Evaluating Innovative Treatment Formats for Difficult-to-Treat Child Populations

评估难以治疗儿童群体的创新治疗形式

• 批准号: 9396778
• 负责人: Danielle Cornacchio
• 金额: $ 3.45万
• 依托单位: FLORIDA INTERNATIONAL UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-14 至 2018-08-13
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9396778
• 关键词: Acute; Address; Affect; Aftercare; Age; Anxiety; Anxiety Disorders; Attention; Behavior Therapy; Caring; Child; Child Care; Clinic; Clinical; Code; Communities; Competence; Complex; Consumer Satisfaction; Destinations; Development; Diagnostic; Disease; Dropout; Evaluation; Failure; Family; Fostering; Foundations; Funding; Geography; Grant; Health Personnel; Healthcare; Immigrant; Impairment; Individual; Individual Differences; Intervention; Interview; Investigational Therapies; Linguistics; Low Prevalence; Maintenance; Measures; Mental Health; Mental Health Services; National Research Service Awards; Parents; Pathological anxiety; Patients; Population; Population Heterogeneity; Provider; Quality of Care; Randomized; Reporting; Research; Research Personnel; Research Training; Schools; Scientist; Services; Standardization; Structure; Symptoms; Techniques; Technology; Time; Training; Training Activity; Travel; Verbal Behavior; Voluntary Mutism; Youth; base; behavior observation; career; control trial; cost; early childhood; experience; improved; infancy; innovation; medical specialties; metropolitan; novel; peer; predictive of treatment response; programs; research clinical testing; satisfaction; skills; skills training; social; social situation; standardize measure; teacher; treatment group; treatment program; treatment response

PROJECT SUMMARY/ABSTRACT This application will foster the development of an independent research career focused on leveraging innovative treatment formats and techniques to target difficult-to-treat and difficult-to-reach child populations. The PI will gain the necessary skills and research training to conduct rigorous clinical evaluations from an experimental therapeutics framework for youth populations that present with unique obstacles to care, such as complex symptom presentations and/or lack of accessibility to quality care. Selective mutism (SM) is one such complex child disorder that requires specialized care that is not readily available for most youth in need. SM is an anxiety disorder characterized by an inability to speak in certain social situations, despite ability to speak in familiar situations. Despite its low prevalence, SM results in severe impairment in children's social and academic functioning; because most affected children fail to speak in school, they are often insufficiently evaluated for appropriate academic services, and do not get their day-to- day needs met in the classroom. As a low base-rate disorder, expert care for SM is not broadly accessible, and the vast majority of affected children do not receive appropriate services. To address problems of access to quality care for many low base rate disorders, expert providers are increasingly offering intensive treatment options, in which individuals travel from across the world for brief (e.g., 1 week) periods of all-day sessions in treatments not offered, or not offered with similar quality and competency, in the patient's local community. Despite tremendous clinical advances in the development of group intensive behavior therapy formats for the treatment of SM, to date research has not evaluated intensive treatments for SM in a controlled trial. The project at the center of this NRSA training grant entails a pilot waitlist controlled trial evaluating a one-week group intensive behavior therapy in a diverse population of children SM (N=30) delivered over the summer. Youth will be randomized to either immediate SM intensive group behavior therapy (IGBT), or to a waitlist control (WL). Aim 1 will examine feasibility of and parental satisfaction with the program by examining dropout and daily attendance rates, standardized consumer satisfaction and barriers to treatment participation measures, and costs incurred as a result of participation in the program. Aim 2 will examine reductions in SM symptoms (as well as overall anxiety and functioning) across the two conditions after one week and potential predictors of treatment response. Aim 3 will examine maintenance of treatment response by evaluating whether or not the intensive group treatment program improves children's SM symptoms (as well as overall anxiety and academic functioning) across the two groups in the classroom 8 weeks into the following school year. Finally exploratory Aim 4 will examine individual differences in treatment response related to cultural and sociodemographic factors.

项目总结/摘要 该应用程序将促进独立研究事业的发展，重点是利用 创新的治疗形式和技术，以针对难以治疗和难以接触的儿童群体。 PI将获得必要的技能和研究培训，以进行严格的临床评价， 针对存在独特护理障碍的青年人群的实验性治疗框架，例如 复杂的症状表现和/或缺乏获得优质护理的机会。 选择性缄默症（SM）是一种复杂的儿童疾病，需要专门的护理， 为大多数有需要的年轻人提供。SM是一种焦虑症，其特征是无法说话， 在某些社交场合，尽管有能力在熟悉的场合说话。尽管患病率低，但SM导致 严重损害儿童的社会和学术功能;因为大多数受影响的儿童无法说话 在学校里，他们往往得不到适当的学术服务的充分评价， 在课堂上满足日常需求。作为一种低基础率的疾病，SM的专家护理并不广泛， 绝大多数受影响的儿童得不到适当的服务。为了解决获得 对于许多基础率低的疾病，专家提供者越来越多地提供强化治疗 选项，其中个人从世界各地短暂旅行（例如，为期一周的全天会议， 在患者所在的当地社区没有提供或没有提供类似质量和能力的治疗。 尽管在针对儿童的群体强化行为治疗形式的发展方面取得了巨大的临床进展， SM的治疗，迄今为止的研究还没有在对照试验中评估SM的强化治疗。 该项目在这个NRSA培训补助金的中心需要一个试点候补名单对照试验评估 一个为期一周的团体强化行为治疗的儿童SM（N=30）在不同的人口交付超过 夏天青少年将随机接受即时SM强化团体行为疗法（IGBT）或 等待列表控制（WL）。目标1将通过以下方式检查该计划的可行性和家长满意度： 辍学率和每日出勤率、标准化消费者满意度和参与治疗的障碍 措施，以及因参与该计划而产生的费用。目标2将审查减少标准管理 症状（以及整体焦虑和功能）在两种情况下一周后， 治疗反应的预测因子。目标3将通过评估来检查治疗反应的维持 强化组治疗计划是否改善了儿童的SM症状（以及总体 焦虑和学术功能）在两组的教室8周进入下一个学校 年最后，探索性目标4将检查与文化和 社会人口因素。