Martinez Ruben G, Weiner Bryan J, Meza Rosemary D, Dorsey Shannon, Palazzo Lorella G, Matson Abigail, Bain Carolyn, Mettert Kayne D, Pullmann Michael D, Lewis Cara C
The Warren Alpert Medical School of Brown University, Providence, RI, USA.
Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA.
Implement Sci Commun. 2023 Nov 28;4(1):152. doi: 10.1186/s43058-023-00526-z.
For youth receiving care in community mental health centers, comorbidities are the rule rather than the exception. Using measurement-based care (MBC), or the routine evaluation of symptoms to inform care decisions, as the foundation of treatment for youth with comorbid problems significantly improves the impact of psychotherapy by focusing care and building engagement and alliance. MBC increases the rate of symptom improvement, detects clients who would otherwise deteriorate, and alerts clinicians to non-responders. Despite its demonstrated utility, MBC is rarely implemented with fidelity; less than 15% of providers report using MBC per recommendations. Previous efforts to support MBC implementation have yielded suboptimal outcomes, in part, due to organizations' challenges with identifying and prioritizing barriers and selecting and developing strategies to overcome them. New methods are needed for identifying and prioritizing barriers, and matching strategies to barriers to optimize MBC implementation and treatment quality to improve youth mental health outcomes in community settings.
Pragmatic implementation methods will be piloted in four diverse community mental health centers. Methods include (a) rapid evidence synthesis; (b) rapid ethnography; (c) design kits (e.g., kits with disposable cameras, journals, maps); (d) barrier prioritization, and (e) causal pathway diagramming. These activities will generate actionable barriers; subsequently, we will use facilitated group processes to prioritize barriers and develop causal pathway diagrams to match strategies to barriers to create implementation plans that optimize MBC fidelity (Aim 1). We will track strategy deployment for 6 months, then compare MBC fidelity for another 6 months post-implementation with data from 2 years of historical controls (Aim 2). Finally, we will co-design a toolkit for design kit methods with youth and the practice and scientific communities (Aim 3).
Optimizing MBC implementation in community mental health centers could transform youth mental health care by ensuring the most pressing symptoms are targeted early in treatment. The discussion section highlights expected challenges and limits to using the five methods, including recruitment and engagement given the high pressure on community mental health settings.
Clinicaltrials.gov. NCT05644756 . Registered on 18 November 2022. This trial was retrospectively registered.
对于在社区心理健康中心接受治疗的青少年而言，共病情况很常见而非个别现象。将基于测量的护理（MBC），即对症状进行常规评估以指导护理决策，作为治疗共病问题青少年的治疗基础，通过聚焦护理、建立参与度和联盟，可显著提高心理治疗的效果。MBC可提高症状改善率，发现那些否则会病情恶化的患者，并提醒临床医生注意无反应者。尽管MBC已证明其效用，但很少能得到切实执行；不到15%的提供者报告按照建议使用MBC。此前支持MBC实施的努力取得的效果并不理想，部分原因是各组织在识别障碍并确定其优先级以及选择和制定克服障碍的策略方面面临挑战。需要新的方法来识别障碍并确定其优先级，以及使策略与障碍相匹配，以优化MBC的实施和治疗质量，从而改善社区环境中青少年的心理健康结果。
将在四个不同的社区心理健康中心试点务实的实施方法。方法包括：（a）快速证据综合；（b）快速人种志研究；（c）设计工具包（如配备一次性相机、日志、地图的工具包）；（d）障碍优先级确定；以及（e）因果路径图绘制。这些活动将产生可采取行动的障碍；随后，我们将利用便利的小组流程来确定障碍的优先级，并绘制因果路径图，使策略与障碍相匹配，以制定优化MBC保真度的实施计划（目标1）。我们将跟踪策略部署6个月，然后在实施后的另外6个月里，将MBC保真度与来自两年历史对照的数据进行比较（目标2）。最后，我们将与青少年以及实践和科学界共同设计一个用于设计工具包方法的工具包（目标3）。
在社区心理健康中心优化MBC的实施可以通过确保在治疗早期针对最紧迫的症状来改变青少年心理健康护理。讨论部分强调了使用这五种方法预期会面临的挑战和限制，包括鉴于社区心理健康机构面临的巨大压力，在招募和参与方面的挑战。
Clinicaltrials.gov。NCT05644756。于2022年11月18日注册。本试验为回顾性注册。
