Mental Health Care for Children With Disruptive Behavior Problems: A View Inside Therapists' Offices
Mental Health Care for Children With Disruptive Behavior Problems: A View Inside Therapists' Offices
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DOI：
10.1176/ps.2010.61.8.788
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发表时间：
2010-08-01
影响因子：
3.8
通讯作者：
Ganger, William
中科院分区：
文献类型：
--
作者：
Garland, Ann F.;Brookman-Frazee, Lauren;Ganger, William
目的：在美国，花在儿童心理健康问题治疗上的钱比花在其他任何儿童疾病治疗上的钱都多，但人们对儿童的常规护理治疗知之甚少。本研究的目的是表征具有破坏性行为问题的儿童的常规护理门诊心理治疗，并确定常规护理与循证实践的共同要素之间的一致性和不一致性，以便为在常规护理中实施循证实践的努力提供信息。方法：参与者包括96名心理治疗师和191名4至13岁的儿童，他们在六个常规护理诊所之一接受破坏性行为治疗。采用儿童心理治疗策略治疗过程观察编码系统量表（TPOCS-S）的改编版本，对随机选择的1215个（从收集的3241个）录像治疗过程进行心理治疗过程评估；治疗疗程记录长达16个月。结果：大多数儿童接受了大量的治疗（平均治疗次数为22次，加上儿童接受了其他辅助服务），并且在接受的治疗数量和类型上存在很大的差异。治疗师采用了一系列针对儿童和家长的治疗策略，但平均而言，所有策略的强度都很低。经常观察到几种在概念上与循证实践一致的策略（例如，影响教育和使用正强化）；然而，其他人很少被观察到（例如，分配或复习家庭作业和角色扮演）。结论：常规护理治疗的广度大，深度小。结果突出了循证护理和常规护理之间的具体差异，从而确定了提高常规护理有效性的潜在有效目标。（精神科服务61:788-795,2010）
Objectives: In the United States, more money is spent on treatment for children's mental health problems than for any other childhood medical condition, yet little is known about usual care treatment for children. Objectives of this study were to characterize usual care outpatient psychotherapy for children with disruptive behavior problems and to identify consistencies and inconsistencies between usual care and common elements of evidence-based practices in order to inform efforts to implement evidence-based practices in usual care. Methods: Participants included 96 psychotherapists and 191 children aged four to 13 who were presenting for treatment for disruptive behavior to one of six usual care clinics. An adapted version of the Therapy Process Observational Coding System for Child Psychotherapy-Strategies scale (TPOCS-S) was used to assess psychotherapy processes in 1,215 randomly selected (out of 3,241 collected) videotaped treatment sessions; treatment sessions were recorded for up to 16 months. Results: Most children received a large amount of treatment (mean number of sessions=22, plus children received other auxiliary services), and there was great variability in the amount and type of care received. Therapists employed a wide array of treatment strategies directed toward children and parents within and across sessions, but on average all strategies were delivered at a low intensity. Several strategies that were conceptually consistent with evidence-based practices were observed frequently (for example, affect education and using positive reinforcement); however, others were observed rarely (for example, assigning or reviewing homework and role-playing). Conclusions: Usual care treatment for these youths reflected great breadth but not depth. The results highlight specific discrepancies between evidence-based care and usual care, thus identifying potentially potent targets for improving the effectiveness of usual care. (Psychiatric Services 61:788-795, 2010)