Objective

Measurement-based care (MBC), which collects session-by-session symptom data from patients and provides clinicians with feedback on treatment response, is a highly generalizable evidence-based practice with significant potential to improve the outcomes of youth mental health treatment when implemented with fidelity; however, it is rarely used in community settings. This study tested whether an implementation strategy targeting organizational leadership and organizational implementation climate could improve MBC fidelity and clinical outcomes for youth in outpatient mental health clinics.

Method

In a cluster-randomized trial, 21 clinics were assigned to the Leadership and Organizational Change for Implementation (LOCI) strategy plus training and technical assistance in MBC (k=11, n=117) or training and technical assistance only (k=10, n=117). Primary outcomes of MBC fidelity (assessed via electronic meta-data) and youth symptom improvement (assessed via caregiver-reported change on the Shortform Assessment for Children Total Problem Score) were collected for consecutively enrolled youth (ages 4-18 years) who initiated treatment in the 12 months following MBC training. Each youth’s outcomes were assessed for six months following baseline.

Results

In total, 234 youths were enrolled and included in intent-to-treat analyses. At baseline, there were no significant differences by condition on clinic, clinician, or youth characteristics. Youths in LOCI clinics experienced significantly higher MBC fidelity compared to youths in control (23.1% vs. 3.4%, p=.014), and exhibited significantly greater reductions in symptoms from baseline to 6-months (d=0.31, 95% CI: 0.04, 0.58, p=.023).

Conclusion

Implementation strategies targeting organizational leadership and focused implementation climate can improve fidelity to evidence-based practices and clinical outcomes of youth mental health services.

中文翻译：

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组织实施策略的随机试验，以提高社区心理健康中基于测量的护理保真度和青年成果

客观的

基于测量的护理（MBC）是一种高度通用的循证实践，可从患者处收集每次疗程的症状数据，并向临床医生提供治疗反应的反馈，在实施后具有改善青少年心理健康治疗结果的巨大潜力忠诚；然而，它很少在社区环境中使用。本研究测试了针对组织领导力和组织实施氛围的实施策略是否可以提高门诊心理健康诊所青少年的 MBC 保真度和临床结果。

方法

在一项整群随机试验中，21 家诊所被分配到实施领导力和组织变革 (LOCI) 策略以及 MBC 培训和技术援助 (k=11，n=117) 或仅接受培训和技术援助 (k=10， n=117）。收集开始治疗的连续入组青少年（4-18 岁）的 MBC 保真度（通过电子元数据评估）和青少年症状改善（通过护理人员报告的儿童总问题评分简短评估变化进行评估）的主要结果MBC 培训后的 12 个月内。每个青少年的成果均在基线后六个月内进行评估。

结果

总共有 234 名青少年被纳入意向治疗分析。在基线时，临床情况、临床医生或青少年特征没有显着差异。与对照组的青少年相比，LOCI 诊所的青少年的 MBC 保真度显着更高（23.1% vs. 3.4%，p = 0.014），并且从基线到 6 个月的症状明显减少（d = 0.31，95% CI： 0.04, 0.58, p =.023)。

结论

针对组织领导和重点实施氛围的实施策略可以提高青少年心理健康服务对循证实践和临床结果的忠诚度。