Community-Based Care for Minority Adolescents With ADHD: Improving Fidelity With Machine Learning-Assisted Supervision and Fidelity Feedback.

The registry criteria, word for word

What the trial wants to find out

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.

The 2 groups in the trial

• Artificial Intelligence-Assisted Supervision ProtocolTreatment being tested

  Measurement-based supervision protocol that incorporates fidelity measurement from a machine learning tool and feedback reports from this tool into a standardized supervision protocol for behavior therapy to task-shift burdensome supervision tasks to a machine, reducing costs and improving precision of fidelity measurement for agencies.

• Enhanced Supervision as Usual (ESAU) ConditionNo study treatment, for comparison

  ESAU therapists will be given standard, paper-based facilitation resources for STAND and will receive 4 hours of training on how to navigate these materials and self-assess fidelity. ESAU therapists will also be trained how to upload recordings into Care4 and complete self-assessments for each session. Supervisors will be given access to these data and recordings once uploaded (but not Lyssn scores or electronic facilitation resources).