Attention Deficit Hyperactivity Disorder Clinical Trial
Official title:
Community-Based Care for Minority Adolescents With ADHD: Improving Fidelity With Machine Learning-Assisted Supervision and Fidelity Feedback.
This project proposes to reduce disparities in care among disadvantaged racial/ethnic minority adolescents with ADHD by improving community therapist fidelity to evidence-based behavior therapy through a technology-assisted supervision intervention. In Y01, the research team will work with stakeholders to develop the proposed supervision intervention utilizing two novel technologies: Lyssn + Care4 (LC4S). In Y02, a preliminary clinical trial (N=72) will be conducted in three community mental health agencies in Miami, FL. Adolescent participants will be randomly assigned to receive supervision from a therapist who is trained in LCS4 or provides enhanced supervision as usual(ESAU)using a permuted block randomization strategy that randomizes within site. There will also be double randomization of agency therapists to supervisors. Supervisors will deliver both conditions and investigators will test for contamination to determine the integrity of this design prior to a future R01 that measures patient outcomes. Data from therapists, adolescents and their parents, and supervisors will be collected pre-training, post-training, weekly during service delivery, at EBT completion, and at the end of the trial. The proximal intervention target is therapist fidelity to EBT and the distal targets are service delivery outcomes that include quality, quantity, and speed of delivery. Investigators will also measure indices of consumer fit: cost, acceptability, feasibility, and fidelity to supervision procedures. Sources of data will be audio recorded therapy and supervision sessions, therapist and supervisor report, and project and electronic health records. In longitudinal analyses, time will be modeled as a person-specific variable representing months since baseline. Investigators will nest adolescents within therapists for all analyses.
Status | Not yet recruiting |
Enrollment | 72 |
Est. completion date | December 1, 2022 |
Est. primary completion date | September 1, 2022 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 11 Years to 17 Years |
Eligibility | Inclusion Criteria: - DSM-5 ADHD diagnosis, Enrollment in 6th-12th grade, IQ greater than 70, no history of autism spectrum disorder or thought disorder, client of one of two community mental health agencies Exclusion Criteria: - Autism Spectrum/Thought Disorders, IQ<70 |
Country | Name | City | State |
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n/a |
Lead Sponsor | Collaborator |
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Seattle Children's Hospital | Florida International University |
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Other | Cost | Cost of implementing/subscribing to Care4/Lyssn; Supervisor/ therapist time , technical supports, stakeholder-identified costs | cost will be computed at the end of the year from study records and electronic heath records, an average of 9 months | |
Other | Technology Acceptability | Therapists and supervisors will complete an end of study questionnaire on the acceptability of the Lyssn Care4 Study protocol. | At end of the study, after an average of 9 months | |
Other | Satisfaction with supervision | The Short Supervisory Relationship Questionnaire (Cliffe et al., 2006), which will be completed by therapists and supervisors. | At end of the study, after an average of 9 months | |
Other | Supervision Fidelity | We will adapt a project specific version of the Supervisor Adherence and Competence Scale (SACS; Martino et al., 2016), which will be completed by trained research assistants who listen to audio recordings. In addition, we will train Lyssn to evaluate supervision sessions on this checklist by the end of the trial for potential use as supervisor feedback tool in a future R01. | Weekly, through study completion, an average of 9 months | |
Other | Therapist engagement | Therapist Supervision Attendance: Supervisor logs of supervision dates/times; cancelations/reasons for cancelation; to be developed Weekly Facilitation Resources Use-measure; and completion rate for weekly Care4 support tasks (uploading session audio file and completing fidelity self-report form prior to supervision) forms are very brief questionnaires completed by therapists and supervisors prior to uploading each session in Care4 to measure therapist engagement with Care4 and Lyssn integrations | Weekly, through study completion, an average of 9 months | |
Other | Supervisor Burden | Minutes discussing case on audio recording; supervisor log of prep work for case (not including research tasks). Tapes will be coded by RAs for length and supervision logs will be kept by the supervisors. | Weekly, through study completion, an average of 9 months | |
Other | Exit Interviews | Semi-Structured exit interviews designed to collect qualitative perspectives on the LC4S intervention. | At end of the study, after an average of 9 months | |
Primary | Therapist STAND Fidelity | Behavior therapy content: STAND treatment fidelity checklists (Sibley et al., 2013, 2016, 2019). This data will be collected via therapist self-report, Lyssn (the machine learning tool), and coded by trained research assistants from audio recordings. If there is a discrepancy in sources, a trained RA will code the tape to resolve the discrepancy. | Weekly for an average of 9 months | |
Primary | Therapist MITI Fidelity | Behavior therapy content:Motivational Interviewing Treatment Integrity (MITI) measure (Moyers et al., 2014) will measure MI integrity.This data will be collected via therapist self-report, Lyssn (the machine learning tool), and coded by trained research assistants from audio recordings. If there is a discrepancy in sources, a trained RA will code the tape to resolve the discrepancy. | Weekly for an average of 9 months | |
Secondary | Service Delivery Quality | Quality: (1) Time to Therapist MI Competence; MITI Benchmarks,(Moyers et al., 2014) Accuracy of therapist self-report on MITI indices and fidelity checklists (tested using Polynomial Regression)--will assess concordance between reporters over time. This data will be collected from electronic health records and by coding audio recordings of therapy sessions. |
Weekly for duration that case is active in the agency, an average of 9 months | |
Secondary | Service Delivery Quantity | Quantity: (2) Proportion of EBT delivered by 10th session Speed of Delivery: Number of sessions and days to completion of EBT. This data will be collected from electronic health records and by coding audio recordings of therapy sessions. | Weekly for duration that case is active in the agency, an average of 9 months |
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