Improving Care for Anxiety in Pediatric Settings

描述（由申请人提供）：该指导研究科学家发展奖（K01）将为申请人提供从事独立研究项目的技能，最终改善初级保健机构中患有焦虑症的儿童的治疗。该奖项将在圣地亚哥儿童和青少年服务研究中心和加州大学圣地亚哥分校的背景下进行，候选人的赞助人将是Ann Garland博士和共同赞助人Murray Stein博士。该奖项将允许申请人在儿童焦虑和治疗结果研究方面建立强大的现有培训。申请人正在寻求心理健康服务研究方面的新培训和经验，以解决与服务参与有关的关键问题（例如，最初接受和持续使用服务），以便推进对传统上服务不足的人群，即焦虑症患者和拉丁裔青年的有效性研究。建议的培训计划包括：1)卫生服务研究的理论和实证模型，2)拉丁美洲人的服务利用，3)定性方法，4)服务参与和有效性干预策略，以及5)多层次和纵向数据分析。本研究的主要目标是确定影响服务参与的儿童和父母因素，并利用这些信息在初级保健环境中适应和试点测试基于证据的儿童焦虑干预。第二个目标是研究影响拉丁裔家庭参与的因素。该研究计划采用混合方法，包括定性和定量策略。参与者将从儿科初级保健机构招募。将对30名满足和未满足治疗需求的焦虑青年的父母进行定性访谈。一项针对150个焦虑青年家庭的定量研究也将用于确定影响参与的易感性、促成性和需求特征。有了父母对护理障碍的看法，儿童焦虑治疗将适应包括参与策略，并在初级保健中可行。焦虑青少年的家庭（N= 26）将随机接受基于证据的焦虑干预，包括参与策略或支持治疗（N= 26）。有关功能和症状改善、治疗可接受性、初始吸收和依从性的数据将用于设计和参数化初级保健中儿童焦虑症的更大有效性试验。

DESCRIPTION (provided by applicant): This Mentored Research Scientist Development Award (K01) will provide the applicant with skills to pursue an independent program of research to ultimately improve treatment for children with anxiety disorders in primary care settings. This award will be pursued within the context of the San Diego Child and Adolescent Services Research Center and the University of California San Diego where the candidate's sponsor will be Dr. Ann Garland and co-sponsor, Dr. Murray Stein. This award will allow the applicant to build on strong existing training in child anxiety and treatment outcome research. The applicant is seeking new training and experience in mental health services research to address critical issues related to service engagement (e.g., initial uptake and ongoing use of services) in order to advance effectiveness studies for traditionally underserved populations, namely those with anxiety disorders and Latino youth. The proposed training plan includes coursework and mentoring in: 1) theoretical and empirical models of health services research, 2) service utilization in Latinos, 3) qualitative methodologies, 4) service engagement and effectiveness intervention strategies, and 5) multilevel and longitudinal data analysis. The primary goal of the proposed research is to identify child and parent factors that affect service engagement and to use this information to adapt and pilot test an evidence based child anxiety intervention in the primary care setting. A secondary goal is to examine factors that affect engagement for Latino families. The research plan relies on a mixed method approach including qualitative and quantitative strategies. Participants will be recruited from pediatric primary care settings. Qualitative interviews will be conducted with 30 parents of anxious youth with met and unmet treatment need. A quantitative study with 150 families of anxious youth will also be used to identify predisposing, enabling, and need characteristics that influence engagement. Equipped with parent perspectives about barriers to care, a child anxiety treatment will be adapted to include engagement strategies and to be feasible in primary care. Families of anxious youth (N= 26) will be randomized to receive an evidence based anxiety intervention with engagement strategies or supportive therapy (N = 26). Data regarding functional and symptom improvement, treatment acceptability, initial uptake and adherence will be used to design and parameterize a larger effectiveness trial for child anxiety disorders in primary care.