Utilizing Health Information Technology to improve Health Care Quality: Implement

描述（由申请人提供）：儿童焦虑症是相当常见的，并与显着的心理障碍和痛苦。认知行为疗法（CBT）提供与药物疗法相同的疗效，而没有常见的副作用，是青少年焦虑症的一线治疗方法。然而，社区环境中的CBT传播非常有限。通过传统的CBT进行有效的治疗通常需要患者前往专门从事这种治疗的中心，特别是对于那些社会经济地位较低的人来说，成本可能是一个障碍。此外，不同的理论方法和培训导致少数焦虑儿童接受循证CBT。因此，迫切需要更广泛地采用这些做法。因此，我们建议进行一项两阶段试验，评估在社区精神卫生中心实施以患者为中心的干预措施的可行性，然后进行疗效试验。在第一阶段，将完成计算机化CBT（CCBT）的开放试验，重点是在社区精神卫生中心提供这种干预的可行性问题。此后，我们将完成一项比较CCBT与常规治疗（TAU）的随机对照试验。公开试验将招募18名7至13岁的青少年，目的是测试已经开发的CCBT方案的实用性和管理（Kendall &卡纳，2010）。结果试验将招募110名年轻人，以衡量CCBT方案在一线环境中的有效性。与TAU组相比，CCBT组的症状明显减轻，这将为将CCBT作为没有立即获得这种亲自护理的焦虑青年的治疗选择提供关键证据。虽然这项研究将由南佛罗里达大学罗斯曼神经精神病学中心团队协调，但招募将在整个佛罗里达的三个社区精神健康中心进行，这些中心为社会经济地位较低的家庭提供服务。南佛罗里达大学行为与社区科学学院的安德尔博士将提供数据管理服务。主要结果将由独立评估者评估，包括焦虑症状严重程度的变化;应答率;和缓解率。CCBT将遵循Kendall和卡纳（2008 b）手册进行适当的完整性检查。这项研究的意义是显着的，因为计算机化的CBT可能使广泛传播的有效治疗儿童焦虑症。 公共卫生相关性：儿童焦虑症影响相当大比例的青少年，造成严重的痛苦和损害。认知行为疗法（CBT）是治疗青少年焦虑症的金标准，但它在社区心理健康环境中的传播有限。因此，我们建议评估的可行性和初步疗效传播的计算机化CBT协议，社区精神卫生中心。一个有效的计算机交付CBT协议可以有助于公共卫生工作，以解决大量被诊断患有焦虑症的儿童的心理健康需求。

DESCRIPTION (provided by applicant): Childhood anxiety disorders are quite common and associated with significant psychosocial impairment and distress. Offering equivalent efficacy to pharmacotherapy without the common side effect profile, cognitive behavioral therapy (CBT) is a first line treatment for anxiety disorders in youth. However, dissemination of CBT to community settings is very limited. Effective treatment via traditional CBT often necessitates that the patient travel to a center that specializes in this treatment, and cost can prove an impediment to those of lower socioeconomic status, in particular. As well, differing theoretical approaches and training result in a minority of children with anxiety receiving evidence-based CBT. Accordingly, there is a great need for more widely accessible practices. As such, we are proposing a two phase trial that evaluates the feasibility of implementing a patient-centered intervention in community mental health centers, followed by an efficacy trial. In Phase I, an open trial of computerized CBT (CCBT) will be completed that focuses on feasibility issues of providing this intervention in community mental health centers. Thereafter, we will complete a randomized controlled trial comparing CCBT to treatment as usual (TAU). The open trial will recruit 18 youth ages 7 to 13 years, with the purpose of testing both practicality and management of an already developed CCBT protocol (Kendall & Khanna, 2010). The outcome trial will recruit 110 youth accounting for attrition, with the purpose of measuring the efficacy of the CCBT protocol in front-line settings. Significantly greater symptom reductions in the CCBT group as compared to the TAU group would provide critical evidence for the inclusion of CCBT as a treatment option for anxious youth without immediate access to such in-person care. While this study will be coordinated by the University of South Florida Rothman Center for Neuropsychiatry team, recruitment will take place at three community mental health centers throughout Florida that serve families of lower socioeconomic status. Dr. Andel from the College of Behavioral and Community Sciences at the University of South Florida will provide data management services. Primary outcomes will be assessed by an independent evaluator, and will include change in anxiety symptom severity; response rates; and remission rates. CCBT will follow the Kendall and Khanna (2008b) manual with appropriate integrity checks. The implications of this study are significant, as computerized CBT may enable widespread dissemination of efficacious therapy for childhood anxiety disorders. PUBLIC HEALTH RELEVANCE: Childhood anxiety disorders affect a significant percentage of youth, causing substantial distress and impairment. Cognitive behavioral therapy (CBT) is the gold standard treatment for youth with an anxiety disorder but its dissemination to community mental health settings is limited. Thus, we propose to evaluate the feasibility and preliminary efficacy of disseminating a computerized CBT protocol to community mental health centers. An efficacious computer delivered CBT protocol could contribute to public health efforts to address the mental health needs of a large number of children diagnosed with anxiety disorders.