Local Quality Assurance Tool for Family Therapy in Usual Care for Adolescent Substance Use

青少年药物使用日常护理家庭治疗的本地质量保证工具

• 批准号: 9012070
• 负责人: Aaron Hogue
• 金额: $ 40.02万
• 依托单位: PARTNERSHIP TO END ADDICTION
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-02-15 至 2019-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9012070
• 关键词: Accountability; Adherence; Adolescent; Adopted; Adoption; Affordable Care Act; Archives; Area; Behavior; Behavior Therapy; Behavioral; Caring; Certification; Child Welfare; Childhood; Client; Clinical; Clinical Management; Code; Communities; Competence; Consensus; Continuity of Patient Care; Contracts; Data; Data Analyses; Databases; Development; Dimensions; Discrimination; Disease; Diverse Workforce; Elements; Evaluation; Family; Family psychotherapy; Gold; Guidelines; Health; Healthcare; High Prevalence; Intervention; Justice; Licensing; Manuals; Measures; Mental Health; Methods; Modeling; Monitor; Names; Outcome; Outcomes Research; Parents; Performance; Policies; Procedures; Process; Property; Provider; Quality Indicator; Research; Resources; Review Literature; Sampling; Services; Structure; Supervision; Symptoms; System; Techniques; Testing; Time; Training; Training Technics; Youth; addiction; adolescent substance use; alternative treatment; base; control trial; cost; cost efficient; evidence base; follow-up; innovation; medical specialties; meetings; probation; public health priorities; quality assurance; response; routine care; skills; success; theories; tool; treatment as usual; treatment planning

DESCRIPTION (provided by applicant): Ecological family therapy (EFT) has by far the largest base of empirical support for treating adolescent substance use (ASU). Manualized EFT models have proven consistently superior to every type of alternative treatment in controlled trials. Yet, EFT has not been widely adopted within ASU treatment systems nationwide. A primary barrier to adoption is the mismatch between the purveyor-driven methods used by manualized EFTs and the needs of the provider community. There are several EFT brands and each has a proprietary set of expensive and highly structured training, supervision, and fidelity control guidelines. These quality assurance (QA) procedures are too costly, inflexible, and externally controlled to meet all needs of a diverse workforce. This study will empirically distill the core techniques of manualized EFTs to produce a non-proprietary, freely available, psychometrically valid EFT QA toolkit (fidelity tool, training/implementation supports) that can be locally sustaine with intramural resources. This toolkit will promote high-fidelity delivery of EFT in routine care or ASU. The timing is perfect for developing this resource: The Affordable Care Act and related policy changes have ushered in unprecedented opportunities to increase adoption of evidence-based approaches in behavioral healthcare via training and certification requirements built into provider contracts. As a result, valid QA procedures and measures for behavioral treatments are in enormous demand. Unfortunately, existing QA procedures do not contain implementation fidelity guidelines: what specific interventions to deliver, and how to do them well. This is currently true for the ASU treatment system, which has promulgated "best practices" consisting of broad principles of client engagement and continuity-of-care rather than specific techniques. The proposed study will synthesize core techniques from three EFT models to construct a QA toolkit for supporting EFT fidelity in routine care. The study will conduct observational fidelity analyses on two pools of recorded sessions: (a) 300 gold-standard EFT sessions from controlled trials of Functional Family Therapy (FFT), Multidimensional Family Therapy (MDFT), and Brief Strategic Family Therapy (BSFT); and (b) 300 front-line EFT sessions from three implementation studies with ASU samples conducted in in routine settings. A new EFT QA measure will be derived from coding these two session pools using well-validated observational fidelity measures associated with FFT, MDFT, and BSFT respectively. As is true for the parent measures, the new QA tool will assess four fidelity dimensions: adherence to core EFT techniques, global EFT competence, therapist-family alliance, and ecological foci. Specific items for the EFT QA tool will be synthesized from gold- standard sessions (Aim 1), verified on front-line sessions (Aim 2), and validated on front-line fidelity ratings and client outcomes (Aim 3). We anticipate success in synthesizing core EFT techniques based on pilot data collected using the same samples, observational fidelity measures, and coding methods described in this proposal. Our pilot data reveal strong correlations among similar items representing four EFT treatment components projected to emerge during data analysis: family engagement, relational reframing, family restructuring, and family skill building. All study analyses and QA toolkit products (fideliy tool and coding manual, description of EFT techniques, training and implementation resources) will be vetted during a collaborative toolkit development process by an Expert Review Panel containing experts in EFT clinical theory and research, distillation of the core elements of manualized treatment models for various childhood disorders, and EFT fidelity-outcome research, along with front-line family therapists who treat ASU. Developing a psychometrically valid EFT QA toolkit from existing manualized resources would create a new QA resource that could be used to assess a wide spectrum of EFT implementation activities in behavioral care: evaluation of EFT training outcomes, data-based treatment planning for ASU and related disorders, administrative and regulatory review of treatment practices, and provider certification, to name a few. Most importantly, the new EFT QA toolkit could accelerate the adoption of EFT in routine care for ASU because providers will be inclined to select an approach that is both highly effective and meets regulatory demands for quality standards in a cost-efficient manner. The proposed toolkit will be available in two ways: (1) Cost-free to any licensed provider for incorporation into their existing intramural procedures for training and monitoring staff clinician; or (2) Packaged as one treatment module within a larger QA and clinical management system. The proposed study is innovative in several ways. It would develop the first QA tool capable of defining universal quality standards for EFT. Existing EFT tools define performance standards only for the given brand- name model and have limited value outside the purveyor's sphere of influence. The study will also produce a roadmap for developing empirical methods for distilling core QA tools based on validated fidelity measures; this innovation has broad applicability to other treatment approaches with multiple manualized versions (e.g., CBT for SUD) and will advance a vital new research area for behavioral healthcare. Finally, study methods will accelerate the pace of identifying quality indicators of EBPs for youth disorders. Current efforts rely on coordinated efforts from multiple research centers to identify quality metrics based on extended periods of literature review and consensus building. In contrast, this study will use empirical distillation methods and vet study data and products with a purposively convened expert panel.

描述（由申请人提供）：生态家庭疗法（EFT）迄今为止在治疗青少年药物滥用（ASU）方面拥有最大的经验支持基础。在对照试验中，手动 EFT 模型已被证明始终优于每种类型的替代治疗。然而， EFT 尚未在全国 ASU 治疗系统中广泛采用。采用的主要障碍是手动电子转账所使用的供应商驱动方法与供应商社区的需求之间的不匹配。有多个 EFT 品牌，每个品牌都有一套专有的昂贵且高度结构化的培训、监督和保真度控制指南。这些质量保证 (QA) 程序成本过高、缺乏灵活性且受外部控制，无法满足多元化员工的所有需求。本研究将根据经验提炼手动 EFT 的核心技术，以生成非专有、免费提供、心理测量有效的 EFT QA 工具包（保真度工具、培训/实施支持），该工具包可以通过校内资源在本地维持。该工具包将促进常规护理或 ASU 中 EFT 的高保真交付。开发此资源的时机非常完美：《平价医疗法案》和相关政策变化带来了前所未有的机会，通过提供者合同中内置的培训和认证要求，增加行为医疗保健中循证方法的采用。因此，对行为治疗有效的质量保证程序和措施的需求量很大。不幸的是，现有的质量保证程序不包含实施保真度指南：要提供哪些具体干预措施以及如何做好这些干预措施。目前，亚利桑那州立大学的治疗系统就是如此，该系统颁布了“最佳实践”，其中包括客户参与和护理连续性的广泛原则，而不是具体的技术。拟议的研究将综合三个 EFT 模型的核心技术，构建一个 QA 工具包，以支持日常护理中的 EFT 保真度。该研究将对两组记录的会话进行观察保真度分析：(a) 来自功能家庭治疗 (FFT)、多维家庭治疗 (MDFT) 和简短战略家庭治疗 (BSFT) 对照试验的 300 个黄金标准 EFT 会话； (b) 300 场一线 EFT 会议，来自在常规环境中使用 ASU 样本进行的三项实施研究。新的 EFT QA 测量将通过分别使用与 FFT、MDFT 和 BSFT 相关的经过充分验证的观察保真度测量对这两个会话池进行编码而得出。与家长测量一样，新的 QA 工具将评估四个保真度维度：对核心 EFT 技术的遵守、全球 EFT 能力、治疗师-家庭联盟和生态焦点。 EFT QA 工具的具体项目将从黄金标准会议（目标 1）中合成，在一线会议上进行验证（目标 2），并在一线保真度评级和客户结果上进行验证（目标 3）。我们 预计基于使用本提案中描述的相同样本、观察保真度测量和编码方法收集的导频数据来合成核心 EFT 技术的成功。我们的试点数据显示，代表数据分析过程中预计出现的四个 EFT 治疗组成部分的相似项目之间存在很强的相关性：家庭参与、关系重构、家庭重组和家庭技能建设。所有研究分析和 QA 工具包产品（保真工具和编码手册、EFT 技术描述、培训和实施资源）都将在协作工具包开发过程中由专家审查小组进行审查，该专家审查小组包含 EFT 临床理论和研究、EFT 临床理论和研究方面的专家、各种儿童疾病手动治疗模型的核心要素、EFT 保真度结果研究，以及治疗 ASU 的一线家庭治疗师。利用现有的手动资源开发心理测量上有效的 EFT QA 工具包将创建新的 QA 资源，可用于评估行为护理中广泛的 EFT 实施活动：评估 EFT 培训结果、针对 ASU 和相关疾病的基于数据的治疗计划、治疗实践的行政和监管审查以及提供者认证， 仅举几例。最重要的是，新的 EFT QA 工具包可以加速 ASU 在日常护理中采用 EFT，因为提供商将倾向于选择一种既高效又以经济高效的方式满足质量标准监管要求的方法。拟议的工具包将以两种方式提供：（1）任何获得许可的提供者都可以免费将其纳入其现有的内部程序中，以培训和监测临床医生； (2) 在更大的 QA 和临床管理系统中打包为一个治疗模块。拟议的研究在几个方面具有创新性。它将开发第一个能够定义电子转帐通用质量标准的质量保证工具。现有的 EFT 工具仅针对给定的品牌型号定义性能标准，并且在供应商影响范围之外的价值有限。该研究还将制定一个路线图，用于开发基于经过验证的保真度测量来提炼核心质量保证工具的经验方法；这项创新对具有多种手动版本的其他治疗方法（例如 SUD 的 CBT）具有广泛的适用性，并将推动行为医疗保健的重要新研究领域。最后，研究方法将加快确定青少年疾病 EBP 质量指标的步伐。目前的工作依赖于多个研究中心的协调努力，根据长期的文献回顾和共识建立来确定质量指标。相比之下，本研究将使用经验蒸馏方法，并通过有目的地召集的专家小组来审查研究数据和产品。