Collaborative Child Mental Healthcare in Low-Resource Settings

资源匮乏环境中的协作儿童心理保健

• 批准号: 9323592
• 负责人: LAWRENCE S WISSOW
• 金额: $ 20.98万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-08-01 至 2019-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9323592
• 关键词: Address; Adolescence; Adolescent; Adult; Age; Area; Caring; Characteristics; Child; Child Care; Child Mental Health; Childhood; Cities; Clinical; Clinical assessments; Comorbidity; Country; Data; Development; Diagnostic; Disease; Early Intervention; Effectiveness; Elements; Family; Family Physicians; Feedback; General Practitioners; Goals; Health Resources; Health Services Research; Health system; Healthcare; Human Resources; Hybrids; Information Systems; Intervention; Iran; Knowledge; Life Cycle Stages; Measurement; Measures; Medical; Mental Health; Methods; Modeling; National Institute of Mental Health; Nature; Outcome; Outcome Assessment; Parents; Play; Population; Preventive Intervention; Primary Health Care; Process; Process Assessment; Provider; Psyche structure; Psychiatric Hospitals; Psychiatrist; Randomized; Recruitment Activity; Referral and Consultation; Registries; Research; Research Personnel; Research Project Grants; Resources; Role; Rural; Schools; Services; South Asian; Symptoms; Testing; Training; Training Programs; Visit; Work; Youth; base; burden of illness; cohort; collaborative care; collaborative trial; community based service; course development; design; deviant; disability burden; global health; health training; implementation trial; improved; improved outcome; low and middle-income countries; medical specialties; payment; prevent; primary care setting; primary outcome; programs; public health relevance; response; scale up; screening; social stigma; uptake

 DESCRIPTION (provided by applicant): Mental health problems cause a disproportionate burden of disability among children and youth compared to adults. Primary care plays an important role in efforts to prevent and intervene early in the course of child and adolescent mental health problems, but while research with adults has shown the feasibility of integrating mental health care into primary care settings there have been few studies among children and youth. Evidence remains lacking that integration is feasible in diverse settings, that it improves outcomes and that methods can be developed to address the multi-dimensional symptoms of emerging child/youth problems and their co-morbidity with developmental and parental disorders. Goals: The purpose of this application, in response to RFA-MH-15-330, is to test the effectiveness of adding a child/youth mental health component into an existing collaborative care program for adult mental health problems. The work will refine a framework for efficient cultural adaption and tailoring of an existing child/youth primary care mental health intervention and then test whether the tailored intervention results in improved child and parent outcomes. The work will also provide evidence about the mechanisms by which those outcomes are achieved and what factors influence uptake of the child/youth component by general practitioners (GPs). These results should be generalizable to other low and middle income countries and to underserved areas of the US where there are minimal child mental health resources and family physicians provide the bulk of medical care for children and youth. Methods: The planned work involves the adaptation/tailoring process followed by a hybrid effectiveness-implementation trial with 45 GPs already engaged in collaborative care for adults; the trial will study adding collaborative care for children ages 3-15. GPs will be randomly assigned, using a stepped wedge design, to begin 6-month control periods involving child mental health screening and referral. They will then receive child/youth training and begin second 6-month periods of screening plus ongoing coaching and booster sessions and collaborative management. Primary outcomes will be measured by recruiting and following for 6 months two cohorts of children/youth and their parents (one control, one collaborative care). Data collected from GPs, parents, youth, and the collaborative care data system will allow measurement of key moderators of implementation and effectiveness.

 描述（由申请人提供）：与成年人相比，精神健康问题在儿童和青少年中造成不成比例的残疾负担。初级保健在儿童和青少年心理健康问题的早期预防和干预方面发挥着重要作用，但尽管对成人的研究表明将心理健康护理纳入初级保健环境的可行性，但在儿童和青少年中的研究很少。仍然缺乏证据表明，整合在不同的环境中是可行的，它可以改善结果，并可以制定方法来解决新出现的儿童/青年问题的多方面症状及其与发育和父母疾病的共同发病率。目标：本申请的目的是响应RFA-MH-15-330，旨在测试将儿童/青少年心理健康组件添加到现有成人心理健康问题协作护理计划中的有效性。这项工作将完善一个框架，有效的文化适应和定制现有的儿童/青少年初级保健心理健康干预，然后测试是否量身定制的干预措施，改善儿童和家长的结果。这项工作还将提供有关实现这些成果的机制的证据，以及影响全科医生（GP）对儿童/青年部分的吸收的因素。这些结果应该推广到其他低收入和中等收入国家，以及美国服务不足的地区，那里的儿童心理健康资源最少，家庭医生为儿童和青少年提供大部分医疗服务。研究方法：计划的工作包括适应/定制过程，然后是混合有效性实施试验，其中45名全科医生已经参与了成人的协作护理;该试验将研究增加3-15岁儿童的协作护理。全科医生将被随机分配，采用阶梯楔形设计，开始6个月的控制期，包括儿童心理健康筛查和转诊。然后，他们将接受儿童/青少年培训，并开始第二个6个月的筛选期，加上持续的辅导和助推器会议和协作管理。主要结局将通过招募两个队列的儿童/青少年及其父母（一个对照组，一个协作组）并随访6个月来测量。从全科医生、家长、青少年和协作护理数据系统收集的数据将允许测量实施和有效性的关键调节者。