Utilizing Health Information Technology to improve Health Care Quality: Implement

描述(由申请人提供)：儿童焦虑症相当常见，并与严重的心理社会损伤和痛苦有关。认知行为疗法(CBT)具有与药物疗法相同的疗效，没有常见的副作用，是治疗青少年焦虑症的一线疗法。然而，CBT在社区环境中的传播非常有限。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，尤其是对于那些社会经济地位较低的患者来说，成本可能会被证明是一个障碍。此外，不同的理论方法和培训导致少数焦虑症儿童接受循证CBT。因此，非常需要更广泛的做法。因此，我们建议进行两个阶段的试验，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，计算机化CBT(CCBT)的公开试验将完成，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和常规治疗(TAU)的随机对照试验。公开试验将招募18名7至13岁的年轻人，目的是测试已经开发的CCBT协议的实用性和管理性(Kendall&Khanna，2010)。结果试验将招募110名青年，其中包括自然减员，目的是衡量CCBT议定书在前线环境中的效力。与TAU组相比，CCBT组的症状明显减少，这将为将CCBT作为焦虑青年的治疗选择提供关键证据，因为他们无法立即获得这种面对面的护理。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，但招募工作将在佛罗里达州的三个社区精神卫生中心进行，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人员评估，并将包括焦虑症状严重程度、应答率和缓解率的变化。CCBT将遵循Kendall and Khanna(2008b)手册进行适当的完整性检查。这项研究的意义重大，因为计算机化的CBT可能会使儿童焦虑症的有效治疗方法得到广泛传播。

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.