Sibley Margaret H, Bickman Leonard, Atkins David, Tanana Michael, Coxe Stefany, Ortiz Mercedes, Martin Pablo, King Julian, Monroy Jessica M, Ponce Teodora, Cheng Jenny, Pace Brian, Zhao Xin, Chawla Varun, Page Timothy F
University of Washington School of Medicine, Seattle Children's Research Institute.
Center for Children & Families, Florida International University, Ontrak Health Inc., Henderson, NV.
Cogn Behav Pract. 2024 Nov;31(4):482-497. doi: 10.1016/j.cbpra.2023.02.001. Epub 2023 Mar 3.
Implementation of behavior therapy for ADHD faces challenges in community settings. We describe development of a community-based implementation model for adolescent ADHD behavior therapy (Supporting Teens' Autonomy Daily; STAND) blended with Motivational Interviewing (MI). A stakeholder-engaged development approach is used based on the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. Resulting model features include: (a) task-shifting supervision from experts to agency supervisors, (b) holding bi-weekly technical assistance drop-ins to provide training and implementation supports, (c) MI integrity monitoring and feedback by artificial intelligence (AI), (d) AI-generated metrics for STAND content fidelity, (e) digitizing resources (manual, worksheets, tips, videos) on a clinician dashboard, (f) creating visual displays of feedback using badges and graphs, and (g) adding a rapport-building session prior to manualized content. We conducted stakeholder focus groups (=32) and two pilot studies to evaluate the new STAND AI measurement tool and revised service-delivery model (=6 therapists, 7 youth and parents, 3 agency supervisors). Results revealed advantages and disadvantages of the model, supported the promise of a STAND AI fidelity measurement tool, and indicated initial feasibility, acceptability, and agency engagement in STAND's community-based implementation model. We discuss future directions for continued iterative development and testing. Video examples are included as supplementary material.
在社区环境中实施注意力缺陷多动障碍（ADHD）行为疗法面临挑战。我们描述了一种基于社区的青少年ADHD行为疗法实施模型（每日支持青少年自主；STAND）的开发，该模型融合了动机性访谈（MI）。基于探索、准备、实施、维持（EPIS）框架采用了利益相关者参与的开发方法。最终模型的特点包括：（a）将监督任务从专家转移到机构主管，（b）每两周进行一次技术援助即席指导，以提供培训和实施支持，（c）通过人工智能（AI）监测MI的完整性并提供反馈，（d）AI生成的STAND内容保真度指标，（e）在临床医生仪表板上对资源（手册、工作表、提示、视频）进行数字化处理，（f）使用徽章和图表创建反馈的可视化展示，以及（g）在手册化内容之前增加一个建立融洽关系的环节。我们进行了利益相关者焦点小组（n = 32）和两项试点研究，以评估新的STAND AI测量工具和修订后的服务提供模式（6名治疗师、7名青少年及其父母、3名机构主管）。结果揭示了该模型的优缺点，支持了STAND AI保真度测量工具的前景，并表明了STAND基于社区的实施模型的初步可行性、可接受性以及机构参与度。我们讨论了持续迭代开发和测试的未来方向。视频示例作为补充材料包含在内。
