EFFECTIVENESS OF COMMUNITY SERVICES FOR CONDUCT PROBLEMS

描述（申请人的摘要）：本提案寻求改善 为行为问题儿童提供精神健康服务的成效 (CP)和他们的家庭通过评估的假设，交付）， 社区环境中支持和维持社区卫生服务的服务将得到加强 治疗结果、服务满意度/使用和成本效益。 针对三个领域的多模式服务：（家庭、学校、社区） 无论是在社区还是门诊诊所进行， 在140名临床转诊儿童的随机临床试验中进行比较 (ages 6-11）诊断为对立/违抗性障碍或行为 Disorder. 治疗将持续大约四个月， 通过录像带/录音带和监督进行监测，以确保遵守。 例 将在治疗前、治疗后以及6个月和 12-月随访。 终点和意向治疗分析将纳入 多变量模型 干预后和两次随访病例 预计接受社区服务的人数将有更大的改善 比那些接受诊所为基础的服务的具体措施，在五个 建议用于评估计划有效性的评估领域（见 Hoagwood等人，1996）：1）CP症状的严重程度（例如，更少的CD 症状），2）功能状态/损伤（例如，改善家庭和学校 调整），3）环境背景（例如，减少家庭胁迫/暴力）， 4)客户消费者满意度（例如，更高的儿童和家长评分 服务的可接受性和有用性），以及5）服务使用/系统参与 (e.g.,更高的参与率）。 将测试预测模型， 确定孩子（例如，ADHD，社交能力），父母（例如，抑郁症， 严厉的惩罚）和家庭变量（例如，支持、冲突）相关 提高服务参与度和临床改善， 确定这些预测因素在治疗环境中的差异。 最终 探索性的目的是估计提供的直接成本， 以社区为基础的服务，并评估 以社区为基础的服务相对于诊所为基础的服务， 关键有效性变量（例如，行为障碍、家庭暴力）。 的 研究结果有望带来更具响应性和成本效益的干预措施 为这些高危青少年和他们的家庭提供帮助。 这种研究尤其 鉴于围绕第三方意愿的争议， 支付这些服务。

DESCRIPTION (Applicant's abstract): This proposal seeks to improve the effectiveness of mental health services for children with Conduct Problems (CP) and their families by evaluating the hypothesis that delivery), of services in the community settings that support and maintain CP will enhance treatment outcome, service satisfaction/use, and cost-effectiveness. Multimodal services targeting three domains: (family, school, neighborhood) that are conducted either in the Community or an outpatient Clinic will be compared in a randomized clinical trial for 140 clinically referred children (ages 6-11) with a diagnosis of Oppositional/Defiant Disorder or Conduct Disorder. Treatment will last approximately four months and will be monitored via video/audio tapes and supervision to ensure adherence. Cases will be evaluated at pretreatment, posttreatment, and at both six-month and 12-month follow-up. End-point and intent-to-treat analyses will incorporate multivariate models. After intervention and at both follow-ups cases receiving Community-based services are expected to show greater improvements than those receiving Clinic-based services on specific measures in the five assessment domains recommended for evaluation of program effectiveness (see Hoagwood et al., 1996): 1) Severity of CP symptoms (e.g., fewer CD symptoms), 2) functional status/impairment (e.g., enhanced home and school adjustment), 3) environmental context (e.g., less family coercion/violence), 4) client consumer satisfaction (e.g., higher child and parent ratings of service acceptability and usefulness), and 5) service use/system involvement (e.g., higher rates of participation). Predictive models will be tested to determine child (e.g., ADHD, social competence), parent (e.g., depression, harsh punishment) and family variables (e.g., support, conflict) associated with heightened service participation and clinical improvement, and to determine how these predictors differ by treatment setting. A final exploratory aim is designed to estimate the direct cost of providing community-based services and evaluate the cost-effectiveness of community-based services relative to clinic-based services with respect to key effectiveness variables (e.g., Conduct Disorder, family violence). The findings promise to lead to more responsive, cost-effective interventions for these high-risk youth and their families. Such research is especially timely given the controversy surrounding the willingness of third-party payers to cover these services.