The recent, poor meta-analytic results of evidence-based treatment (EBT) represent a crisis in youth mental health services. There is a dire need for innovative approaches to improving transportability, implementation, and outcomes of services. Model adherence (EBT fidelity) is a necessary but not sufficient mechanism for improving outcomes in community settings. Real-world mental health treatment requires attention to the complexities inherent in the interaction between unique settings, therapists, and clients. As such, therapists implementing EBTs need better support for clinical decision making that may lead to adaptations of the EBT in the service of tailoring treatment. A measurement feedback system (MFS) provides the ongoing treatment progress and process information necessary to assist the therapist in making treatment decisions. As a benefit to the MFS, the EBT provides an essential framework for integration of systematic data into logistical, clinical, and supervisory operations. The synergy of the combination of an MFS and an EBT should improve transportability of EBT, implementation of MFS, and youth and family outcomes. We will integrate an existing EBT [and an existing MFS. The EBT is Functional Family Therapy (FFT), an empirically supported intervention for youths in the juvenile justice and mental health systems. Model-specific data on treatment adherence and progress are provided in the FFT Q-system, a computerized model-specific quality improvement system. The MFS is Contextualized Feedback Intervention and Training (CFIT), which provides computerized feedback on treatment progress and process upon weekly completion of brief standardized measures administered to youths, caregivers, and therapists.] We will determine if this innovative combination has the desired synergistic effect on the provider organizations, therapist behavior, and youth/family outcomes in a community mental health agency with 4 sites where 102 therapists will serve over 4000 youths during the life of the study. A current foundation grant is supporting the development and testing of a computerized system that integrates both existing feedback systems. That work will be complete[d in January 2010]. Therapists will be randomly assigned to one of two groups: (1) Basic FFT (FFT only) or (2) Enhanced FFT (FFT + CFIT). Feedback for the Basic FFT condition includes adherence only, consistent with the typical FFT supervision protocol. For the Enhanced FFT condition, feedback also includes information on youth treatment progress and process This study will address the changes in therapist behavior and youth/family outcomes that may result from providing two different types of therapist feedback in community mental health agencies. The proposed project also includes a low-cost quasi-experimental design comparing implementation of CFIT in this study with a current NIMH study where CFIT is implemented in the absence of an EBT.
Evidence-based treatments (EBTs) have not reached their potential to improve the outcomes for clients in community mental health treatment settings. There is a crisis in youth mental health services demanding innovative approaches for improving transportability, implementation, and outcomes of clinical treatments. The proposed study tests whether adding a measurement feedback system (MFS) that provides feedback on the therapeutic process and outcomes, to an existing EBT that only measures model adherence, improves therapist behavior and ultimately youth/family outcomes.
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