Telemental Health to Improve Mental Health Care and Outcomes for Children in Unde

描述（由申请人提供）：二十年来，人们已经认识到需要在初级保健（PC）中提供心理健康服务的新模式，但一直缺乏满足这一需求的联邦资金。全国正在实施基本健康计划，以解决获得精神卫生服务方面的不平等问题，但关于其有效性的科学证据很少，特别是对儿童。拟议研究的目标是测试TMH服务提供模式的有效性，以改善由初级保健医生（PCP）在太平洋西北部5个服务不足的社区治疗的儿童的普遍精神疾病的护理和结果。该研究是一项随机对照试验，对诊断为注意力缺陷多动障碍（ADHD）的7-11岁儿童（N=250）进行经TMH提供循证治疗的PCP护理与PCP常规治疗。西班牙裔儿童将占研究样本的30%。实验条件将包括6个药物治疗课程，由儿童精神科医生通过视频会议与转诊PCP一起提供，PCP将开具药物，以及6个由远程心理学家监督的社区治疗师亲自提供的父母行为培训课程。控制条件将包括与PCP一样的常规治疗，并通过单一远程精神病学咨询进行增强，这是参与社区目前的标准治疗。对于实验和对照条件下的儿童，从基线至25周随访，将对多动、注意力不集中、对立/违抗和功能障碍以及父母压力、负担和授权进行5次评估。在实验组中，将仔细监测家庭、远程精神科医生、当地社区治疗师和PCP对治疗方案的遵守情况。如果在实验交付模式下，临床结果的改善得到证明，如果循证治疗协议可以实现保真度，那么TMH卫生服务交付模式可以部署有信心，以帮助纠正严重的地理分布不均的儿科心理健康服务，并建立新的模式，协作护理内PC。这项远程健康（TMH）调查有望从三个方面改善国家的公共健康和福利。首先，TMH通过将专业精神卫生保健从城市中心重新分配到服务不足的社区，为患有情绪和行为障碍的儿童和家庭提供当地无法找到的帮助。第二，TMH提供二级和三级预防，在精神疾病及其相关障碍全面发展之前达到有需要的儿童。第三，TMH提供初级保健医生，教师和其他专业人员的援助，在他们努力照顾我们国家的儿童。

DESCRIPTION (provided by applicant): The need for new models for delivering mental heath services within primary care (PC) has been recognized for two decades, yet federal funding to address this need has been lacking. Telemental health (TMH) programs are being implemented nationally to address inequities in access to mental health services, but little scientific evidence is available regarding their efficacy, particularly with children. The goal of the proposed research is to test the efficacy of a TMH service delivery model for improving care and outcomes for children with a prevalent psychiatric condition who are treated by primary care physicians (PCPs) in 5 underserved communities in the Pacific Northwest. The research proposed is a randomized controlled trial of PCP care augmented by TMH-delivered evidence- based treatment of children (N=250) 7-11 years old diagnosed with attention-deficit hyperactivity disorder (ADHD) versus treatment as usual by the PCP. Hispanic children will comprise 30% of the study sample. The experimental condition will consist of 6 pharmacotherapy sessions delivered by child psychiatrists through videoconferencing in conjunction with the referring PCP who will prescribe medications and 6 sessions of parent behavioral training delivered in-person by a community therapist supervised by a telepsychologist. The control condition will consist of treatment as usual with the PCP augmented by a single telepsychiatric consultation, which is current standard care in the participating communities. For children in both experimental and control conditions, hyperactivity, inattentiveness, oppositionality/defiance, and functional impairment, as well as parental stress, burden, and empowerment will be assessed 5 times from baseline to 25-week follow- up. In the experimental group, adherence to treatment protocols will be carefully monitored for families, telepsychiatrists, local community therapists, and PCPs. If under the experimental delivery model, improvements in clinical outcomes are demonstrated, and if an evidence-based treatment protocol can be implemented with fidelity, then TMH health service delivery models could be deployed with confidence to help rectify the severe geographic maldistribution of pediatric mental health services and to build new models of collaborative care within PC. This telemental health (TMH) investigation holds promise for improving the nation's public health and welfare in three ways. First, TMH offers children and families suffering with emotional and behavioral disorders help that cannot be found locally by redistributing specialty mental health care from urban centers to underserved communities. Second, TMH offers secondary and tertiary prevention by reaching children's in need prior to the full evolution of mental illness and its associated impairments. Third, TMH offers primary care physicians, teachers, and other professionals' assistance in their efforts to care for our nation's children.