1/2-Unified Treatment of Adolescent Emotional Disorders in Community Clinics

 描述(申请人提供)：情绪障碍，包括一系列的焦虑和抑郁障碍，是青春期最普遍和最常见的精神障碍。它们是慢性的、有害的、代价高昂的，并且有共同之处。不幸的是，循证疗法(EBT)仅适用于单一的疾病或领域(如抑郁症)，很少被社区精神卫生中心(CMHC)的临床医生采用，而且疗效规模不大(40%-50%的年轻人是治疗无反应者)。因此，需要采取各种方法来改善这些青年的结果，特别是在儿童保健中心。这项研究测试了两种新的干预措施的有效性，以满足这一需求。第一个干预措施是跨诊断治疗(青少年情绪障碍治疗统一议定书，UP-A)，这是一种很有前途的新方法，使用少量常见策略来治疗广泛的情绪障碍。跨诊断模式与美国国立卫生研究院利用研究领域标准(RDoC)推进对精神病理学的理解和治疗的倡议相一致。重要的是，这种治疗方法预计将改善客户的结果，并更快地被CMHC临床医生接受，因为：(1)共病是规则，而不是例外，使这种干预与CMHC中的患者更相关，(2)跨越诊断界限的方案减少了培训负担。第二个干预措施是标准化的监测和反馈系统(MFS；青年成果问卷，YOQ)。这种干预可以内置到现有的电子病历基础设施中 因此，它因其可接受性、易于进入临床实践和可持续性而具有吸引力。新出现的数据表明，与TAU相比，MFS本身就能改善结果，但还没有在年轻人中进行充分的测试。作为一个附加价值，这项研究还通过隔离增加的测量和对临床医生的反馈的混杂影响，解决了对先前评估EBT的随机对照试验的内部有效性的共同威胁。最后，针对这种RFA的一个中心目标，并对治疗文献做出独特和关键的贡献，这项研究将检验UP-A和YOQ的治疗结果的理论联系机制(患者和提供者层面)。这个合作的R01应用程序(响应RFA-MH-15-325)是由迈阿密大学(迈阿密)的Ehrenreich-May博士和Jensen-Doss博士以及康涅狄格大学医学院(UConn；应用程序完全相同)的Ginsburg博士准备的。为了测试研究目标，将在迈阿密和哈特福德的CMHC招募222名患有焦虑和/或抑郁障碍的青少年(12-17岁)(每个地点111名青少年和9名临床医生)。青少年和临床医生将被随机分为三种情况之一：(1)仅接受TAU；(2)TAU+YOQ；(3)UP-A+YOQ。研究评估将在基线、治疗开始后8周和16周进行，并进行为期3个月的随访。如果有效，这些干预措施有可能通过为临床医生提供更有效的干预措施来改变CMHC的临床实践，这些干预措施可以应用于广泛的患者。

 DESCRIPTION (provided by applicant): Emotional disorders, encompassing a range of anxiety and depressive disorders, are the most prevalent and comorbid psychiatric disorders in adolescence. They are chronic, impairing, costly, and share overarching commonalities. Unfortunately, evidence-based therapies (EBTs) exist for only single disorders or domains (e.g., depression), are rarely adopted by community mental health center (CMHC) clinicians, and effect sizes are modest (40-50% of youth are treatment non-responders). Thus, methods for improving outcomes for these youth, particularly in CMHCs are needed. This study tests the effectiveness of two novel interventions to address this need. The first intervention is a transdiagnostic treatment (the Unified Protocol for the Treatment of Emotional Disorders in Adolescents, UP-A), a promising new approach that uses a small number of common strategies to treat a broad range of emotional disorders. Transdiagnostic models align with NIH's initiative to advance the understanding and treatment of psychopathology using the Research Domain Criteria (RDoC). Importantly, this treatment approach is expected to improve client outcomes and have quicker uptake by CMHC clinicians because: (1) comorbidity is the rule, rather than the exception making this intervention more relevant for the patients seen in CMHCs, and (2) protocols cutting across diagnostic boundaries reduce training burden. The second intervention is a standardized monitoring and feedback system (MFS; Youth Outcomes Questionnaires, YOQ). This intervention can be built into the existing electronic medical records infrastructure of CMHCs and thus has appeal for its acceptability, ease of transport into clinical practice, and sustainability. Emerging data suggests that MFS alone improves outcomes relative to TAU but has not been adequately tested in youth. As an added value, this study also addresses a common threat to the internal validity of previous RCTs evaluating an EBT by isolating the confounding effects of increased measurement and feedback to clinicians. Finally, addressing a central aim of this RFA and making a unique and critical contribution to the treatment literature, this study will examine theoretically linked mechanisms (both patient and provider level) of treatment outcomes of both the UP-A and the YOQ. This collaborative R01 application (in response to RFA-MH-15-325) was prepared by Drs. Ehrenreich-May and Jensen-Doss at the University of Miami (Miami) and Dr. Ginsburg at The University of Connecticut School of Medicine (UConn; applications are identical). To test study aims, 222 adolescents (ages 12-17) with anxiety and/or depressive disorders will be recruited in CMHCs in Miami and Hartford (111 adolescents and 9 clinicians at each site). Both adolescents and clinicians will be randomized to one of three conditions: (1) TAU alone; (2) TAU plus YOQ, and (3) UP-A plus YOQ. Research assessments will occur at baseline, 8 weeks and 16 weeks after treatment initiation and a 3-month follow-up. If effective, these interventions have the potential to change clinical practice i CMHCs by equipping clinicians with more effective interventions that can be applied to a broad range of patients.