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一项随机试验,比较通过社区心理健康服务提供者以培训培训师的方式实施的适应性版本与标准版本的跨诊断睡眠和昼夜节律功能障碍干预措施(TSC)。

A randomized trial of Adapted versus Standard versions the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TSC) implemented via facilitation and delivered by community mental health providers using train-the-trainer.

作者信息

Harvey Allison, Agnew Emma R, Hache Rafael Esteva, Callaway Catherine A, Patino Estephania Ovalle, Milner Anne, Spencer Julia M, Diaz Marlen, Dong Lu, Kilbourne Amy M, Buysse Daniel J, Stice Eric, Sarfan Laurel D

出版信息

Res Sq. 2025 Jul 14:rs.3.rs-6414484. doi: 10.21203/rs.3.rs-6414484/v1.

Abstract

Grounded in the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework, we investigated the Train-the-Trainer (TTT) to expand access to evidence-based psychological treatments (EBPTs) in community mental health centers (CMHCs), focusing on the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TSC). Eight Californian counties were cluster-randomized to Standard TSC or an adapted version designed to improve the "fit" of TSC to CMHCs. University-based trainers trained CMHC providers ("Generation 1 providers") in either Adapted or Standard TSC. These trained providers were then trained to become local CMHC trainers ("Generation 1 trainers"), who then trained a new cohort of providers ("Generation 2 providers") in TSC. Within each county, patients diagnosed with serious mental illness (SMI) were randomized to receive either immediate TSC or usual care and delayed treatment with TSC (UC-DT) from the Generation 2 providers ("Generation 2 patients"). This study focused on 53 Generation 2 providers (Adapted TSC = 47; Standard TSC = 6), and 143 Generation 2 patients (Adapted TSC = 127; Standard TSC = 16) (the larger Adapted sample was driven by recruitment, perhaps reflecting preference for the "fitted" approach). Patient assessments were conducted pre-treatment, post-treatment, and six-month follow-up (6FU). Provider assessments occurred after completing TSC training and post-treatment for each patient treated. Combining Adapted and Standard, TSC was associated with improvements for Generation 2 patients from pre- to post-treatment in sleep disturbance ( < 0.001, -0.90), sleep-related impairment ( = 0.001, -0.69), psychiatric symptoms ( = 0.002, = -0.48), and functional impairment ( = 0.002, = -0.54), relative to UC-DT. The effects of sleep disturbance and impairment on the relationship between treatment condition (TSC vs. UC-DT) and psychiatric symptoms and functional impairment were significant. Higher provider perception of TSC fit predicted improvements in selected patient outcomes. TSC can be delivered by CMHC providers trained by local CMHC trainers with strong outcomes. These data contribute to the dearth of evidence for TTT collected from locally trained providers and from patients treated by local CMHC trainers. Clinicaltrials.gov identifier: NCT05805657. Registered on March 10, 2023. https://clinicaltrials.gov/ct2/show/NCT05805657.

摘要

基于卫生服务研究实施综合促进行动(i-PARIHS)框架,我们对培训培训师(TTT)项目进行了调查,以扩大社区心理健康中心(CMHC)获得循证心理治疗(EBPT)的机会,重点关注睡眠和昼夜节律功能障碍的跨诊断干预(TSC)。加利福尼亚州的八个县被整群随机分为标准TSC组或为提高TSC与CMHC的“适配性”而设计的改良版TSC组。大学培训师对CMHC提供者(“第一代提供者”)进行改良版或标准版TSC培训。这些经过培训的提供者随后被培训成为当地CMHC培训师(“第一代培训师”),然后他们再对新一批提供者(“第二代提供者”)进行TSC培训。在每个县内,被诊断患有严重精神疾病(SMI)的患者被随机分为立即接受TSC治疗或接受常规护理,并由第二代提供者(“第二代患者”)延迟给予TSC治疗(UC-DT)。本研究聚焦于53名第二代提供者(改良版TSC = 47;标准版TSC = 6)和143名第二代患者(改良版TSC = 127;标准版TSC = 16)(改良版样本量较大是由于招募原因,可能反映出对“适配”方法的偏好)。在治疗前、治疗后和六个月随访(6FU)时对患者进行评估。对提供者的评估在完成TSC培训以及对每位接受治疗的患者治疗后进行。综合改良版和标准版来看,相对于UC-DT,TSC与第二代患者从治疗前到治疗后的睡眠障碍(<0.001,-0.90)、睡眠相关损害(=0.001,-0.69)、精神症状(=0.002,=-0.48)和功能损害(=0.002,=-0.54)的改善相关。睡眠障碍和损害对治疗条件(TSC与UC-DT)与精神症状和功能损害之间关系的影响显著。提供者对TSC适配性的更高认知预示着特定患者结局的改善。TSC可由当地CMHC培训师培训的CMHC提供者提供,且效果良好。这些数据填补了从当地培训提供者以及由当地CMHC培训师治疗的患者中收集的TTT证据的空白。Clinicaltrials.gov标识符:NCT05805657。于2023年3月10日注册。https://clinicaltrials.gov/ct2/show/NCT05805657

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/37f7/12288530/c35e6e05b29c/nihpp-rs6414484v1-f0001.jpg

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