Training Outpatient Clinicians to Deliver Cognitive Behavior Therapy to Children

培训门诊临床医生为儿童提供认知行为治疗

• 批准号: 8206009
• 负责人: Judy Reaven
• 金额: $ 25.56万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-30 至 2014-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8206009
• 关键词: 14 year old; Age; Alabama; Ambulatory Care Facilities; Anxiety; Anxiety Disorders; Autistic Disorder; Child; Childhood; Clinical; Code; Cognitive Therapy; Communities; Comorbidity; Consultations; Data; Development; Developmental Disabilities; Disease; Educational workshop; Face; Family; Family Relationship; Feedback; Fright; Goals; Guidelines; Health; Home environment; Individual; Instruction; Intervention; Interview; Knowledge; Lead; Learning; Licensing; Manuals; Manuscripts; Measures; Methods; Modeling; Modification; Outcome; Outcome Measure; Outpatients; Parents; Participant; Performance; Phase; Population; Procedures; Process; Protocols documentation; Psychologist; Psychology; Public Health; Publications; Publishing; Qualifying; Randomized; Recommendation; Recruitment Activity; Risk; Schedule; Schools; Sequential Treatment; Severities; Site; Social isolation; Students; Symptoms; Techniques; Telephone; Testing; Training; Travel; Universities; Videotape; Work; autism spectrum disorder; base; clinical anxiety; clinical practice; clinical research site; cohort; high risk; impression; meetings; novel; peer; portability; primary outcome; protocol development; public health relevance; success; symposium

DESCRIPTION (provided by applicant): Training Outpatient Clinicians to Deliver Cognitive Behavior Therapy to Children with High- Functioning Autism Spectrum Disorders and Anxiety: A Comparison of Three Methods of Learning Children with high-functioning autism spectrum disorders (ASD) are at greater risk for developing psychiatric symptoms, particularly anxiety symptoms, compared to typically developing children and children with other developmental disabilities. Anxiety problems can be especially "debilitating" to individuals with ASD by adversely impacting school performance, peer relationships, family functioning, and further exacerbating the core-deficits of ASD. Cognitive behavioral treatments (CBT) are frequently used in the general pediatric population with good success to reduce anxiety symptoms. Recently published studies, have demonstrated significant reductions in anxiety symptoms for children with ASD following the delivery of modified CBT interventions. Because these treatment studies have occurred exclusively in lab settings, generalizability to other clinical settings may be limited. To enhance the portability and generalizability of novel interventions, it is important to introduce the interventions into real world settings to inform protocol development, increase acceptability of the intervention and subsequently maximize the success for clinical practice. To further enhance acceptability, it is also important to identify the instruction methods necessary for the intervention to be delivered to fidelity. There are two main goals for this proposal. First, to train outpatient clinicians (professionals in psychology) to fidelity on an original, manualized group CBT (Face Your Fears - FYF) intervention for 8-14 year old children with high-functioning ASD and clinical anxiety. Second, to develop an optimal training model for clinicians delivering the FYF intervention by comparing three different instruction methods for learning the FYF intervention. In Phase 1, eight clinicians will be recruited from one site, to deliver the FYF intervention to four sequential treatment groups (four children and their families). Clinicians will work in teams of three. Training materials will be developed, and the outpatient cohort of clinicians will be trained to fidelity on the FYF intervention. In Phase 2, 36 total clinicians will be recruited from three sites to deliver the FYF intervention to three sequential treatment groups. Clinicians will be randomized to one of three instruction methods.--1) manual only (Manual), 2) manual plus three-day workshop (Workshop), and 3) manual plus three-day workshop, plus bi-weekly supervised consultation (Workshop-Plus). The efficacy of the different instruction methods will be evaluated by examining a) the increases in the clinicians' acquisition of the intervention techniques, and b) the reductions in anxiety symptoms for children with ASD. PUBLIC HEALTH RELEVANCE: Children with autism spectrum disorders (ASD) are at high risk for developing co- occurring anxiety symptoms, which can interfere significantly with the child's ability to participate in home, school and community activities. Thus, the careful and systematic development of feasible and efficacious treatments for children with ASD and serious psychiatric co-morbidity, clearly meets a strong public health need. Anxiety symptom reduction may result in a greater sense of mastery, less social isolation and more opportunities to participate in community activities.

描述（由申请人提供）：培训门诊临床医生为患有高功能自闭症谱系障碍和焦虑的儿童提供认知行为治疗：三种学习方法的比较与正常发育的儿童和患有其他发育障碍的儿童相比，患有高功能自闭症谱系障碍（ASD）的儿童出现精神症状，特别是焦虑症状的风险更大。焦虑问题对自闭症谱系障碍患者尤其“衰弱”，会对学校表现、同伴关系、家庭功能产生不利影响，并进一步加剧自闭症谱系障碍的核心缺陷。认知行为治疗 (CBT) 经常用于普通儿科人群，在减轻焦虑症状方面取得了良好的效果。最近发表的研究表明，接受改良的 CBT 干预后，自闭症谱系障碍儿童的焦虑症状显着减轻。由于这些治疗研究仅在实验室环境中进行，因此对其他临床环境的普遍适用性可能有限。为了增强新型干预措施的可移植性和普遍性，重要的是将干预措施引入现实世界环境中，为方案制定提供信息，提高干预措施的可接受性，并随后最大限度地提高临床实践的成功。为了进一步提高可接受性，确定干预措施保真度所需的指导方法也很重要。该提案有两个主要目标。首先，培训门诊临床医生（心理学专业人士）对患有高功能 ASD 和临床焦虑的 8-14 岁儿童进行原创的、手动的团体 CBT（面对恐惧 - FYF）干预。其次，通过比较三种不同的学习 FYF 干预的指导方法，为临床医生提供 FYF 干预的最佳培训模型。在第一阶段，将从一个地点招募 8 名临床医生，为四个连续治疗组（四名儿童及其家人）提供 FYF 干预。临床医生将以三人小组的形式工作。我们将开发培训材料，并对门诊临床医生进行培训，使其忠实地执行 FYF 干预措施。在第二阶段，将从三个地点招募总共 36 名临床医生，为三个连续治疗组提供 FYF 干预。临床医生将被随机分配到三种指导方法中的一种。--1) 仅手册 (Manual)，2) 手册加三天研讨会 (Workshop)，以及 3) 手册加三天研讨会，加上每两周一次的监督咨询 (Workshop-Plus)。不同教学方法的效果将通过检查a）临床医生对干预技术的掌握程度的提高，以及b）自闭症谱系障碍儿童焦虑症状的减少来评估。 公共卫生相关性：患有自闭症谱系障碍 (ASD) 的儿童同时出现焦虑症状的风险很高，这可能会严重影响孩子参与家庭、学校和社区活动的能力。因此，针对患有自闭症谱系障碍和严重精神共病的儿童，认真、系统地开发可行且有效的治疗方法，显然可以满足强烈的公共卫生需求。焦虑症状的减轻可能会带来更大的掌控感、更少的社会孤立感以及更多参与社区活动的机会。