Enhancing the Capacity of Pediatric Primary Care Providers: A Pilot Trial of Anxiety Action Plan

青年焦虑症是：1）最普遍的精神疾病，2）与严重残疾有关， 和3）考虑网关障碍-因为它们预测了广泛的成人精神和功能障碍 问题尽管患病率和损害率很高，但只有不到一半的焦虑青年获得心理健康 服务和获得循证干预措施远远落后于不太常见的精神病 注意力缺陷多动障碍等疾病。这个应用程序解决了这个心理健康服务 差距和回应NIH的优先事项PAR-MH-21-131：试点有效性试验的治疗，预防 和服务干预措施（R34），旨在测试社区环境中先前有效的干预措施 使用新颖的服务交付方法。具体而言，我们建议完善和评估 焦虑行动计划（AxAP），由初级保健提供者提供的减少儿科焦虑的简短干预措施 (PCPs;此处定义为执业护士、医师助理和/或儿科医生）， 初级保健诊所。初级保健机构是解决儿科焦虑症的理想选择，具体原因如下：1） 过度焦虑的患病率在初级保健中很高（约10-20%），2）超过90%的焦虑 青少年报告身体不适（例如，胃痛），是初级保健机构的“常客”，3） 与没有接受PCP治疗的儿童相比， 4）PCP通常是第一个也是唯一一个健康专业儿童访问。该提案建立在 作为NIMH资助的精神疾病中心的一部分，PI与PCP的开发和可行性试点工作 作为教育部补助金的一部分，儿童初级保健和学校护士的健康。的 AxAP以PCP熟悉的哮喘行动计划为模型，基于认知的核心要素， 焦虑的行为疗法（即，行为暴露），旨在适应短期初级保健访问 （20-30分钟），可以虚拟交付，简短（1-4次会议），可以作为办公室访问计费。 独特的是，与托管或集成模型形成鲜明对比的是，AxAP的目标是增强 PCP识别和干预焦虑青年的能力，这将增加获得一般护理的机会 尤其是在心理健康专家很少的地方。该提案还纳入了一些创新的 功能包括进行措施的试点测试：1）AxAP的成本效益分析和2） 在儿童、父母和初级保健人员各级检查基于理论的目标机制。如果这项研究的结果是 积极的，研究结果将支持一个大的有效性试验使用的干预措施，是准备传播 这可以显著改善对焦虑青年的临床护理，提高PCP识别 减少焦虑，降低与儿科焦虑相关的个人和经济成本。

Anxiety disorders in youth are: 1) the most prevalent psychiatric illnesses, 2) associated with severe disability, and 3) considered gateway disorders--as they predict a broad range of adult psychiatric and functional problems. Despite the high prevalence and impairment, less than half of anxious youth receive mental health services and access to evidenced-based interventions lags far behind that of less common psychiatric illnesses, such as attention deficit hyperactivity disorder. This application addresses this mental health service gap and responds to NIH’s priorities in PAR-MH-21-131: Pilot Effectiveness Trials for Treatment, Preventive and Services Interventions (R34) aimed at testing interventions with previous efficacy in community settings using novel service delivery methods. Specifically, we propose to refine and assess the feasibility of the Anxiety Action Plan (AxAP), a brief intervention to reduce pediatric anxiety, delivered by primary care providers (PCPs; defined here as nurse practitioners, physician assistants, and/or pediatricians) in community pediatric primary care clinics. Primary care settings are ideal for addressing pediatric anxiety specifically because: 1) prevalence rates of excessive anxiety are high in primary care (approximately 10-20%), 2) over 90% of anxious youth report physical complaints (e.g., stomach aches) and are “frequent flyers” in primary care settings, 3) children with, compared to without, medical conditions treated by PCPs are more likely to have elevated anxiety, and 4) PCPs are often the first and only health professional children visit. This proposal builds on the PI’s development and feasibility pilot work with PCPs conducted as part of the NIMH-funded Center for Mental Health in Pediatric Primary Care and with school nurses as part of a Department of Education grant. The AxAP, modeled after the Asthma Action Plan familiar to PCPs, is based on the core element of cognitive behavioral therapy for anxiety (i.e., behavioral exposure), was designed to fit within the short primary care visit (20-30 minutes), can be delivered virtually, is brief (1-4 sessions), and can be billed for as an office visit. Uniquely, and in stark contrast to co-location or integrated models, the goal of the AxAP is to enhance the capacity of PCPs to identify and intervene with anxious youth, which will enhance access to care in general and especially in locations with few mental health specialists. The proposal also incorporates several innovative features including pilot tests of measures to conduct: 1) a cost-benefit analysis of the AxAP and 2) an examination of theory-based target mechanisms at the child, parent and PCP levels. If results of this study are positive, findings would support a large effectiveness trial using an intervention that is ready for dissemination and that could significantly improve clinical care for anxious youth, enhance the capacity of PCPs to identify and reduce anxiety, and lower personal and economic costs associated with pediatric anxiety.