Trial of psychosocial training for pediatric generalists

背景：社区调查发现，15%-20%的学龄儿童有一种或多种严重的心理健康状况，足以需要治疗。即使在有专门的心理健康咨询的地方，很大一部分儿童的心理健康问题也是由多面手来识别和治疗的。尽管许多多面手的提供者坚定地致力于治疗心理健康问题，但评估表明，在多面手确认的任何地方，15%到40%的儿童没有得到治疗。针对治疗成人的全科医生的培训计划表明，精神卫生保健可以得到改善，但这些研究尚未转化为儿科环境。心理治疗技术概念化的进展，以及关于培训医生沟通技能的不断发展的知识，为儿科医生和家庭医生的干预提供了强有力的背景。方法：准实验性临床试验，包括模拟患者和个性化、结构化的反馈以及分析心理社会技能的两个疗程、高度互动的培训计划。该培训计划基于心理治疗过程的跨理论模型，包括与父母和孩子接触、发现问题、专注于解决方案的治疗以及使用激励性访谈进行有效的心理健康转介相关的技能。人口和环境：大约50名职业生涯中期的儿科医生和家庭医生；大约350名5-17岁的儿童和他们的母亲。两个区域、多地点、多专业的工作人员模式实践，为城市、郊区和农村人口提供免费的服务护理。结果指标：通过标准化工具(强项和困难问卷)衡量儿童心理健康症状和功能的改善(在6个月内)；儿科服务利用的变化；社区服务的利用；母亲的情绪健康和家庭功能的衡量。

Background: Community surveys find that from 15-20 percent of school-age children have one or more mental health conditions sufficiently severe to warrant treatment. Even where specialty mental health consultation is available, a substantial proportion of children's mental health problems are identified and treated by generalists. Though many generalist providers are strongly committed to treating mental health problems, evaluations suggest that anywhere from 15 to 40 percent of children identified by generalists get no treatment. Training programs for generalists treating adults show that mental health care can be improved, but these studies have yet to be translated into pediatric settings. Advances in the conceptualization of psychotherapeutic techniques, and evolving knowledge about training physicians in communication skills, provide a strong background on which to base an intervention for pediatricians and family physicians. Methods: Quasi-experimental clinical trial of a two-session, highly interactive, training program involving simulated patients and personalized, structured feedback and analysis of psychosocial skills. The training program is based on a transtheoretical model of psychotherapuetic process, and includes skills related to engaging parents and children, problem identification, solution-focused therapy, and using motivational interviewing to make effective mental health referrals. Population and setting: Approximately 50 mid-career pediatricians and family physicians; approximately 350 children ages 5-17 and their mothers. Two regional, multi-site, multi-specialty staff model practices providing capitated and fee for service care to urban, suburban, and rural populations. Outcome measures: Improvement in child mental health symptoms and functioning (over a 6 month period) measured by a standardized instrument (the Strengths and Difficulties Questionnaire); changes in utilization of pediatric services; utilization of community services; measures of mothers' emotional well-being and of family function.