Clinician-Consumer Collaboration in Transdiagnostic, Modular Youth Psychotherapy

项目摘要 大多数被转介到社区精神卫生服务机构的年轻人都表现出一种以上的疾病症状。 跨诊断、模块化的心理疗法是为这些年轻人设计的，近年来已经激增， 其中研究最彻底的是儿童焦虑、抑郁、 创伤或行为问题（MATCH）。MATCH产生了比平常更好的临床结果， 在一些有效性试验中采用标准循证护理，但在其他试验中则不然，这突出表明需要确定 提高其有效性的方法。一种这样的方法可以是解决MATCH的重大挑战 和一般的模块化治疗：要求临床医生做出大量和频繁的决定 关于模块选择和整个治疗中的应用。在MATCH中，鼓励临床医生 这些决定基于来自MATCH消费者的基线和每周基于测量的护理数据-即， 青年和照顾者。然而，临床医生在决策中使用这些措施是不标准的， 系统性;因此，利用消费者观点为决策提供信息的程度是可变的。 除了使用消费者报告的措施，临床决策也可能受益于信息， 从与消费者的协作互动。事实上，越来越多的研究表明，临床医生- 消费者协作可以改善年轻人的决策、个性化和有效性 psychotherapy.根据NIMH的研究优先事项4.1“提高现有心理治疗的有效性”， 卫生服务，”目前的研究旨在评估两种形式的临床医生-消费者合作：（1）措施- 基于-即，临床医生使用消费者报告的测量来指导决策，以及（2）基于交互-即， 临床医生努力在MATCH会话期间使一个或两个消费者参与协作决策。 这项研究将利用来自一项已完成试验的数据，其中42名临床医生向200名临床- 推荐的青少年（7-15岁）。使用这些数据，本研究将评估基于测量的临床医生-消费者 在比赛开始时（目标1）和整个比赛期间（目标2）的协作，作为 治疗过程和青年临床结果。为了评估基于互动的协作，目标3将涉及 临床医生-消费者观察性编码系统的开发、应用和评价 在录制的MATCH会议期间进行协作。这一编码过程将产生测试数据（目标4） 在整个MATCH过程中基于互动的临床医生-消费者协作，作为相同过程的预测器 以及目标1和目标2中检验的成果。总的来说，拟议的研究将提供多方法测试， 在整个护理过程中，几种形式的临床医生-消费者合作之间的关联， 比赛的过程和结果。最终，这项工作的定位是促进我们对 临床医生与消费者在决策方面的合作，以及其提高 针对青少年的跨诊断模块化心理治疗

Project Summary A majority of youths referred to community mental health services shows symptoms of more than one disorder. Transdiagnostic, modular psychotherapies are designed for such youths and have proliferated in recent years, with the most thoroughly-studied being Modular Approach to Therapy for Children with Anxiety, Depression, Trauma, or Conduct Problems (MATCH). MATCH has produced better clinical outcomes than usual and standard evidence-based care in some effectiveness trials, but not others, highlighting the need to identify methods for improving its effectiveness. One such method may be to address a significant challenge of MATCH and modular therapies in general: the requirement that clinicians make numerous and frequent decisions about module selection and application throughout treatment. In MATCH, clinicians are encouraged to make these decisions based on baseline and weekly measurement-based care data from MATCH consumers—i.e., youths and caregivers. However, clinician use of these measures in decision-making is not standardized or systematic; thus, the degree to which consumer perspectives are leveraged to inform decisions is variable. Beyond the use of consumer-reported measures, clinical decisions might also benefit from information derived from collaborative interactions with consumers. Indeed, a growing body of research indicates that clinician- consumer collaboration can improve decision-making in, and the personalization and effectiveness of, youth psychotherapy. In line with the NIMH’s Research Priority 4.1 “to improve the effectiveness…of existing mental health services,” the current study aims to assess both forms of clinician-consumer collaboration: (1) measure- based—i.e., clinician use of consumer-reported measures to guide decisions, and (2) interaction-based–i.e., clinician efforts to engage one or both consumers in collaborative decision-making during MATCH sessions. This study will leverage data from a completed trial, in which 42 clinicians provided MATCH to 200 clinically- referred youths (7-15 years old). Using these data, this study will assess measure-based clinician-consumer collaboration at the start of MATCH (Aim 1), and throughout MATCH sessions (Aim 2), as predictors of treatment processes and youth clinical outcomes. To assess interaction-based collaboration, Aim 3 will involve the development, application, and evaluation of an observational coding system of clinician-consumer collaboration during audio-recorded MATCH sessions. This coding process will yield data to test (Aim 4) interaction-based clinician-consumer collaboration throughout MATCH as a predictor of the same processes and outcomes tested in Aims 1 and 2. Overall, the proposed research will provide multi-method tests of the associations between several forms of clinician-consumer collaboration across the course of care, and key processes and outcomes of MATCH. Ultimately, this work is positioned to advance our understanding of clinician-consumer collaboration in decision-making, as well as its potential to enhance the effectiveness of transdiagnostic, modular psychotherapy for youths.