Evidence-Based Practices and Service Outcomes in Usual Care for ASA

ASA 日常护理的循证实践和服务成果

• 批准号: 7691100
• 负责人: SARAH E. DAUBER
• 金额: $ 26.1万
• 依托单位: PARTNERSHIP TO END ADDICTION
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-07-01 至 2012-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7691100
• 关键词: Adherence; Adolescent; Adoption; Alcohol consumption; Benchmarking; Caregivers; Caring; Client; Client satisfaction; Clinical; Code; Communities; Competence; Controlled Study; Counseling; Country; Crime; Data; Development; Device or Instrument Development; Disease; Drug abuse; Drug usage; Effectiveness; Elements; Evaluation; Evidence based practice; Family Process; Family psychotherapy; Funding; Future; Hand; Healthcare; Knowledge; Laboratory Study; Learning; Life; Manuals; Measures; Mental Health; Mental disorders; Methods; Monitor; Nature; Outcome; Parents; Participant; Patient Self-Report; Pharmaceutical Preparations; Phase; Prevention; Prevention approach; Procedures; Process; Productivity; Program Evaluation; Psychometrics; Public Health; Randomized; Randomized Controlled Clinical Trials; Reporting; Research; Research Training; Resources; Sampling; Services; Site; Specific qualifier value; Structure; Symptoms; Techniques; Testing; Therapeutic; Training; Treatment outcome; Validity and Reliability; Videotape; Youth; adolescent substance abuse; care systems; clinical care; clinical research site; cognitive behavior therapy; community setting; comparative; control trial; cost; drug abuser; evidence base; follow-up; innovation; juvenile justice system; motivational enhancement therapy; programs; psychologic; public health relevance; research study; routine practice; satisfaction; service utilization; sound; treatment as usual; treatment program; treatment site; user-friendly

DESCRIPTION (provided by applicant): The ultimate objective of the proposed study is to examine the fidelity and effectiveness of evidence-based practices (EBPs) for adolescent substance abuse when implemented by community therapists in usual care. Although clinicians and treatment programs espouse allegiance to various EBPs, and a large proportion report using manualized treatments in routine practice, there is little reliable knowledge about the treatment ingredients actually delivered in community settings. To support adoption and training efforts, it is critical to know whether EBPs retain their integrity and potency in the hands of end users. The proposed study would be the first to examine implementation effects of EBPs for ASA in natural service conditions using rigorous observational methods. The study will leverage the resources of CASALEAP, an ongoing randomized trial testing the effectiveness of existing ASA treatment services in four clinical sites. Each site endorses at least two of the following EBPs as a primary treatment approach for ASA: cognitive-behavioral therapy (CBT), family therapy (FT), 12-step drug counseling (DC), and motivational interviewing (MI). The CASALEAP trial is collecting the following implementation data on a projected N = 205 participants: videotapes of three treatment sessions (2, 6,10) and a pilot therapist self-report checklist of EBP adherence after every session. At minimal cost, the proposed study will augment CASALEAP assessment procedures in two innovative ways. First, videotaped sessions will be coded by clinically trained raters using validated observational measures of adherence and competence for all four EBPs: CBT, FT, DC, and MI. Tapes will also be rated for therapeutic alliance with adolescents and caregivers. Second, data from completed pilot versions of the therapist-report checklist will be analyzed, participating therapists will be trained to reliably complete a reduced-item version of the checklist, and the new brief version will be tested for reliability and construct and criterion validity. The first aim of the study is to determine whether EBP adherence, competence, and alliance predict service utilization and one-year outcomes for ASA in usual care. The second aim is to develop and test a brief, psychometrically sound therapist-report measure of adherence to EBPs for ASA that can be included in program evaluation toolkits for monitoring treatment service implementation in systems of care. The third aim is to examine whether routine implementation of EBPs in community agencies approaches fidelity benchmarks set by research-trained therapists in controlled studies. PUBLIC HEALTH RELEVANCE: Adolescent substance abuse (ASA) continues to be a highly prevalent, often life-threatening, and costly public health problem. The costs of ASA include those associated with treatment and prevention, crime, and lost productivity; recent estimates of ASA-related costs, available for alcohol consumption only, total $58 billion dollars per year. Also, co-occurrence of ASA with other psychiatric disorders has been established in both community and clinical samples. Adolescent drug abusers with comorbid conduct disorders create a significant burden on the juvenile justice system; for example, in the year 2000 over 203,000 juveniles were arrested for drug abuse violations. For all these reasons, ASA treatment is among the most pressing youth mental health needs in the country. However little is known about the nature and quality of ASA services currently available in usual care settings. This study will begin to fill this gap by providing a rigorous evaluation of the implementation of evidence-based practices for ASA in usual care.

描述（由申请人提供）：拟议研究的最终目标是检查社区治疗师在常规护理中实施针对青少年药物滥用的循证实践（EBP）的保真度和有效性。尽管临床医生和治疗项目拥护各种 EBP，并且很大一部分报告在常规实践中使用手动治疗，但对社区环境中实际提供的治疗成分知之甚少。为了支持采用和培训工作，了解 EBP 在最终用户手中是否保持其完整性和效力至关重要。拟议的研究将是第一个使用严格的观察方法在自然服务条件下检查 ASA 的 EBP 实施效果的研究。该研究将利用 CASALEAP 的资源，这是一项正在进行的随机试验，测试四个临床中心现有 ASA 治疗服务的有效性。每个站点都认可以下 EBP 中的至少两种作为 ASA 的主要治疗方法：认知行为疗法 (CBT)、家庭疗法 (FT)、12 步药物咨询 (DC) 和动机访谈 (MI)。 CASALEAP 试验正在收集预计 N = 205 名参与者的以下实施数据：三个治疗疗程（2、6、10）的录像以及每个疗程后试点治疗师自我报告 EBP 依从性清单。拟议的研究将以最低的成本以两种创新方式增强 CASALEAP 评估程序。首先，录像课程将由经过临床培训的评估员使用所有四种 EBP（CBT、FT、DC 和 MI）的依从性和能力的经过验证的观察措施进行编码。磁带还将被评为与青少年和护理人员的治疗联盟。其次，将对已完成的治疗师报告清单试点版本的数据进行分析，参与的治疗师将接受培训，以可靠地完成清单的减少项目版本，并且将测试新的简短版本的可靠性、结构和标准有效性。该研究的第一个目的是确定 EBP 依从性、能力和联盟是否可以预测 ASA 在常规护理中的服务利用和一年结果。第二个目标是开发和测试一种简短的、心理测量学上合理的治疗师报告测量方法，用于衡量 ASA 遵守 EBP 的情况，该测量方法可以包含在项目评估工具包中，用于监测护理系统中治疗服务的实施情况。第三个目标是检查社区机构 EBP 的常规实施是否接近受过研究培训的治疗师在对照研究中设定的保真度基准。公共卫生相关性：青少年药物滥用 (ASA) 仍然是一个非常普遍、常常危及生命且代价高昂的公共卫生问题。 ASA 的成本包括与治疗和预防、犯罪以及生产力损失相关的成本；最近估计与 ASA 相关的成本（仅适用于酒精消费）每年总计 580 亿美元。此外，社区和临床样本中都已证实 ASA 与其他精神疾病同时存在。患有共病行为障碍的青少年吸毒者给少年司法系统造成沉重负担；例如，2000年，超过203 000名青少年因吸毒违法行为被捕。由于所有这些原因，ASA 治疗是该国最紧迫的青少年心理健康需求之一。然而，人们对目前在常规护理环境中提供的 ASA 服务的性质和质量知之甚少。这项研究将通过对 ASA 循证实践在常规护理中的实施情况进行严格评估来填补这一空白。