Improving Care for Anxiety in Pediatric Settings

该指导研究科学家发展奖（K01）将为申请人提供技能，以追求独立的研究计划，最终改善初级保健环境中焦虑症儿童的治疗。该奖项将在圣地亚哥儿童和青少年服务研究中心和加州圣地亚哥大学的范围内进行，候选人的赞助商将是安加兰博士和共同赞助商默里斯坦博士。该奖项将使申请人能够在儿童焦虑和治疗结果研究方面建立强大的现有培训。申请人正在寻求心理健康服务研究方面的新培训和经验，以解决与服务参与相关的关键问题（例如，（c）在服务的初始接受和持续使用方面开展研究，以推进对传统上得不到充分服务的人群，即焦虑症患者和拉丁美洲青年的有效性研究。拟议的培训计划包括以下方面的课程和指导：1）卫生服务研究的理论和经验模型，2）拉丁美洲人的服务利用率，3）定性方法，4）服务参与和有效性干预策略，以及5）多层次和纵向数据分析。拟议的研究的主要目标是确定儿童和父母的因素，影响服务的参与，并利用这些信息来适应和试点测试的证据为基础的儿童焦虑干预在初级保健设置。第二个目标是研究影响拉丁美洲家庭参与的因素。研究计划依赖于一种混合方法，包括定性和定量策略。参与者将从儿科初级保健机构招募。定性访谈将进行与30名家长的焦虑与满足和未满足的治疗需要的青年。定量研究与150个家庭的焦虑青年也将被用来确定诱发，使，需要的特点，影响参与。配备了家长的角度来看，照顾的障碍，儿童焦虑治疗将适应包括参与战略，并在初级保健是可行的。焦虑青年的家庭（N= 26）将被随机分配接受基于证据的焦虑干预与参与策略或支持性治疗（N = 26）。关于功能和症状改善、治疗可接受性、初始吸收和依从性的数据将用于设计和参数化初级保健中儿童焦虑症的更大有效性试验。

DESCRIPTION (provided by applicant): This Mentored Research Scientist Development Award (K01) will provide the applicant with skills to pursue an independent program of research to ultimately improve treatment for children with anxiety disorders in primary care settings. This award will be pursued within the context of the San Diego Child and Adolescent Services Research Center and the University of California San Diego where the candidate's sponsor will be Dr. Ann Garland and co-sponsor, Dr. Murray Stein. This award will allow the applicant to build on strong existing training in child anxiety and treatment outcome research. The applicant is seeking new training and experience in mental health services research to address critical issues related to service engagement (e.g., initial uptake and ongoing use of services) in order to advance effectiveness studies for traditionally underserved populations, namely those with anxiety disorders and Latino youth. The proposed training plan includes coursework and mentoring in: 1) theoretical and empirical models of health services research, 2) service utilization in Latinos, 3) qualitative methodologies, 4) service engagement and effectiveness intervention strategies, and 5) multilevel and longitudinal data analysis. The primary goal of the proposed research is to identify child and parent factors that affect service engagement and to use this information to adapt and pilot test an evidence based child anxiety intervention in the primary care setting. A secondary goal is to examine factors that affect engagement for Latino families. The research plan relies on a mixed method approach including qualitative and quantitative strategies. Participants will be recruited from pediatric primary care settings. Qualitative interviews will be conducted with 30 parents of anxious youth with met and unmet treatment need. A quantitative study with 150 families of anxious youth will also be used to identify predisposing, enabling, and need characteristics that influence engagement. Equipped with parent perspectives about barriers to care, a child anxiety treatment will be adapted to include engagement strategies and to be feasible in primary care. Families of anxious youth (N= 26) will be randomized to receive an evidence based anxiety intervention with engagement strategies or supportive therapy (N = 26). Data regarding functional and symptom improvement, treatment acceptability, initial uptake and adherence will be used to design and parameterize a larger effectiveness trial for child anxiety disorders in primary care.