改善基于社区环境的实践：监督的随机试验 - 研究方案。
Improving practice in community-based settings: a randomized trial of supervision - study protocol.
机构信息
Department of Psychology, University of Washington, 335 Guthrie Hall, Seattle, WA 98195, USA.
出版信息
Implement Sci. 2013 Aug 10;8:89. doi: 10.1186/1748-5908-8-89.
BACKGROUND
Evidence-based treatments for child mental health problems are not consistently available in public mental health settings. Expanding availability requires workforce training. However, research has demonstrated that training alone is not sufficient for changing provider behavior, suggesting that ongoing intervention-specific supervision or consultation is required. Supervision is notably under-investigated, particularly as provided in public mental health. The degree to which supervision in this setting includes 'gold standard' supervision elements from efficacy trials (e.g., session review, model fidelity, outcome monitoring, skill-building) is unknown. The current federally-funded investigation leverages the Washington State Trauma-focused Cognitive Behavioral Therapy Initiative to describe usual supervision practices and test the impact of systematic implementation of gold standard supervision strategies on treatment fidelity and clinical outcomes.
METHODS/DESIGN: The study has two phases. We will conduct an initial descriptive study (Phase I) of supervision practices within public mental health in Washington State followed by a randomized controlled trial of gold standard supervision strategies (Phase II), with randomization at the clinician level (i.e., supervisors provide both conditions). Study participants will be 35 supervisors and 130 clinicians in community mental health centers. We will enroll one child per clinician in Phase I (N = 130) and three children per clinician in Phase II (N = 390). We use a multi-level mixed within- and between-subjects longitudinal design. Audio recordings of supervision and therapy sessions will be collected and coded throughout both phases. Child outcome data will be collected at the beginning of treatment and at three and six months into treatment.
DISCUSSION
This study will provide insight into how supervisors can optimally support clinicians delivering evidence-based treatments. Phase I will provide descriptive information, currently unavailable in the literature, about commonly used supervision strategies in community mental health. The Phase II randomized controlled trial of gold standard supervision strategies is, to our knowledge, the first experimental study of gold standard supervision strategies in community mental health and will yield needed information about how to leverage supervision to improve clinician fidelity and client outcomes.
TRIAL REGISTRATION
ClinicalTrials.gov NCT01800266.
背景
循证治疗儿童心理健康问题的方法在公共心理健康环境中并不普遍。扩大可及性需要对劳动力进行培训。然而，研究表明，仅培训不足以改变服务提供者的行为，这表明需要持续的干预措施特定的监督或咨询。监督明显研究不足，尤其是在公共心理健康环境中。目前尚不清楚在这种环境中监督中包含了来自疗效试验的“黄金标准”监督要素的程度（例如，会议审查、模型保真度、结果监测、技能建设）。目前这项由联邦政府资助的研究利用华盛顿州创伤聚焦认知行为治疗计划来描述公共心理健康中的常规监督实践，并测试系统实施黄金标准监督策略对治疗一致性和临床结果的影响。
方法/设计：该研究有两个阶段。我们将对华盛顿州公共心理健康中的监督实践进行初步描述性研究（第 I 阶段），然后对黄金标准监督策略进行随机对照试验（第 II 阶段），随机化在临床医生层面进行（即，监督者提供两种条件）。研究参与者将包括社区心理健康中心的 35 名监督者和 130 名临床医生。在第 I 阶段（N=130）中，我们将为每位临床医生招募一名儿童，在第 II 阶段（N=390）中，我们将为每位临床医生招募三名儿童。我们使用多水平混合的个体内和个体间纵向设计。在两个阶段中，将收集和编码监督和治疗会议的音频记录。将在治疗开始时以及治疗的三个月和六个月时收集儿童的结果数据。
讨论
本研究将深入了解监督者如何为提供循证治疗的临床医生提供最佳支持。第 I 阶段将提供关于社区心理健康中常用监督策略的描述性信息，这些信息在文献中目前尚不可用。第 II 阶段的黄金标准监督策略随机对照试验是我们所知的社区心理健康中黄金标准监督策略的首个实验性研究，将提供有关如何利用监督来提高临床医生的一致性和客户结果的必要信息。
试验注册
ClinicalTrials.gov NCT01800266。
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