Preventive Effects of Treatment for Childhood Mental Illness on Adolescent Substance Use

项目摘要/摘要 这项修订后的K23指导职业发展奖将支持候选人开展独立研究 调查儿童在日常护理环境和长期护理环境中使用精神卫生服务的决定因素 儿童心理健康服务使用对青少年心理社会行为结局的预防作用 功能和物质使用。该奖项将为候选人提供物质使用方面的广泛培训 流行病学、卫生政策、卫生服务研究、高级纵向数据分析和潜在变量分析；以及 混合方法研究。这项培训将使应聘者更好地理解循证思维 卫生服务影响以后的物质使用，这是一个重要的公共健康结果，并提供更个性化的有针对性的信息 精神卫生服务和药物使用预防。这项K23奖将为候选人提供方法论和 达到以患者为中心的研究的长期职业目标所需的分析技能 该方案的重点是改善青少年的物质使用结果和获得优质护理的机会。随机对照试验 后续研究表明，儿童精神障碍(CMD)的治疗降低了使用药物的风险；然而， 这些研究无法阐明社区儿童使用心理健康服务的模式对以后的影响 物质使用。此外，确定儿童治疗之间联系的调解人和调解人的研究 精神疾病和后来的药物使用是缺乏的。因此，拟议的研究项目将审查治疗模式 青春期的原发CMD、相关物质使用结果，以及潜在的中介和调节因素 协会。此外，采用混合方法，包括来自主要利益攸关方(青少年、 他们的父母和精神卫生保健提供者)将进一步阐明循证精神卫生的障碍和促进者 卫生服务和其他治疗挑战。具体目标包括：1)描述儿童的心理健康模式 日常护理环境中的服务使用情况；确定与服务使用的连续性相关的人口统计学和临床因素 接受指南一致性护理；2)确定常规护理对SUD和SSD的近端风险因素的影响 随后有问题的物质使用；评估近端危险因素是否中介了CMD常规护理的影响 青春期有问题的物质使用。3)评估早期SUD风险因素是否缓和了常规护理的效果 关于青春期有问题的物质使用的CMD。4)评估物质使用/SUD和CMD的相互影响 儿童和青少年发展的过程。5)与关键利益相关者组成焦点小组，以获得更深层次的 了解指南一致性护理的障碍，并协助制定战略以优化获得高质量护理的机会 并降低弱势青年使用药物的风险。该项目的创新重点是检查长期公众 儿童心理健康服务在发展背景下的健康影响，对来自 高危样本和混合方法的使用将有助于了解青少年SUD的风险和保护因素 以及循证服务的障碍和促进者。

Project Summary/Abstract This revised K23 Mentored Career Development Award will support the candidate in developing an independent research career to investigate determinants of children’s mental health services use in usual care settings and the long-term preventive effects of children’s mental health services use on adolescent behavioral outcomes including psychosocial functioning and substance use. This award will provide the candidate with extensive training in substance use epidemiology, health policy, health services research, advanced longitudinal data analysis and latent variable analysis, and mixed-methods research. This training will permit the candidate to expand understanding of how evidence-based mental health services impact later substance use, an important public health outcome, and inform more individualized targeted mental health services and substance use prevention. This K23 Award will provide the candidate the methodological and analytical skills needed to reach a long-term career goal of developing and implementing a patient-centered research program focused on improving youths’ substance use outcomes and access to quality care. Randomized controlled trial follow-up studies suggest that treatment for childhood mental disorders (CMD) reduces risk of substance use; however, these studies cannot elucidate how patterns of children’s use of mental health services in the community affect later substance use. Further, research identifying moderators and mediators of the association between treatment for childhood mental illness and later substance use is lacking. Thus, the proposed research project will examine treatment patterns for primary CMD, associated substance use outcomes in adolescence, and potential mediating and moderating factors of the association. Additionally, a mixed methods approach, including focus group data from key stakeholders (adolescents, their parents, and mental health care providers), will further elucidate barriers and facilitators to evidence-based mental health services and other treatment challenges. Specific aims include: 1) Characterize children’s patterns of mental health service use in usual care settings; identify demographic and clinical factors associated with continuity of service use and receipt of guideline concordant care; 2) Determine the effects of usual care on proximal risk factors for SUD and subsequent problematic substance use; assess whether proximal risk factors mediate the effect of usual care for CMD on problematic substance use in adolescence. 3) Assess whether early SUD risk factors moderate the effect of usual care for CMD on problematic substance use in adolescence. 4) Assess the reciprocal effects of substance use/SUD and CMD over the course of child and adolescent development. 5) Conduct focus groups with key stakeholders to gain a deeper understanding of barriers to guideline-concordant care and aid in developing strategies to optimize access to quality care and decrease substance use risk among vulnerable youth. This project’s innovative focus on examining long-term public health impacts of children’s mental health services within the developmental context, analysis of longitudinal data from an at-risk sample, and use of mixed methods will contribute to understanding of adolescent SUD risk and protective factors and barriers and facilitators of evidence-based services.