Research on mechanisms of behavior change (MOBCs) has identified several processes that appear to facilitate successful drinking outcomes in alcohol use disorder (AUD) treatments. Often, different evidence- based treatments appear work through similar mechanisms, suggesting that constructs such as drink-refusal self-efficacy, craving, social support for abstinence, and other MOBCs are key variables that should be assessed, targeted in treatment, and monitored for change. Although the research base on MOBCs continues to expand, more work is needed to understand how to utilize MOBCs in real-world practice settings. In non- AUD contexts, measurement-based care research has shown that mental health symptoms improve more quickly and to a greater degree if they are routinely assessed, presented to patients, and discussed with clinicians. However, the impact of a similar approach for MOBCs - i.e., assessing, providing feedback, and discussing MOBCs as routine practice during treatment sessions- has not been tested. Moreover, the specific manner in which assessment, feedback, and discussion of MOBCs could be facilitated in real-world practice has not been explored. MOBC-based assessment tools could be particularly appealing to frontline clinicians given that (1) theoretical approaches often vary between clinicians despite the underlying MOBCs often being similar and (2) movement toward outcome-based performance measures and healthcare reform will require increased measurement and documentation of relevant treatment targets. The proposed K01 career development award provides training to support a research career focused on developing and testing tools that assist frontline clinicians and enhance the quality of their service delivery. Carefully devised training plans will provide training in (1) implementation science in addiction treatment, (2) user centered technology design, and (3) cross-disciplinary collaboration, research dissemination, and grant writing. These goals will be achieved through several means including mentorship from experts, coursework, clinical training, and hands-on experience. The proposed research project complements these training aims by developing a computer-based clinical support tool that is implementation-focused and helps frontline clinicians assess and review patient MOBC data during their treatment sessions. The project will include phases to (1) assess opinions, needs, and desires of stakeholders around developing such a clinical support tool, (2) iteratively test and modify a software prototype to increase the ease of using the tool and understanding its feedback, and (3) test the tool's feasibility, acceptability, and impact on clinicians' within-session behavior. The research will take place at a publicly-funded treatment setting with frontline clinicians and patients. The award will complement the candidate's existing strengths in MOBC research by providing training in new domains involving cross- disciplinary research partnerships, user-centered design, and implementation-focused research.
Research is increasingly improving our understanding of the mechanisms that facilitate better alcohol use disorder treatment outcomes; however, little is known about how to improve clinicians' attention toward assessing, monitoring, and planning treatment goals around these mechanisms. This career development award proposal supports research and training to develop technology that assists frontline clinicians assess, monitor, and develop treatment plans around mechanisms of change in alcohol use disorder treatment.
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