Collaborative Mental Health Services for Behavior Disorders in Primary Care

描述（由申请人提供）：这个竞争性的延续扩展了我们的父母研究（初级保健中行为问题治疗的有效性；MH63272），寻求在儿科初级保健环境中更有效和有效地治疗具有破坏性行为问题（DBP）的儿童。我们的强化治疗方案，医生-办公室协作护理（DOCC），反映了一种护理管理方法，通过综合内部服务和由临床护理经理协调的资源，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组将随机分配到DOCC或常规治疗（TAU）。这些pcp的患者只会收到各自pcp的干预条件。将收集背景信息，以检查原始父母研究中使用的相同三个协变量（ADHD，任何其他共病障碍，既往MH治疗）的组可比性。根据我们的母体研究和为期一年的试点研究的结果，在此纳入了以下几点进展：1)适应慢性护理模式和参与式管理理论，创建一个以证据为基础的协作式护理交付系统，旨在加强培训、实施和可持续性；2)修订临床内容，包括ADHD药物管理、短暂焦虑管理和对父母痛苦/转诊的关注；3)技术进步，促进有效的护理、监测和沟通过程。4)改进的方法，包括新的样本，测量和设置。干预过程（实施）和结果（有效性）数据将在四个时间点进行评估：1)入院，2)出院，3)1年随访，4)2年随访。评估将包括多方法（例如，个性化和标准化评分量表、办公室医疗记录、提供者报告）、多信息提供者（儿童、家长、护理经理、儿科医生）方法，以评估对关键儿童行为和情绪结果（症状严重程度、诊断）和功能/健康状况（损伤）的影响。我们还将探讨DOCC对儿童服务/系统使用、父母功能和支持协作护理的医生信仰/实践的影响。分析将使用层次线性模型和方差分析进行。本研究的最终目标是在儿科初级保健设置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.