Saturday, November 23, 2024
11/23/2024
DESCRIPTION (provided by applicant): Ecological family therapy (EFT) has by far the largest base of empirical support for treating adolescent substance use (ASU). Manualized EFT models have proven consistently superior to every type of alternative treatment in controlled trials. Yet, EFT has not been widely adopted within ASU treatment systems nationwide. A primary barrier to adoption is the mismatch between the purveyor-driven methods used by manualized EFTs and the needs of the provider community. There are several EFT brands and each has a proprietary set of expensive and highly structured training, supervision, and fidelity control guidelines. These quality assurance (QA) procedures are too costly, inflexible, and externally controlled to meet all needs of a diverse workforce. This study will empirically distill the core techniques of manualized EFTs to produce a non-proprietary, freely available, psychometrically valid EFT QA toolkit (fidelity tool, training/implementation supports) that can be locally sustaine with intramural resources. This toolkit will promote high-fidelity delivery of EFT in routine care or ASU. The timing is perfect for developing this resource: The Affordable Care Act and related policy changes have ushered in unprecedented opportunities to increase adoption of evidence-based approaches in behavioral healthcare via training and certification requirements built into provider contracts. As a result, valid QA procedures and measures for behavioral treatments are in enormous demand. Unfortunately, existing QA procedures do not contain implementation fidelity guidelines: what specific interventions to deliver, and how to do them well. This is currently true for the ASU treatment system, which has promulgated "best practices" consisting of broad principles of client engagement and continuity-of-care rather than specific techniques. The proposed study will synthesize core techniques from three EFT models to construct a QA toolkit for supporting EFT fidelity in routine care. The study will conduct observational fidelity analyses on two pools of recorded sessions: (a) 300 gold-standard EFT sessions from controlled trials of Functional Family Therapy (FFT), Multidimensional Family Therapy (MDFT), and Brief Strategic Family Therapy (BSFT); and (b) 300 front-line EFT sessions from three implementation studies with ASU samples conducted in in routine settings. A new EFT QA measure will be derived from coding these two session pools using well-validated observational fidelity measures associated with FFT, MDFT, and BSFT respectively. As is true for the parent measures, the new QA tool will assess four fidelity dimensions: adherence to core EFT techniques, global EFT competence, therapist-family alliance, and ecological foci. Specific items for the EFT QA tool will be synthesized from gold- standard sessions (Aim 1), verified on front-line sessions (Aim 2), and validated on front-line fidelity ratings and client outcomes (Aim 3). We anticipate success in synthesizing core EFT techniques based on pilot data collected using the same samples, observational fidelity measures, and coding methods described in this proposal. Our pilot data reveal strong correlations among similar items representing four EFT treatment components projected to emerge during data analysis: family engagement, relational reframing, family restructuring, and family skill building. All study analyses and QA toolkit products (fideliy tool and coding manual, description of EFT techniques, training and implementation resources) will be vetted during a collaborative toolkit development process by an Expert Review Panel containing experts in EFT clinical theory and research, distillation of the core elements of manualized treatment models for various childhood disorders, and EFT fidelity-outcome research, along with front-line family therapists who treat ASU. Developing a psychometrically valid EFT QA toolkit from existing manualized resources would create a new QA resource that could be used to assess a wide spectrum of EFT implementation activities in behavioral care: evaluation of EFT training outcomes, data-based treatment planning for ASU and related disorders, administrative and regulatory review of treatment practices, and provider certification, to name a few. Most importantly, the new EFT QA toolkit could accelerate the adoption of EFT in routine care for ASU because providers will be inclined to select an approach that is both highly effective and meets regulatory demands for quality standards in a cost-efficient manner. The proposed toolkit will be available in two ways: (1) Cost-free to any licensed provider for incorporation into their existing intramural procedures for training and monitoring staff clinician; or (2) Packaged as one treatment module within a larger QA and clinical management system. The proposed study is innovative in several ways. It would develop the first QA tool capable of defining universal quality standards for EFT. Existing EFT tools define performance standards only for the given brand- name model and have limited value outside the purveyor's sphere of influence. The study will also produce a roadmap for developing empirical methods for distilling core QA tools based on validated fidelity measures; this innovation has broad applicability to other treatment approaches with multiple manualized versions (e.g., CBT for SUD) and will advance a vital new research area for behavioral healthcare. Finally, study methods will accelerate the pace of identifying quality indicators of EBPs for youth disorders. Current efforts rely on coordinated efforts from multiple research centers to identify quality metrics based on extended periods of literature review and consensus building. In contrast, this study will use empirical distillation methods and vet study data and products with a purposively convened expert panel.
HHS’ Tracking Accountability in Government Grants System (TAGGS) website provides access to detailed descriptions of grants, loans, aggregated direct payments and other types of financial assistance awarded by the HHS Operating Divisions (OPDIVs) and the Office of the Secretary Staff Divisions (STAFFDIVs).
