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

点击翻译按钮获取中文摘要

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.