CENTRAL ARKANSAS VETERANS HLTHCARE SYS
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-07-01 至 2019-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10016120
• 关键词: Anxiety; Anxiety Disorders; Caring; Clinic; Clinical; Cognitive Therapy; Communities; Computer Assisted; Computers; Disease; Effectiveness; Evidence based treatment; Future; Health Personnel; Hybrids; Instruction; Intervention; Measures; Mental Depression; Mental Health; Mental disorders; Methodological Studies; Methods; Modeling; Needs Assessment; Outcome; Outpatients; Patients; Post-Traumatic Stress Disorders; Protocols documentation; Provider; Psychotherapy; Randomized; Randomized Controlled Trials; Rural Community; Technology; Testing; Training; Veterans; base; design; evidence base; improved; medical specialties; primary care setting; programs; routine care; rural area; scale up; tool

DESCRIPTION (provided by applicant): Background and Significance: Randomized Controlled Trials (RTCs) have demonstrated that evidence-based psychotherapies (EBPs), particularly Cognitive Behavioral Therapy (CBT), are highly effective in treating anxiety and depression, the most common mental health disorders in primary care settings. Mental health (MH) providers in VA Community-Based-Out-Patient-Clinics (CBOCs) are often located in rural areas and isolated from educational opportunities. Almost half of Veterans now use CBOCs. Studies have shown that the quality of delivery of EBPs (fidelity) impacts clinical outcomes. This study will test a computer-assisted tool (CALM Tools for Living) that increases fidelity to CBT in treating depression and four common anxiety disorders, including PTSD. Although results of a large RCT, the CALM study, suggested that the tool contributed to fidelity to the CBT protocol, this hypothesis has not been tested. This study will test the tool in primarily rural CBOCs in VA VISN16. Objective: To modify a computer-assisted CBT tool to meet the needs of CBOC MH providers and Veterans, to evaluate the impact on providers' fidelity to the CBT model and clinical outcomes, and to assess how best to support future implementation. Specific Aims/Hypothesis: (1) Engage CBOC MH providers in modifying the computer-assisted CBT tool such that its content is relevant and acceptable to Veterans and providers. We hypothesize that the modified tool will be acceptable to both Veterans and providers. (2) Compare MH provider fidelity to CBT and clinical outcomes among providers who used the tool and those who did not. We hypothesize that clinicians who use the tool will have a higher fidelity to CBT and clinical outcomes among patients will be superior. (3) Prepare for future implementation of the tool in the VA. Methodology: This study will use a Type III hybrid effectiveness design. Methods common to the field of Instructional Design and Technology (IDT) will be used to modify the tool. Thirty-four CBOC MH providers will be trained in CBT and randomized to use the tool or not. Both groups will receive external facilitation to encourage the full implementation of CBT into practice on the clinic level. MH providers will treat 10 patients each. Patients will be assessed at baseline, 3, 6, and 12 months. Provider fidelity to the CBT protocol will be measured, and finally, a tool kit for future implementation of the tool wil be disseminated. Impact: We expect the intervention to improve the technical quality of MH treatment in CBOCs and improve clinical outcomes among Veterans.

描述（由申请人提供）： 背景和意义：随机对照试验（RTC）已经证明，循证心理治疗（EBP），特别是认知行为治疗（CBT），对于治疗初级保健机构中最常见的精神健康障碍焦虑和抑郁非常有效。退伍军人管理局社区门诊 (CBOC) 的心理健康 (MH) 提供者通常位于农村地区，远离教育机会。 近一半的退伍军人现在使用 CBOC。研究表明，EBP 的传输质量（保真度）会影响临床结果。这项研究将测试一种计算机辅助工具（CALM Tools for Living），该工具可以提高 CBT 在治疗抑郁症和四种常见焦虑症（包括 PTSD）方面的保真度。尽管一项大型随机对照试验（CALM 研究）的结果表明该工具有助于提高 CBT 协议的保真度，但这一假设尚未得到检验。本研究将在 VA VISN16 的主要农村 CBOC 中测试该工具。 目标：修改计算机辅助 CBT 工具以满足 CBOC MH 提供者和退伍军人的需求，评估对提供者对 CBT 模型和临床结果的忠诚度的影响，并评估如何最好地支持未来的实施。 具体目标/假设： (1) 让 CBOC MH 提供者参与修改计算机辅助 CBT 工具，使其内容与退伍军人和提供者相关并可接受。 我们假设修改后的工具将被退伍军人和提供者接受。 (2) 比较使用该工具和未使用该工具的 MH 提供者对 CBT 的忠诚度以及临床结果。我们假设使用该工具的临床医生对 CBT 的忠诚度更高，患者的临床结果也会更好。 (3) 为未来在 VA 中实施该工具做好准备。 方法：本研究将使用 III 型混合有效性设计。将使用教学设计和技术（IDT）领域常见的方法来修改该工具。 34 名 CBOC MH 提供者将接受 CBT 培训，并随机选择使用或不使用该工具。两个小组都将接受外部协助，以鼓励在临床层面全面实施 CBT。 MH 提供者将治疗 每人 10 名患者。患者将在基线、3、6 和 12 个月时接受评估。将衡量提供商对 CBT 协议的忠诚度，最后将分发用于未来实施该工具的工具包。 影响：我们期望干预措施能够提高 CBOC 的 MH 治疗技术质量，并改善退伍军人的临床结果。