Eiraldi Ricardo, Khanna Muniya S, Jawad Abbas F, Fishman Jessica, Glick Henry A, Schwartz Billie S, Cacia Jaclyn, Wandersman Abraham, Beidas Rinad
The Children's Hospital of Philadelphia, 3535 Market Street, Rm. 1474, Philadelphia, PA, 19104, USA.
Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
Implement Sci. 2016 Jul 12;11:92. doi: 10.1186/s13012-016-0453-z.
Schools present a context with great potential for the implementation of psychosocial evidence-based practices. Cognitive behavioral therapy (CBT) is an evidence-based practice that has been found to be very effective in treating anxiety in various community settings, including schools. Friends for Life (FRIENDS) is an efficacious group CBT protocol for anxiety. Unfortunately, evidence-based practices for anxiety are seldom employed in under-resourced urban schools, because many treatment protocols are not a good fit for the urban school context or the population, existing behavioral health staff do not receive adequate training or support to allow them to implement the treatment with fidelity, or school districts do not have the resources to contract with external consultants. In our prior work, we adapted FRIENDS to create a more culturally sensitive, focused, and feasible CBT protocol for anxiety disorders (CBT for Anxiety Treatment in Schools (CATS)).
METHODS/DESIGN: The aim of this 5-year study is to evaluate both the effectiveness of CATS for urban public schools compared to the original FRIENDS as well as compare the implementation strategies (train-the-trainer vs. train-the-trainer + ongoing consultation) by conducting a three-arm, parallel group, type 2 hybrid effectiveness-implementation trial in 18 K-8 urban public schools. We will also assess the cost-effectiveness and the mediators and moderators of fidelity. Ninety therapists, 18 agency supervisors, and 360 children will participate. The interactive systems framework for dissemination and implementation guides the training and support procedures for therapists and supervisors.
This study has the potential to demonstrate that agency therapists and supervisors who have had little to no prior exposure to evidence-based practices (EBPs) can implement an anxiety disorder EBP with fidelity. Comparisons of the implementation strategies would provide large urban mental health systems with data to make decisions about the adoption of EBPs.
ClinicalTrials.gov, NCT02651402.
学校为实施基于社会心理证据的实践提供了极具潜力的环境。认知行为疗法（CBT）是一种基于证据的实践方法，已发现在包括学校在内的各种社区环境中治疗焦虑症非常有效。“一生之友”（FRIENDS）是一种有效的针对焦虑症的团体认知行为疗法方案。不幸的是，资源匮乏的城市学校很少采用基于证据的焦虑症治疗方法，因为许多治疗方案不太适合城市学校环境或学生群体，现有的行为健康工作人员没有接受足够的培训或支持以确保他们能忠实地实施治疗，或者学区没有资源与外部顾问签约。在我们之前的工作中，我们对FRIENDS进行了调整，以创建一种更具文化敏感性、针对性且可行的焦虑症认知行为疗法方案（学校焦虑症治疗的认知行为疗法（CATS））。
方法/设计：这项为期5年的研究旨在评估CATS相对于原始FRIENDS对城市公立学校的有效性，并通过在18所K - 8城市公立学校进行三臂平行组2型混合有效性 - 实施试验，比较实施策略（培训培训师与培训培训师 + 持续咨询）。我们还将评估成本效益以及忠诚度的调节因素和中介因素。90名治疗师、18名机构主管和360名儿童将参与。传播与实施的交互式系统框架指导治疗师和主管的培训及支持程序。
本研究有可能证明，之前几乎没有接触过基于证据的实践（EBP）的机构治疗师和主管能够忠实地实施焦虑症EBP。实施策略的比较将为大型城市心理健康系统提供数据，以便就采用EBP做出决策。
ClinicalTrials.gov，NCT02651402。
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