EFFECTIVENESS OF COMMUNITY SERVICES FOR CONDUCT PROBLEMS

说明(申请人摘要)：这项建议旨在改善 行为问题儿童心理健康服务的有效性研究 (CP)及其家人，通过评估分娩的假设)， 支持和维护CP的社区环境中的服务将增强 治疗结果、服务满意度/使用和成本效益。 针对三个领域的多式联运服务：(家庭、学校、邻里) 在社区或门诊进行的活动将是 140例临床转诊儿童的随机临床试验对照研究 (6-11岁)被诊断为对抗性/违抗性障碍或行为 无序。治疗将持续大约四个月，并将 通过视频/音频磁带和监督进行监测，以确保遵守。案例 将在治疗前、治疗后以及6个月和6个月后进行评估 随访12个月。终点和意向治疗分析将纳入 多变量模型。干预后和两次随访病例 接受以社区为基础的服务预计会有更大的改善 在五项具体措施上接受以诊所为基础的服务的人 建议用于评估方案有效性的评估域(见 Hoagwood等人，1996)：1)CP症状的严重性(例如，CD减少 症状)，2)功能状态/损害(例如，强化的家庭和学校 调整)，3)环境背景(例如，较少的家庭胁迫/暴力)， 4)客户消费者满意度(例如，更高的孩子和家长评级 服务可接受性和有用性)，以及5)服务使用/系统参与 (例如，更高的参与率)。预测模型将被测试为 确定孩子(例如，ADHD，社交能力)，父母(例如，抑郁， 严厉的惩罚)与家庭变量(例如，支持、冲突)相关 更高的服务参与度和临床改进，以及 确定这些预测因素根据治疗设置有何不同。决赛 探索性目标旨在估计提供服务的直接成本 以社区为基础的服务并评估 基于社区的服务相对于以诊所为基础的服务 关键有效性变量(例如，品行障碍、家庭暴力)。这个 研究结果有望带来更具响应性、更具成本效益的干预措施 为这些高危青年和他们的家人。这样的研究尤其是 考虑到围绕第三方意愿的争议，时间很及时 付款人支付这些服务的费用。

DESCRIPTION (Applicant's abstract): This proposal seeks to improve the effectiveness of mental health services for children with Conduct Problems (CP) and their families by evaluating the hypothesis that delivery), of services in the community settings that support and maintain CP will enhance treatment outcome, service satisfaction/use, and cost-effectiveness. Multimodal services targeting three domains: (family, school, neighborhood) that are conducted either in the Community or an outpatient Clinic will be compared in a randomized clinical trial for 140 clinically referred children (ages 6-11) with a diagnosis of Oppositional/Defiant Disorder or Conduct Disorder. Treatment will last approximately four months and will be monitored via video/audio tapes and supervision to ensure adherence. Cases will be evaluated at pretreatment, posttreatment, and at both six-month and 12-month follow-up. End-point and intent-to-treat analyses will incorporate multivariate models. After intervention and at both follow-ups cases receiving Community-based services are expected to show greater improvements than those receiving Clinic-based services on specific measures in the five assessment domains recommended for evaluation of program effectiveness (see Hoagwood et al., 1996): 1) Severity of CP symptoms (e.g., fewer CD symptoms), 2) functional status/impairment (e.g., enhanced home and school adjustment), 3) environmental context (e.g., less family coercion/violence), 4) client consumer satisfaction (e.g., higher child and parent ratings of service acceptability and usefulness), and 5) service use/system involvement (e.g., higher rates of participation). Predictive models will be tested to determine child (e.g., ADHD, social competence), parent (e.g., depression, harsh punishment) and family variables (e.g., support, conflict) associated with heightened service participation and clinical improvement, and to determine how these predictors differ by treatment setting. A final exploratory aim is designed to estimate the direct cost of providing community-based services and evaluate the cost-effectiveness of community-based services relative to clinic-based services with respect to key effectiveness variables (e.g., Conduct Disorder, family violence). The findings promise to lead to more responsive, cost-effective interventions for these high-risk youth and their families. Such research is especially timely given the controversy surrounding the willingness of third-party payers to cover these services.