SBIR-STTR Award

The fields of mental health, child welfare, and juvenile justice are jointly faced with the challenge of reducing the prevalence of antisocial behavior among adolescents. In the last 20 years, conduct disorders have moved from being considered intractable difficulties to having difficult but available solutions. Empirically-validated interventions are now being widely disseminated, but the replication of the results from clinical trials in community settings remains problematic. The systems, which produced impressive effects in a research-context, are difficult to replicate without intensive monitoring of fidelity by the intervention developers. Intensive monitoring is a barrier toward adoption, in particular, as the distance between the adopter and developer increases so does cost. At the same time, states, communities, and agencies are under increasing pressure to implement those intervention services that have been shown to be most effective. One possible solution to this problem is to develop feedback mechanisms for supervisors and interventionists as part of the data collection and reporting functions with an Internet-based system. Such a system could link local clinical programs and nationally-based dissemination teams through direct, immediate to high quality data, and would make it more likely that local service organizations are able to implement services at the highest possible fidelity. As fidelity of these empirically-validated treatments has been shown to be related to the quality of their outcomes, it is of critical importance to develop innovative service delivery systems that increase fidelity in the dissemination of these proven treatment approaches. This project would develop and test the feasibility and satisfaction with an enhanced Internet-based supervision/fidelity system among agencies delivering Multidimensional Treatment Foster Care (MTFC). Our proposed system will include: (a) a secure website with multiple levels of access restrictions for data storage, display of reports (both graphical and tabular) and observations for dynamic feedback; (b) computer-mediated forms of clinical (e.g. daily reporting of child behavior) and supervisory ratings and activities (e.g., program tasks such as therapy appointments and clinical meetings) tailored to the participating program with both Internet-based and automated-phone-based response formats; and (c) computer-mediated video observation (clinical meetings & individual sessions). This proposed system would record (via computer digital video camera) essential clinical staff and foster parent meetings, compress and encrypt the video data for transmission via the Internet, and the secure transmission of the video data over the Internet for coding and reporting.

Thesaurus Terms:
Internet, antisocial personality, child behavior disorder, child foster care /adoption, computer assisted medical decision making, computer system design /evaluation, data management computer graphics /printing, computer human interaction, computer program /software, digital imaging, information dissemination, personal log /diary, telemedicine, video recording system behavioral /social science research tag, clinical research, human subject

The proposed project builds upon Phase I ""proof of concept"" efforts wherein the basic foundational components of an Internet-based Treatment Fidelity Monitoring System, the ITFMS, were created to assist MTFC consultants and implementing agencies to improve clinical outcomes by moving more efficiently towards and maintaining fidelity of program implementation. ITFMS feasibility for community agency, foster parent, and program consultant use was also examined (please see Phase I report). The Phase II aims involve the completion of the ITFMS system and a randomized controlled trial of the effectiveness of the final system. Within our effectiveness examination, we will focus on outcomes related to increasing MTFC agency and program consultant efficiency in moving towards criteria for implementation fidelity. Completion objectives for the ITFMS system will involve: 1) refinement and enhancement of the existing ITFMS foundational system components, in response to both reviewers and Phase I beta testers, such that the full set of site data necessary to fulfill MTFC fidelity criteria and certification requirements can be remotely and more efficiently entered and viewed by implementing agencies;2) addition of an integrated system component that will take the day-to-day data collected within each implementation site and automatically integrate and display it in a manner that will allow sites, program consultants, and developers to be more formatively aware of agency movement towards MTFC fidelity and more proactive in their feedback and discussions relative to supporting positive changes in site implementation;3) addition of a professional communication system that will allow for the free-flow of program ideas and implementation information not only between program consultants and sites, but also between implementation sites such that issues, problems and support can be garnered in an on- going, productive, and meaningful manner;and 4) a parent support component with resources and moderated peer-to-peer support. Once ITFMS system development is completed, it will first be offered to currently active MTFC sites for beta-testing and feedback on the entire system. Feedback from these sites will be integrated into the ITFMS system and then new and developing implementation sites will be solicited to participate in the randomized-controlled trial. The trial will involve randomly assigning sites to either a standard or internet-based MTFC consultant-supported implementation service. Because ITFMS is meant to facilitate movement towards MTFC fidelity implementation by community agencies, important fidelity domains derived from the fidelity management and effectiveness research will be assessed, including outcome indicants of implementation process, implementation efficiency, and implementation effectiveness. It is hypothesized that ITFMS agencies will report greater levels within each of these implementation fidelity domains when compared to the traditionally-implemented MTFC program. We will also assess commercialization indicants reflecting ITFMS usage and system satisfaction within implementing agencies. , ,

Public Health Relevance:
Mental health, child welfare, and juvenile justice agencies are jointly faced with the challenge of reducing the prevalence of adolescent antisocial behavior, but sadly, even though empirically-validated programs are available and widely disseminated, replication of research results in community settings remains slow and problematic. A critical contributor to unsuccessful dissemination efforts is the prohibitive need for intensive monitoring by intervention developers/consultants;a difficulty exacerbated as the distance increases between these individuals and community agencies attempting to achieve and maintain implementation fidelity. The current project proposes one possible solution to this problem by developing an Internet-based fidelity feedback mechanism for program consultants, clinical supervisors and interventionists as part of an empirically-validated program's data collection and reporting functions;mechanisms that would link local clinical programs and nationally-based dissemination teams through direct, immediate, high quality data and make it more likely that local service organizations can implement services at the highest possible level of fidelity and achieve stronger community-based intervention outcomes.

Thesaurus Terms:
Adolescent;Adolescent Behavior;Adolescent Youth;Adopted;Adoption;Behavior;Caring;Certification;Child Welfare;Client;Clinical;Clinical Trials;Clinical Trials, Unspecified;Collection;Communication;Communities;Complex;Computer Systems Development;Computers;Continuance Of Education;Continuing Education;Data;Data Collection;Data Display;Data Quality;Data Reporting;Data Storage And Retrieval;Development;Development, Computer Systems;Disease;Disorder;Education, Continuing;Educational Materials;Effectiveness;Europe;Feedback;Funding;Goals;Home;Home Environment;Individual;Infrastructure;Internet;Intervention;Intervention Strategies;Justice;Link;Marketing;Mediating;Mental Health;Mental Hygiene;Methods;Modeling;Monitor;Movement;North America;Outcome;Parents;Phase;Phone;Pressure;Pressure- Physical Agent;Prevalence;Process;Programs (Pt);Programs [publication Type];Protocol;Protocols Documentation;Psychological Health;Randomized;Randomized Controlled Trials;Relative;Relative (Related Person);Reporting;Research;Research Infrastructure;Research Resources;Resources;Secure;Services;Site;Social Support System;Solutions;Supervision;Support System;System;System, Loinc Axis 4;Systems Development;Telephone;Testing;Time;Translations;Www;Youth;Youth 10-21;Access Restrictions;Adolescent Welfare;Alternative Treatment;Anti Social;Antisocial;Base;Body Movement;Clinical Investigation;Cohort;Commercialization;Community Setting;Cost;Data Retrieval;Data Storage;Design;Designing;Disease/Disorder;Effectiveness Research;Flexibility;Foster Care;Foster Parent;Improved;Innovate;Innovation;Innovative;Interventional Strategy;Juvenile;Juvenile Human;Knowledge Base;Meetings;Peer;Pressure;Programs;Prototype;Public Health Relevance;Randomisation;Randomization;Randomized Controlled Study;Randomly Assigned;Response;Satisfaction;Service Intervention;Treatment Effect;Web;Web Site;World Wide Web