Developing and Testing the Feasibility of Voice Over Internet Protocol Delivered

抽动症综合行为干预（CBIT）是治疗抽动症（TS）儿童的一种新兴治疗方法，在儿童和成人的单独随机试验中已被证明是有效的；然而，由于训练有素的治疗提供者有限，许多患有TS的儿童家庭无法获得治疗。最近的研究表明，视频会议授课的CBIT与面对面授课一样有效，而且两种方式都有效。尽管它很有效，但传统的视频会议有其局限性，包括缺乏可移植性、易于访问、需要第三方诊所和成本。一种更新、更方便的增加访问的替代方案是使用互联网协议语音（VoIP）传输，允许将CBIT直接传送到患者家中。因此，拟议研究的广泛、长期目标是通过开发和测试voip提供的CBIT的可行性和初步功效来增加对CBIT的访问。具体而言，本项目旨在修改现有的通过VoIP进行抽动的CBIT协议，评估通过VoIP和面对面进行的抽动严重程度评定量表——耶鲁全球抽动严重程度量表（YGTSS）的跨模式可靠性，确定VoIP修改版CBIT的可接受性、可用性和可行性，并与等待列表对照条件相比，确定VoIP修改版CBIT在减少TS儿童抽动方面的初步效果。作为一项探索性目的，本研究将调查治疗结果的潜在相关因素，包括可用的家用电脑设备（即网络摄像头类型、麦克风类型、互联网上传速度和互联网连接类型）、先前的电脑经验以及对学习电脑设备的舒适度。原始的CBIT手册将适用于VoIP。然后将在4名儿童中对改进后的voip治疗进行试点测试，以确定初步效果，以及是否需要进一步改进。在试验之前，将评估主要结局指标耶鲁全球抽动严重程度量表的跨模态可靠性。为了测试干预措施的初步效果，将招募20名以TS或慢性抽动障碍为主要诊断的儿童（9-17岁）进行随机、观察者盲、等待名单对照的voip交付CBI试验。参与者将被随机分配到通过Skype(c)进行8周的CBIT-VoIP会话，为期10周的急性治疗期，或等待列表控制条件。拟议的研究与NIMH服务和干预研究部概述的高度优先领域是一致的，因为拟议的研究寻求适应一种治疗方法，以用于创新的服务提供模式，并通过有效性研究和初步疗效试验来测试干预措施。

A Comprehensive Behavioral Intervention for Tics (CBIT) is an emerging treatment for children with Tourette Syndrome (TS) and has been shown to be efficacious in separate randomized trials with children and adults; however, many families of children with TS are prevented from accessing it due to limited availability of adequately trained treatment providers. Recent research has shown that videoconference-delivered CBIT is as effective as face to face delivery, and that both modalities are efficacious. Despite its effectiveness, traditional videoconferencing has limitations including lack of portability, ease of access, the need for third party clinics, and cost. A newer, more convenient alternative to increase access is the use of Voice over Internet Protocol (VoIP) transmission, allowing for the direct delivery of CBIT to patients' homes. Therefore the broad, long-term objective of the proposed research is to increase access to CBIT through developing and testing the feasibility and preliminary efficacy of VoIP-delivered CBIT. Specifically, this project seeks to modify the existing CBIT protocol for tics to be administered via VoIP, assess the cross-modality reliability of a tic severity rating scale, the Yale Global Tic Severity Scale (YGTSS) administered via VoIP and face to face, determine the acceptability, usability, and feasibility of the VoIP-modified version of CBIT, and establish the preliminary efficacy of VoIP-modified CBIT for reducing tics in children with TS compared to a waitlist control condition. As an exploratory aim, the current study will investigate potential correlates of treatment outcome, including home computer equipment available (i.e., web camera type, microphone type, internet upload speed, and type of internet connection), prior computer experience, and comfort with study computer equipment. The original CBIT manual will be adapted for use with VoIP. The VoIP-modified treatment will then be pilot tested with 4 children to determine initial effectiveness, and whether further modifications are needed. Prior to the trial, the cross-modality reliability of the primary outcome measure, the Yale Global Tic Severity Scale, will be assessed. To test preliminary efficacy of the intervention, 20 children (ages 9-17) with TS or Chronic Tic Disorder as a primary diagnosis will be recruited for a randomized, observer-blind, waitlist controlled trial of VoIP-delivered CBI. Participants will be randomly assigned to 8 weekly sessions of CBIT-VoIP through Skype(c) over a 10- week acute treatment period, or waitlist control condition. The proposed research is consistent with the areas of high priority outlined by the NIMH Division of Services and Intervention Research, as the proposed research seeks to adapt a treatment for use in an innovative service delivery modality, and test the intervention through both effectiveness research and a preliminary efficacy trial.