Medical University of South Carolina.
Medical University of South Carolina.
Behav Ther. 2019 Mar;50(2):367-379. doi: 10.1016/j.beth.2018.07.005. Epub 2018 Jul 27.
Mental health systems need scalable solutions that can reduce the efficacy-effectiveness gap and improve mental health outcomes in community mental health service settings. Two major challenges to delivery of high-quality care are providers' fidelity to evidence-based treatment models and children's and caregivers' engagement in the treatment process. We developed a novel, tablet-based application designed to enhance via technology the quality of delivery of trauma-focused cognitive-behavioral therapy (TF-CBT). We piloted its use in four community mental health service organizations using a blocked randomized controlled trial to examine the feasibility of implementing tablet-facilitated TF-CBT versus standard TF-CBT with 13 providers and 27 families. Provider fidelity and child engagement in treatment were observationally measured via session audio recording. Parent and child perceptions of the tablet application were assessed using structured interviews and mixed-method analyses. Providers actively and appropriately used tablet TF-CBT to facilitate treatment activities. Providers and families expressed high satisfaction with its use, demonstrating acceptability of this approach. Youth and caregivers in both conditions reported high alliance with their providers. Overall, we found that tablet-facilitated treatment is accepted by providers and families and may be integrated into mental health treatment with minimal training. Further study is needed to examine the extent to which technology-based applications may enhance the reach, quality, and clinical outcomes of mental health treatment delivered to children and families.
心理健康系统需要可扩展的解决方案，以缩小疗效效果差距，并改善社区心理健康服务环境中的心理健康结果。提供高质量护理的两个主要挑战是提供者对基于证据的治疗模式的保真度以及儿童和照顾者对治疗过程的参与。我们开发了一种新颖的基于平板电脑的应用程序，旨在通过技术提高创伤焦点认知行为疗法（TF-CBT）的交付质量。我们使用随机对照试验在四个社区心理健康服务机构中试用了它，以研究使用平板电脑辅助 TF-CBT 与标准 TF-CBT 对 13 名提供者和 27 个家庭的实施的可行性。通过会话音频记录观察测量提供者的保真度和儿童对治疗的参与度。使用结构化访谈和混合方法分析评估了父母和孩子对平板电脑应用程序的看法。提供者积极且适当地使用平板电脑 TF-CBT 来促进治疗活动。提供者和家庭对其使用表示高度满意，证明了这种方法的可接受性。两种情况下的年轻人和照顾者都报告与他们的提供者有很高的联盟关系。总的来说，我们发现，提供者和家庭接受了基于平板电脑的治疗，并且可以在接受最少培训的情况下将其纳入心理健康治疗。需要进一步研究，以确定基于技术的应用程序在多大程度上可以增强向儿童和家庭提供的心理健康治疗的范围、质量和临床结果。
