Trial of psychosocial training for pediatric generalists

背景资料：社区调查发现，15%至20%的学龄儿童有一种或多种严重到需要治疗的心理健康状况。 即使有专门的心理健康咨询，很大一部分儿童的心理健康问题是由通才确定和治疗的。 尽管许多通才提供者都坚定地致力于治疗心理健康问题，但评估表明，由通才确定的儿童中有15%至40%没有得到治疗。 针对治疗成人的全科医生的培训计划表明，精神卫生保健可以得到改善，但这些研究尚未转化为儿科环境。 在概念化的心理治疗技术的进步，不断发展的知识，培训医生的沟通技巧，提供了一个强大的背景下，儿科医生和家庭医生的干预。研究方法：准实验性临床试验的两个阶段，高度互动，培训计划涉及模拟病人和个性化，结构化的反馈和分析的心理社会技能。 该培训计划基于心理治疗过程的跨理论模型，包括与父母和儿童参与，问题识别，以解决方案为中心的治疗以及使用动机访谈进行有效的心理健康转介相关的技能。人口和环境：大约50名职业中期儿科医生和家庭医生;大约350名5-17岁的儿童及其母亲。 两个区域，多站点，多专业的工作人员模式的做法，提供资本和收费的服务照顾城市，郊区和农村人口。结果测量：通过标准化工具（优势和困难问卷）测量儿童心理健康症状和功能的改善（6个月期间）;儿科服务利用率的变化;社区服务利用率;母亲情绪健康和家庭功能的测量。

Background: Community surveys find that from 15-20 percent of school-age children have one or more mental health conditions sufficiently severe to warrant treatment. Even where specialty mental health consultation is available, a substantial proportion of children's mental health problems are identified and treated by generalists. Though many generalist providers are strongly committed to treating mental health problems, evaluations suggest that anywhere from 15 to 40 percent of children identified by generalists get no treatment. Training programs for generalists treating adults show that mental health care can be improved, but these studies have yet to be translated into pediatric settings. Advances in the conceptualization of psychotherapeutic techniques, and evolving knowledge about training physicians in communication skills, provide a strong background on which to base an intervention for pediatricians and family physicians. Methods: Quasi-experimental clinical trial of a two-session, highly interactive, training program involving simulated patients and personalized, structured feedback and analysis of psychosocial skills. The training program is based on a transtheoretical model of psychotherapuetic process, and includes skills related to engaging parents and children, problem identification, solution-focused therapy, and using motivational interviewing to make effective mental health referrals. Population and setting: Approximately 50 mid-career pediatricians and family physicians; approximately 350 children ages 5-17 and their mothers. Two regional, multi-site, multi-specialty staff model practices providing capitated and fee for service care to urban, suburban, and rural populations. Outcome measures: Improvement in child mental health symptoms and functioning (over a 6 month period) measured by a standardized instrument (the Strengths and Difficulties Questionnaire); changes in utilization of pediatric services; utilization of community services; measures of mothers' emotional well-being and of family function.