Behavioral and Affective Skills in Coping: Practice-Adapted Child Psychotherapy

描述（申请人提供）：循证在疗效条件下进行的随机对照试验中，儿童心理健康问题的（心理社会）治疗（EBT）显示出非常有益的效果;然而，这些EBT，其中大多数集中在一个单一的无序或同质集群，当最初运送到日常临床护理环境并由正在学习使用EBT的从业者用于转诊儿童时，可能会面临挑战第一次许多从业人员的工作条件限制了他们学习EBT的速度，特别是为他们不同的案件量提供足够的EBT。儿童合并症加上治疗过程中目标问题的变化也可能使这些医生使用单一疾病EBT变得复杂。为了解决这些和其他挑战，我们建议通过一个简短的治疗方案来补充单一疾病EBT，该方案包括五项基本技能，可用于治疗涉及焦虑，抑郁和破坏性行为的多种儿童疾病，作为从业者循证实践的第一步。该基本方案整合了五个治疗元素，（a）已用于多种疾病的多种EBT，（B）已显示出即使单独使用也具有显著益处的证据。这五种技能是信念修复（识别和修改适应不良的认知），行动（行为激活/暴露于恐惧或挑战性的情况），解决问题（学习系统解决问题的技能），激励（使用奖励和后果来增加期望的行为）和平静（使用放松技巧来减少痛苦，焦虑或愤怒的觉醒）。拟议的项目分三个阶段，将包括改进和测试BASIC，并评估RCT的准备情况。在第1阶段，将完成基本方案草案，然后通过治疗专家和从业者反馈以及现场测试进行完善。第二阶段将是一个试点开放试验，精神卫生诊所的从业人员将使用BASIC来治疗社区推荐的8-13岁的焦虑，抑郁和行为相关疾病。第3阶段将包括数据分析，重点是临床改进、消费者和临床医生对BASIC方案的可接受性和可行性，以及BASIC用于RCT的准备情况。 公共卫生相关性：美国面临的一个重大公共卫生挑战是，在任何特定时间，大约20%的儿童患有精神健康障碍，对许多人来说，有效的治疗是难以捉摸的。临床科学家已经为这些儿童开发了心理社会治疗，但在实践环境中，这些治疗的实施和有效性仍然存在一些挑战。本申请旨在开发、完善和开始测试一种高效、灵活的治疗方案（称为BASIC），该方案旨在补充以单一疾病为重点的循证治疗方法，这些方法在特定疾病的专业化、强化治疗中非常有效。BASIC将作为从业者循证治疗的一种“第一课程”，从而作为一个桥梁，导致在临床护理环境中越来越多地使用循证实践。

DESCRIPTION (provided by applicant): Evidence-based (psychosocial) treatments (EBTs) for children's mental health problems have shown very beneficial effects in RCTs conducted under efficacy conditions; however, these EBTs, most of which focus on a single disorder or homogenous cluster, may face challenges when initially transported to everyday clinical care settings and used with referred children by practitioners who are learning to use EBTs for the first time. Working conditions of many practitioners limit the pace at which they can learn EBTs, particularly enough EBTs for their diverse caseloads. Child comorbidity plus flux in target problems during treatment may also complicate use of single-disorder EBTs by these practitioners. To address these and other challenges, we propose that single-disorder EBTs be complemented by a brief treatment protocol encompassing five basic skills that can be used to treat multiple child disorders involving anxiety, depression, and disruptive conduct, as a first step toward evidence-based practice for practitioners. This BASIC protocol integrates five treatment elements that (a) have been used in multiple EBTs for multiple disorders, and (b) have shown evidence of significant benefit even when used alone. The five skills are Belief Repair (identifying and modifying maladaptive cognitions), Action (behavioral activation/exposure to feared or challenging situations), Solving Problems (learning skills in systematic problem solving), Incentives (using reward and consequences to increase desired behaviors), and Calming (using relaxation skills to reduce distress, anxiety, or angry arousal). In three phases, the proposed project will include refining and testing BASIC and assessing readiness for a RCT. In Phase 1, the draft BASIC protocol will be completed, then refined via treatment expert and practitioner feedback plus field testing. Phase 2 will be a pilot open trial in which mental health clinic practitioners will use BASIC to treat community-referred 8-13 year-olds for anxiety-, depression-, and conduct-related disorders. Phase 3 will include data analysis, focused on clinical improvement, acceptability and feasibility of the BASIC protocol for consumers and clinicians, and readiness of BASIC for a RCT. PUBLIC HEALTH RELEVANCE: A significant public health challenge for America is that about 20% of its children have a mental health disorder at any given time, and effective treatment for many is elusive. Clinical scientists have developed psychosocial treatments for these children, but some challenges remain for both the implementation and the effectiveness of these treatments in practice settings. This application is an effort to develop, refine, and begin testing an efficient, flexible, treatment protocol-called BASIC-that is designed to complement the single-disorder-focused evidence-based treatments that are so effective in specialized, intensive treatment of specific disorders. BASIC will serve as a kind of "first course" in evidence-based treatment for practitioners and thus as a bridge leading to the increased use of evidence-based practices in clinical care settings.