Collaborative Mental Health Services for Behavior Disorders in Primary Care

描述（由申请人提供）：该竞争性延续研究扩展了我们的母研究（初级保健中行为问题治疗的有效性; MH 63272），旨在更有效地治疗儿科初级保健环境中的破坏性行为问题（DBP）儿童。我们的强化治疗计划，医生-办公室协作护理（DOCC），反映了一种护理管理方法，通过由临床护理经理协调的综合内部服务和资源，将儿童的儿科医生纳入其中。来自六个初级保健办公室的医生群将被随机分配到DOCC或按需治疗（TAU）。这些PCP的患者将简单地接受其各自PCP的干预条件。将收集背景信息，以检查原始母研究中使用的相同三个协变量（ADHD、任何其他共病疾病、既往MH治疗）的组可比性。根据我们的母公司研究和为期一年的试点研究的结果，本文纳入了几项进展：1）适应慢性病护理模式和参与式管理理论，以创建一个循证协作护理提供系统，旨在加强培训，实施和可持续性，2）修订临床内容，包括ADHD的药物管理，简短的焦虑管理，和关注父母的痛苦/转介，3）技术进步，以促进有效的护理，监测和沟通过程，和4）改进的方法，包括新的样本，措施和设置。将在4个时间点评估干预过程（实施）和结局（有效性）数据：1）入组、2）出院、3）1年随访和4）2年随访。评估将包括多种方法（例如，个体化和标准化的评定量表、办公室医疗记录、提供者报告）、多信息者（儿童、父母、护理经理、儿科医生）方法来评估对关键儿童行为和情绪结果（症状严重程度、诊断）以及功能/健康状态（损伤）的影响。我们还将探讨DOCC对儿童服务/系统的使用，父母的功能，和医生的信念/做法的支持协作护理的影响。将使用分层线性模型和方差分析进行分析。本研究的最终目标是在儿科初级保健环境中建立一个综合精神卫生服务提供系统的可行性。

DESCRIPTION (provided by applicant): This competing continuation extends our parent study (Effectiveness of Therapy for Behavior Problems in Primary Care; MH63272) by seeking to more efficiently and effectively treat children with a disruptive behavior problem (DBP) in the pediatric primary-care setting. Our enhanced treatment program, Doctor- Office Collaborative Care (DOCC), reflects a care management approach that incorporates the child's pediatrician through integrated in-house services and resources coordinated by a clinical care manager. Physician clusters from six primary care offices will be randomized to either DOCC or Treatment-as-Usual (TAU). Patients of these PCPs will simply receive the intervention condition of their respective PCPs. Background information will be collected to examine group comparability on the same three covariates as used in the original parent study (ADHD, any other comorbid disorder, prior MH treatment). Based on the findings of our parent study and year-long pilot study, several developments are incorporated herein: 1) Adaptation of the chronic care model and participatory management theory to create an evidence-based collaborative care delivery system designed to enhance training, implementation, and sustainability, 2) revised clinical content that includes medication management for ADHD, brief anxiety management, and attention to parental distress/referral, 3) technological advances to facilitate efficient processes of care, monitoring, and communication, and 4) an improved methodology that includes new samples, measures, and settings. Both intervention process (implementation) and outcome (effectiveness) data will be assessed across four timepoints: 1) intake, 2) discharge, 3) 1-year follow-up, and 4) 2-year follow-up. Assessment will include a multi-method (e.g., individualized and standardized rating scales, office medical records, provider reports), multi-informant (child, parent, care manager, pediatrician) approach to evaluate effects on key child behavioral and emotional outcomes (symptom severity, diagnoses), and functional/health status (impairment). We will also explore the impact of DOCC on child services/systems use, parental functioning, and physician beliefs/practices supportive of collaborative care. Analyses will be conducted using Hierarchical Linear Modeling and Analyses of Variance. The ultimate goal for this research is to establish the viability of an integrated mental health service delivery system within the pediatric primary care setting.