Evaluating an Online Adjunctive Support following Intensive Services (OASIS) Strategy for Youth with Selective Mutism

项目摘要 本申请的总体目标是促进申请人所需的必要培训，以便 成功开启学术研究生涯。从长远来看，申请人寻求发展一个 一个独立的研究项目，专注于设计和评估干预创新， 改善难以治疗和难以接触的青年的心理健康结果。为此，目前 建议包括一套培训目标和相应的经验，将战略性地推动 申请人对治疗提供方面的现有障碍和创新的了解，以及 与现代临床试验方法的设计，实施和分析相关的技能，可用于 加强和扩大青年精神病理学支助护理的范围和广度。 在获得和利用精神卫生保健方面的巨大障碍和差距传统上阻碍了 有价值的青年心理健康干预措施的范围和影响。可访问性，可用性， 循证治疗（EBT）的可接受性和可接受性对于基础率低的年轻人尤其明显 问题或需要复杂治疗和高临床专业知识的患者。最近的工作评价密集 治疗-即，一个完整的疗程，通过集中会议在一个压缩的时间内提供， 远程技术-例如，通过视频会议实时向有障碍的家庭提供EBT， 都证明了成功地克服了质量和普遍护理的局限性， 难以治疗和/或难以接触的青年。然而，研究评估哪些青年亚群，根据 哪些特定条件最好地响应于哪些处理格式序列已经被限制。 在这个培训奖学金的中心项目将检查与急性和长期相关的关键因素- 急性期后远程保健延续/过渡规划战略的长期成果， 儿童选择性缄默症（SM）的团体行为治疗（IGBT），然后进行在线视频会议- 基于“助推器”会议。所有参与的家庭（N=69）将完成（或已经完成）为期5天的 SM的IGBT将被纳入以追求目标1，并且一个子集（n=20）将被随机分配给其中之一 在12周内接受6次每两周一次的视频会议提供的“助推器”/一般化会议，或没有 为实现目标2和目标3而进行的额外治疗。目标1将检查儿童严重程度和儿童 对强化策略的响应性预测急性IGBT治疗结果（即，改进， 缓解，功能）。目标2将评估儿童改善、缓解和功能方面的差异 接受IGBT治疗后在线“助推器”的IGBT治疗家庭与不接受IGBT治疗的家庭之间的差异 在初始IGBT后16周接受后IGBT在线“助推器”。最后，目标3将检查是否急性 IGBT结局、临时儿童症状复发、临时父母技能获得或技术素养 在初始IGBT后16周预测或中等结果。

PROJECT SUMMARY The overall goal of this application is to facilitate the necessary training the applicant requires in order to successfully launch an academic research career. In the long-term, the applicant seeks to develop an independent program of research focused on designing and evaluating intervention innovations that lead to improved mental health outcomes for difficult-to-treat and difficult-to-reach youth. To this end, the current proposal includes a set of training goals and corresponding experiences that will strategically advance the applicant’s knowledge of existing barriers to and innovations in treatment delivery, as well as the development of skills related to the design, conduct, and analysis of modern clinical trial methodologies that can be used to enhance and extend the reach and scope of supported care for youth psychopathology. Substantial barriers to and disparities in access and utilization of mental health care have traditionally hindered the reach and impact of valuable youth mental health interventions. Problems with the accessibility, availability, and acceptability of evidence-based treatments (EBTs) are especially pronounced for youth with low base rate problems or who require complex treatments and high clinical expertise. Recent work evaluating intensive treatments—i.e., a full course of treatment offered via massed sessions over a condensed period of time—and remote technologies—e.g., delivering EBTs to families in impaired settings in real-time via videoconferencing— have both demonstrated success in overcoming limitations to quality and generalizable care for such difficult- to-treat and/or difficult-to-reach youth. However, research evaluating which subpopulations of youth, under which particular conditions, respond best to which treatment format sequences has been limited. The project at the center of this training fellowship will examine key factors associated with acute and longer- term outcomes of a post-acute telehealth continuation/transition planning strategy that leverages intensive group behavioral treatment (IGBT) for childhood selective mutism (SM) followed by online, videoconferencing- based “booster” sessions. All participating families (N=69) will complete (or have already completed) a 5-day IGBT for SM and will be included to pursue Aim 1, and a subset (n=20) will be randomly assigned to either receive 6 biweekly videoconferencing-delivered “booster”/generalization sessions across 12 weeks or no additional treatment to pursue Aims 2 and 3. Aim 1 will examine whether child severity and child responsiveness to reinforcement strategies predict acute IGBT treatment outcomes (i.e., improvement, remission, functioning). Aim 2 will evaluate differences in child improvement, remission, and functioning between IGBT-treated families who receive post-IGBT online “boosters” and IGBT-treated families who do not receive post-IGBT online “boosters” 16 weeks after the initial IGBT. Finally, Aim 3 will examine whether acute IGBT outcomes, interim child symptom relapse, interim parental skill acquisition, or technological literacy predict or moderate outcomes 16 weeks after the initial IGBT.