Behavioral and Affective Skills in Coping: Practice-Adapted Child Psychotherapy

描述(由申请人提供)：针对儿童心理健康问题的循证(心理)治疗(EBTS)在疗效条件下进行的随机对照试验中显示出非常有益的效果；然而，这些EBTS大多侧重于单一的障碍或同质性的群体，在最初被运送到日常临床护理环境中并由第一次学习使用EBTS的医生与转诊儿童一起使用时，可能会面临挑战。许多从业者的工作条件限制了他们学习EBT的速度，特别是不同案件数量所需的EBT。儿童共病加上治疗过程中靶点问题的变化也可能使这些从业者对单一障碍EBTS的使用复杂化。为了应对这些和其他挑战，我们建议单一障碍EBTS辅之以简短的治疗方案，该方案包含五项基本技能，可用于治疗涉及焦虑、抑郁和破坏性行为的多个儿童障碍，作为从业者迈向循证实践的第一步。这一基本方案包括五个治疗要素：(A)用于多种疾病的多个EBTS，以及(B)即使单独使用也显示出显著益处的证据。这五种技能是信念修复(识别和修改不适应的认知)、行动(行为激活/暴露在恐惧或挑战的情况下)、解决问题(系统解决问题的学习技能)、激励(使用奖励和结果来增加期望的行为)和镇定(使用放松技能来减少痛苦、焦虑或愤怒的唤醒)。拟议的项目将分三个阶段进行，包括完善和测试基本技术，以及评估区域技术转化的准备情况。在第一阶段，将完成基本方案草案，然后通过治疗专家和从业者的反馈加上现场测试进行细化。第二阶段将是一项试点开放试验，精神卫生诊所的从业者将使用BASIC来治疗社区转诊的8-13岁儿童的焦虑、抑郁和行为相关障碍。第三阶段将包括数据分析，重点是临床改进，消费者和临床医生对基本方案的可接受性和可行性，以及基本方案对随机对照试验的准备情况。 与公共卫生相关：美国面临的一个重大公共卫生挑战是，在任何给定的时间，大约20%的儿童都有心理健康障碍，而对许多儿童来说，有效的治疗是难以实现的。临床科学家已经为这些儿童开发了心理社会治疗方法，但在实践环境中，这些治疗方法的实施和有效性仍然存在一些挑战。这一应用程序致力于开发、改进并开始测试一种高效、灵活的治疗方案-称为BASIC-旨在补充专注于单一障碍的循证治疗，这些治疗在特定疾病的专门、强化治疗中非常有效。BASIC将作为从业者循证治疗的一种“第一课”，从而成为在临床护理环境中更多地使用循证实践的桥梁。

DESCRIPTION (provided by applicant): Evidence-based (psychosocial) treatments (EBTs) for children's mental health problems have shown very beneficial effects in RCTs conducted under efficacy conditions; however, these EBTs, most of which focus on a single disorder or homogenous cluster, may face challenges when initially transported to everyday clinical care settings and used with referred children by practitioners who are learning to use EBTs for the first time. Working conditions of many practitioners limit the pace at which they can learn EBTs, particularly enough EBTs for their diverse caseloads. Child comorbidity plus flux in target problems during treatment may also complicate use of single-disorder EBTs by these practitioners. To address these and other challenges, we propose that single-disorder EBTs be complemented by a brief treatment protocol encompassing five basic skills that can be used to treat multiple child disorders involving anxiety, depression, and disruptive conduct, as a first step toward evidence-based practice for practitioners. This BASIC protocol integrates five treatment elements that (a) have been used in multiple EBTs for multiple disorders, and (b) have shown evidence of significant benefit even when used alone. The five skills are Belief Repair (identifying and modifying maladaptive cognitions), Action (behavioral activation/exposure to feared or challenging situations), Solving Problems (learning skills in systematic problem solving), Incentives (using reward and consequences to increase desired behaviors), and Calming (using relaxation skills to reduce distress, anxiety, or angry arousal). In three phases, the proposed project will include refining and testing BASIC and assessing readiness for a RCT. In Phase 1, the draft BASIC protocol will be completed, then refined via treatment expert and practitioner feedback plus field testing. Phase 2 will be a pilot open trial in which mental health clinic practitioners will use BASIC to treat community-referred 8-13 year-olds for anxiety-, depression-, and conduct-related disorders. Phase 3 will include data analysis, focused on clinical improvement, acceptability and feasibility of the BASIC protocol for consumers and clinicians, and readiness of BASIC for a RCT. PUBLIC HEALTH RELEVANCE: A significant public health challenge for America is that about 20% of its children have a mental health disorder at any given time, and effective treatment for many is elusive. Clinical scientists have developed psychosocial treatments for these children, but some challenges remain for both the implementation and the effectiveness of these treatments in practice settings. This application is an effort to develop, refine, and begin testing an efficient, flexible, treatment protocol-called BASIC-that is designed to complement the single-disorder-focused evidence-based treatments that are so effective in specialized, intensive treatment of specific disorders. BASIC will serve as a kind of "first course" in evidence-based treatment for practitioners and thus as a bridge leading to the increased use of evidence-based practices in clinical care settings.