Consumer and Clinician Feedback in Youth Mental Health Care

描述（由申请人提供）：最近呼吁扩大青少年的循证实践，强调需要将治疗反应的评估数据纳入日常临床护理。经常获得结果数据可以帮助临床医生了解，在治疗过程中，他们的病人是否有反应，是否以及何时需要在中期改变治疗策略，哪些改变是有效的，以及什么时候已经取得了治疗效果，什么时候可以结束治疗。现有的研究越来越多地支持向临床医生提供对其成年客户治疗反应的持续反馈的有益效果，但对青少年治疗的了解较少。在为数不多的青少年研究中，没有一个（据我们所知）评估了直接向青少年及其照顾者提供治疗反应反馈的效果。此外，没有研究解决了这样一个问题，即即使治疗监测和反馈系统已经可用，它们也没有被访问和经常使用，这可能是因为这些系统不能充分响应青少年心理保健参与者的需求。拟议的项目将在青少年门诊治疗的背景下解决这些问题：(a)使用定性方法从利益相关者（照顾者、青少年、临床医生、诊所工作人员和管理人员）那里获得关于青少年精神卫生保健监测和反馈系统所需特征的反馈；(b)根据利益相关者的反馈，修改现有的监测和反馈系统TRAC（儿童治疗反应评估），在两家门诊诊所进行试点，并根据对其使用情况和效用的定量和定性评估进一步修订；(c)使用修订后的TRAC进行小样本随机对照试验。随机对照试验参与者将被随机分配到四种治疗条件之一：1；无系统：TRAC将不会被使用；2. 无反馈：青少年客户及其护理人员将把他们的进展数据输入TRAC，但他们和他们的临床医生都无法访问这些数据；3. 临床医生反馈：青少年客户和护理人员将输入数据，他们的临床医生将有权访问数据；和4。临床医生和消费者反馈：青少年客户和护理人员将输入他们的进展数据，他们以及他们的临床医生将能够访问这些数据。分析将评估更大规模试验的可行性，测试向临床医生、护理人员和青少年提供治疗反应反馈的效果（对治疗过程和结果）。这些目标与NIMH战略计划相一致，该计划强调个性化精神卫生保健的重要性（战略3.2和3.4）。

DESCRIPTION (provided by applicant): Recent calls for the expansion of evidence-based practices for youth have stressed the need to incorporate assessment data on treatment response into everyday clinical care. Receiving frequent outcome data can help clinicians understand, during treatment, whether their clients are responding, whether and when mid-course changes in treatment strategy are needed, which changes are effective, and when treatment gains have been achieved and treatment can end. Extant research increasingly supports the beneficial effects of providing clinicians ongoing feedback on their adult clients' treatment response, but less is known about youth treatment. Among the few youth studies, none (to our knowledge) has evaluated the effects of providing treatment response feedback directly to youths and their caregivers. Also, no studies have solved the problem that, even when treatment monitoring and feedback systems have been made available, they have not been accessed and used frequently, perhaps because the systems are not sufficiently responsive to the needs of participants in youth mental health care. The proposed project will address these issues in the context of youth outpatient treatment by (a) using qualitative methods to obtain feedback from stakeholders (caregivers, youths, clinicians, clinic staff, and administrators) regarding desired features of a monitoring and feedback system for youth mental health care; (b) modifying an existing monitoring and feedback system, TRAC (Treatment Response Assessment for Children), in response to stakeholder feedback, piloting it in two outpatient clinics, and revising it further based on quantitative and qualitative assessments of its use and its utility; and (c) conducting a small-sample RCT with the revised TRAC. RCT participants will be randomized to one of four treatment conditions: 1. No system: TRAC will not be used; 2. No feedback: Youth clients and their caregivers will enter their progress data into TRAC, but neither they nor their clinician will have access to the data; 3. Clinician feedback: Youth clients and caregivers will enter data, and their clinicians will have access to the data; and 4. Clinician and consumer feedback: Youth clients and caregivers will enter their progress data, and they as well as their clinicians will have access to the data. Analyses will evaluate the feasibility of a larger trial testing the effects (on treatment process and outcome) of providing treatment response feedback to clinicians, caregivers, and youth. These aims are consistent with the NIMH strategic plan, which emphasizes the importance of personalizing mental health care (Strategies 3.2 and 3.4). PUBLIC HEALTH RELEVANCE: Providing clinicians, caregivers and youths ongoing feedback on youth treatment response is a consumer- focused approach with the potential to improve the process and outcome of youth mental health care, if these important stakeholders will access and use feedback systems. This project seeks to increase the potential public health impact of treatment response feedback by partnering with clinicians, caregivers, youths, clinic staff, and clinic administrators to identify characteristics of feedback systems that make them appealing and useful. Once the stakeholder comments have been used to revise one existing feedback system, a small- sample randomized controlled trial will be used to assess the feasibility of a larger trial evaluating the potential clinical benefits of providing weekly feedback to clinicians, caregivers, and youths.