Behavioral telehealth in low-resource primary care settings for anxiety and depression in youth: A randomized effectiveness-implementation study
资源匮乏的初级保健机构中针对青少年焦虑和抑郁的行为远程医疗:一项随机有效性实施研究
基本信息
- 批准号:10731716
- 负责人:
- 金额:$ 107.07万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2023
- 资助国家:美国
- 起止时间:2023-08-21 至 2028-05-31
- 项目状态:未结题
- 来源:
- 关键词:AdoptedAffectAftercareAgeAnxietyAnxiety DisordersAreaBehavior TherapyBehavioralCaringClinicClinicalClinical effectivenessCommunitiesCommunity Mental Health ServicesCommunity PracticeCommunity SurveysConsolidated Framework for Implementation ResearchDataDepressed moodDevelopmentDiagnosticDisadvantagedDiseaseEffectivenessElectronic Health RecordEligibility DeterminationEtiologyFaceFamilyFundingFutureHousingHybridsImpairmentImplementation readinessIntakeInterventionInterviewLanguageLatinxLeadLeadershipMasksMediatingMental DepressionMental HealthMental Health ServicesModelingModificationMood DisordersNeighborhood Health CenterOutcomePatientsPediatricsPilot ProjectsPopulationPopulation HeterogeneityPredictive FactorPrimary CareProcessProviderQuality of CareRandomizedReadinessRecurrenceReportingResource-limited settingResourcesRiskSamplingSiteSuicideSurveysTechnologyTestingTranslationsVulnerable PopulationsWorkYouthacceptability and feasibilityanxiety treatmentanxiousarmavoidance behaviorcomorbiditycost effectivecost effectivenesscost estimatecost per quality-adjusted life yeardigital healthdisparity reductioneffective therapyeffectiveness testingeffectiveness-implementation randomized trialeffectiveness/implementation studyevidence baseexperiencefollow-upfunctional disabilityfuture implementationhealth care disparityhealth service useimplementation effortsimplementation evaluationimplementation frameworkimplementation trialimprovedincremental cost-effectivenessinnovationminority childrenprimary care settingprogramspublic health prioritiesrecruitresponsesafety netsocial health determinantstelehealthtooltreatment programtreatment research
项目摘要
The proposed hybrid type 1 randomized effectiveness-implementation trial will probe the effects of brief
behavioral therapy (STEP-UP) for youths with anxiety and/or depression recruited from low-resource
primary care community health centers (CHCs) that serve a diverse population of vulnerable families.
Anxiety and mood disorders in youth are prevalent and impairing, with high current and lifetime comorbidity in
part due to shared etiologic factors. Untreated, these disorders lead to sustained functional impairment and
convey increased risk for recurrent disorder and suicide. Only 1 in 5 anxious and 2 in 5 depressed youth report
any lifetime mental health use, the lowest treatment rates for any youth mental health condition. In addition,
there are notable disparities in care, with families experiencing high social determinants of health (SDOH)
burden and minority youths significantly less likely to receive mental health services than similarly affected, but
less disadvantaged, youths. Further, families who are served in safety-net settings such as CHCs often
experience multiple, intersectional risks and barriers to evidence-based care. Therefore, effective treatment
of anxiety and depression is a critical public health priority, especially for traditionally underserved
youths. STEP-UP is a streamlined transdiagnostic behavioral intervention developed to efficiently treat anxiety
and depression as a unified problem area by targeting avoidance behavior common to both disorder classes.
The proposed study builds on a successful multi-site RCT of STEP-UP based in primary care with an insured
population of youths. To increase dissemination potential to low-resource CHCs, we have adapted the program
from a face-to-face format to a digital health framework and developed a Spanish-language translation. Pilot
studies of this revised version of STEP-UP have shown feasibility and acceptability; however, data on clinical
effectiveness are still needed in this new setting (CHC) and sample (high SDOH risk). Thus, we propose to
conduct an innovative, 5-year hybrid effectiveness-implementation study (Type 1) rigorously testing the
clinical effectiveness of the digital health version of STEP-UP, while simultaneously collecting data to plan
future CHC implementation trials. Youths (age 8.0-16.5, N=220) will be identified and recruited through
electronic health records (EHR) and clinician referral. Eligible youths will be randomized to (a) STEP-UP or
(b) facilitated referral to TAU in the community (TAU+). Clinical effectiveness will be assessed by masked
independent evaluators at STEP-UP post-treatment (Week 16) and at follow-up (Week 32). Implementation
data will be pulled from: (a) surveys of CHC leaders, (b) surveys of and interviews with STEP-UP clinicians,
and (c) EHR and CHC administrative data. Specific aims include testing the clinical effectiveness of STEP-UP
and engagement of the intervention mechanism (Aim 1), probing cost effectiveness (Aim 2), testing SDOH
predictors and moderators to evaluate robustness of effects (Aim 3), and identifying target mechanisms for
future implementation trials using the Consolidated Framework for Implementation Research (Aim 4).
提出的混合1型随机有效性实施试验将探讨brief的效果
项目成果
期刊论文数量(0)
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{{ truncateString('FRANCES L LYNCH', 18)}}的其他基金
Video-visit behavior therapy for anxiety and depression in youth: A randomized effectiveness-implementation study in low-resource primary care settings.
针对青少年焦虑和抑郁的视频访问行为疗法:在资源匮乏的初级保健机构中进行的一项随机有效性实施研究。
- 批准号:
10266175 - 财政年份:2020
- 资助金额:
$ 107.07万 - 项目类别:
Video-visit behavior therapy for anxiety and depression in youth: A randomized effectiveness-implementation study in low-resource primary care settings.
针对青少年焦虑和抑郁的视频访问行为疗法:在资源匮乏的初级保健机构中进行的一项随机有效性实施研究。
- 批准号:
10247224 - 财政年份:2020
- 资助金额:
$ 107.07万 - 项目类别:
Understanding Family Economic Impact of Chronic Child Health Conditions
了解慢性儿童健康状况对家庭经济的影响
- 批准号:
9177102 - 财政年份:2016
- 资助金额:
$ 107.07万 - 项目类别:
Understanding Family Economic Impact of Chronic Child Health Conditions
了解慢性儿童健康状况对家庭经济的影响
- 批准号:
9335986 - 财政年份:2016
- 资助金额:
$ 107.07万 - 项目类别:
Health-related Quality of Life in Teens with Depression
抑郁症青少年的健康相关生活质量
- 批准号:
8259040 - 财政年份:2010
- 资助金额:
$ 107.07万 - 项目类别:
Health-related Quality of Life in Teens with Depression
抑郁症青少年的健康相关生活质量
- 批准号:
8041805 - 财政年份:2010
- 资助金额:
$ 107.07万 - 项目类别:
Health-related Quality of Life in Teens with Depression
抑郁症青少年的健康相关生活质量
- 批准号:
8146175 - 财政年份:2010
- 资助金额:
$ 107.07万 - 项目类别:
Measurement of Family Costs of Child Mental Illness
儿童精神疾病的家庭成本衡量
- 批准号:
6856447 - 财政年份:2005
- 资助金额:
$ 107.07万 - 项目类别:
Measurement of Family Costs of Child Mental Illness
儿童精神疾病的家庭成本衡量
- 批准号:
7008509 - 财政年份:2005
- 资助金额:
$ 107.07万 - 项目类别:
Measurement of Family Costs of Child Mental Illness
儿童精神疾病的家庭成本衡量
- 批准号:
7157628 - 财政年份:2005
- 资助金额:
$ 107.07万 - 项目类别:
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