Child STEPs in California: A Cluster Randomized Effectiveness Trial Comparing Modular Treatment With Community Implemented Treatment for Youth With Anxiety, Depression, Conduct Problems, or Traumatic Stress
Child STEPs in California: A Cluster Randomized Effectiveness Trial Comparing Modular Treatment With Community Implemented Treatment for Youth With Anxiety, Depression, Conduct Problems, or Traumatic Stress
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DOI：
10.1037/ccp0000133
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发表时间：
2017-01-01
影响因子：
5.9
通讯作者：
Krull, Jennifer L.
中科院分区：
文献类型：
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作者：
Chorpita, Bruce F.;Daleiden, Eric L.;Krull, Jennifer L.
目的：本研究报告了一项随机有效性试验的结果，该试验测试了模块化治疗与社区对青少年实施的多种循证治疗。方法：社区治疗师对 138 名年龄在 5 至 15 岁之间的青少年（62 名女孩，76 名男孩）组成不同种族的样本，其主要临床问题涉及与焦虑、抑郁、破坏性行为和/或创伤性应激相关的诊断或临床升高，并由社区治疗师随机分配至以下两种情况之一：(a) 模块化治疗，其中涉及单一模块化方案（即针对儿童的模块化治疗方法；MATCH），允许灵活选择和排序程序以适应不同的情况。在测量反馈的背景下选择治疗重点，以及 (b) 社区实施的治疗 (CIT)，这是县支持的针对青少年实施的多种循证实践。结果：与接受 CIT 治疗的青少年相比，接受 MATCH 治疗的青少年在临床和功能结果方面随着时间的推移表现出明显更快的改善速度，并且在更少的天数内需要明显更少的疗程。护理人员报告的 MATCH 临床改善率 (60%) 显着高于 CIT (36.7%)。此外，处于 CIT 状态的青少年更有可能接受额外的心理社会治疗服务，并且在积极治疗阶段更有可能使用各种精神药物。结论：这些结果扩展了先前的发现，支持模块化、多重点方法的有效性和效率，该方法结合了与社区实施循证治疗相关的监测和反馈。
Objective: This study reports outcomes from a randomized effectiveness trial testing modular treatment versus multiple community-implemented evidence-based treatments for youth. Method: An ethnoracially diverse sample of 138 youth ages 5 to 15 (62 girls, 76 boys) whose primary clinical concerns involved diagnoses or clinical elevations related to anxiety, depression, disruptive behavior, and/or traumatic stress were treated by community therapists randomly assigned to 1 of 2 conditions: (a) modular treatment, which involved a single modular protocol (i.e., modular approach to therapy for children; MATCH) that allowed flexible selection and sequencing of procedures to fit the chosen treatment focus in the context of measurement feedback, and (b) community-implemented treatment (CIT), which was a county-supported implementation of multiple evidence-based practices for youth. Results: Youth treated with MATCH showed significantly faster rates of improvement over time on clinical and functional outcomes relative to youth in the CIT condition and required significantly fewer sessions delivered over significantly fewer days. Caregiver-reported clinical improvement rates were significantly greater for MATCH (60%) versus CIT (36.7%). Further, youth in the CIT condition were significantly more likely to receive additional psychosocial treatment services and were significantly more likely to use a variety of psychotropic medications during the active treatment phase. Conclusions: These results extend prior findings, supporting the effectiveness and efficiency of a modular, multifocus approach that incorporates monitoring and feedback relative to community implementation of evidence-based treatments.