Consumer and Clinician Feedback in Youth Mental Health Care

描述（由申请人提供）：最近呼吁扩大青年循证实践，强调需要将治疗反应的评估数据纳入日常临床护理。接收频繁的结果数据可以帮助临床医生在治疗期间了解他们的客户是否有反应，是否以及何时需要中途改变治疗策略，哪些改变是有效的，以及何时实现治疗收益和治疗可以结束。现有的研究越来越多地支持向临床医生提供关于其成年客户的治疗反应的持续反馈的有益效果，但对青年治疗知之甚少。在为数不多的青少年研究中，（据我们所知）没有一项研究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，没有任何研究解决了这样一个问题，即即使提供了治疗监测和反馈系统，也没有得到经常访问和使用，这可能是因为这些系统没有充分满足青年心理保健参与者的需求。拟议项目将在青年门诊治疗的背景下解决这些问题，方法是：（a）采用定性方法，从利益攸关方获得反馈（照顾者、青少年、临床医生、诊所工作人员和管理人员）关于青少年心理健康护理的监测和反馈系统的期望特征;（B）修改现有的监测和反馈制度，即核心预算资源调拨目标（儿童治疗反应评估），根据利益攸关方的反馈意见，在两个门诊诊所进行试点，并根据对其使用和效用的定量和定性评估进一步修订;（c）利用经修订的TRAC开展小样本随机对照试验。随机对照试验参与者将被随机分配至四种治疗条件之一：1.无系统：将不使用TRAC;无反馈：青少年客户和他们的照顾者将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可以访问这些数据。分析将评估一项更大规模试验的可行性，该试验测试向临床医生、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）。这些目标与国家精神卫生研究所的战略计划相一致，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）。 公共卫生相关性：向临床医生、护理人员和青年提供关于青年治疗反应的持续反馈是一种以消费者为中心的方法，如果这些重要的利益攸关方能够访问和使用反馈系统，就有可能改善青年心理健康护理的过程和结果。该项目旨在通过与临床医生，护理人员，青少年，诊所工作人员和诊所管理人员合作，以确定反馈系统的特征，使其具有吸引力和有用性，从而增加治疗反应反馈的潜在公共卫生影响。一旦利益相关者的意见被用于修改一个现有的反馈系统，一个小样本随机对照试验将被用于评估一个更大的试验的可行性，该试验评估每周向临床医生、护理人员和青少年提供反馈的潜在临床益处。

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.