Consumer and Clinician Feedback in Youth Mental Health Care

描述(由申请人提供)：最近呼吁扩大针对青年的循证实践，强调有必要将治疗反应的评估数据纳入日常临床护理。收到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，是否需要以及何时需要在治疗策略中进行中途改变，哪些改变是有效的，以及何时已经取得治疗成果和治疗可以结束。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。在为数不多的青年研究中，没有一项(据我们所知)评估直接向青年及其照顾者提供治疗反应反馈的效果。此外，没有研究解决这样的问题，即即使提供了治疗监测和反馈系统，也没有人经常使用它们，这可能是因为这些系统没有充分满足青年精神卫生保健参与者的需要。拟议项目将在青年门诊治疗的背景下解决这些问题，办法是：(A)使用定性的方法，就青年精神卫生保健监测和反馈系统的期望特点获得利益攸关方(护理者、青少年、临床医生、诊所工作人员和行政人员)的反馈；(B)根据利益攸关方的反馈，修改现有的监测和反馈系统--儿童治疗反应评估(TRAC)，在两个门诊诊所试行，并根据对其使用及其效用的定量和定性评估进一步修订；(C)根据修订的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为四种治疗条件之一：1.无系统：不使用TRAC；2.无反馈：青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这些数据；3.临床医生反馈：青年客户和照顾者将输入数据，他们的临床医生将可以访问数据；4.临床医生和消费者反馈：青年客户和照顾者将输入他们的进展数据，他们和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，以测试向临床医生、护理人员和青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战略计划一致，该战略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：为临床医生、照顾者和青少年提供关于青少年治疗反应的持续反馈是一种以消费者为中心的方法，有可能改善青少年心理健康护理的过程和结果，如果这些重要的利益攸关方能够获得和使用反馈系统的话。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，确定反馈系统的特点，使其具有吸引力和实用性，从而增加治疗反应反馈对公共卫生的潜在影响。一旦利益相关者的意见被用来修改一个现有的反馈系统，一个小样本的随机对照试验将被用来评估一个更大的试验的可行性，评估每周向临床医生、护理人员和年轻人提供反馈的潜在临床好处。

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.