Trajectories of Symptom Reduction During Treatment for Behavior Problems in Pediatric Primary-Care Settings
Trajectories of Symptom Reduction During Treatment for Behavior Problems in Pediatric Primary-Care Settings
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DOI：
10.1007/s10488-011-0335-2
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发表时间：
2011-11-01
影响因子：
2.6
通讯作者：
Kolko, David J.
中科院分区：
文献类型：
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作者：
Lindhiem, Oliver;Kolko, David J.
我们研究了一个较大的临床试验中的一部分儿童在儿科初级保健机构中进行行为问题现场治疗过程中症状减轻的轨迹。参与者（N = 80）是由于儿科症状自评量表（PSC-17）的外化子量表中度升高（>=第75百分位数）而接受治疗的儿童（6-11岁）。样本是从六个儿科实践中招募的城市环境。治疗（基于糖尿病的护士管理干预方案;波尼）由经过培训的护士在3-6个月的过程中现场管理。总体而言，从第一次治疗到最后一次治疗的症状减轻是中度的（ES = 0.61）和渐进的。大约三分之二（72%）的症状减轻发生在治疗的前8周。症状减轻的平均轨迹的特征在于随着时间推移变平的负斜率，与二次增长模型一致。初始症状严重程度预测最终症状严重程度（r = 0.36，P <0.01），即使初始症状严重程度更高的患者继续治疗的次数明显更多（r = 0.24，P <0.05）。这些研究结果的影响，提高治疗的效率和效果进行了讨论。
We examined trajectories of symptom reduction during the course of on-site treatment for behavior problems in pediatric primary-care settings for a subset of children from a larger clinical trial. Participants (N = 80) were children (ages 6-11) referred for treatment due to moderate elevations (>= 75th percentile) on the externalizing subscale of the Pediatric Symptom Checklist (PSC-17). The sample was recruited from six pediatric practices in an urban setting. The treatment (Protocol for an Office-based Nurse-administered Intervention; PONI) was administered on-site by trained nurses over the course of 3-6 months. Overall, symptom reduction from the first session to last session was moderate (ES = 0.61) and gradual. Roughly two-thirds (72%) of symptom reduction took place over the first 8 weeks of treatment. The average trajectory of symptom reduction was characterized by a negative slope that flattened over time, consistent with a quadratic growth model. Initial symptom severity predicted final symptom severity (r = .36, P < .01), even though patients with greater initial symptom severity remained in treatment for a significantly greater number of sessions (r = .24, P < .05). The implications of these findings for enhancing the efficiency and effectiveness of treatment are discussed.