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

 描述（由申请人提供）：情绪障碍，包括一系列焦虑和抑郁障碍，是青春期最普遍和共病的精神疾病。它们是慢性的、有害的、代价高昂的，并且具有总体的共同点。不幸的是，循证疗法（EBT）仅适用于单一疾病或领域（例如，抑郁症），很少被社区精神卫生中心（CMHC）临床医生采用，效果大小适中（40-50%的青年是治疗无反应者）。因此，需要改善这些青年，特别是CMHC的结果的方法。这项研究测试了两种新的干预措施来满足这一需求的有效性。第一种干预措施是跨诊断治疗（青少年情绪障碍治疗统一方案，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。转诊断模型与NIH的倡议，以促进理解和治疗精神病理学使用研究领域标准（RDoC）。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）合并症是规则，而不是例外，使这种干预措施与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。第二项干预措施是标准化的监测和反馈系统（MFS;青年成果报告，YOQ）。这种干预可以内置到现有的电子医疗记录基础设施中， 因此，CMHC具有可接受性、易于运输到临床实践和可持续性的吸引力。新出现的数据表明，MFS单独改善相对于TAU的结果，但尚未在青年中进行充分的测试。作为一个附加值，本研究还解决了一个共同的威胁，以前的RCT评价EBT的内部有效性，通过隔离增加测量和反馈给临床医生的混杂效应。最后，为了解决RFA的核心目标，并为治疗文献做出独特而关键的贡献，本研究将研究UP-A和YOQ治疗结果的理论联系机制（患者和提供者水平）。本合作R 01申请（响应RFA-MH-15-325）由迈阿密大学（迈阿密）的Escherreich-May博士和Jensen-Doss博士以及康涅狄格大学医学院（UConn;申请相同）的Ginsburg博士编写。为了测试研究目的，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）（每个研究中心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配到以下三种情况之一：（1）TAU单独治疗;（2）TAU + YOQ;（3）UP-A + YOQ。将在基线、治疗开始后8周和16周以及3个月随访时进行研究评估。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.