Clinician-Consumer Collaboration in Transdiagnostic, Modular Youth Psychotherapy

项目摘要 大多数转诊到社区精神卫生服务的年轻人表现出不止一种障碍的症状。 跨诊断、模块化的心理疗法是为这些年轻人设计的，近年来激增， 研究最深入的是模块化方法治疗患有焦虑、抑郁、 精神创伤或行为问题(比赛)。Match产生了比平时更好的临床结果 在一些有效性试验中的标准循证护理，但在其他试验中不是，突出了识别 提高其有效性的方法。一种这样的方法可能是解决匹配的重大挑战 和一般的模块化治疗：要求临床医生做出大量和频繁的决定 在整个治疗过程中关于模块的选择和应用。在比赛中，鼓励临床医生做出 这些决策基于来自匹配消费者的基于基线和每周测量的护理数据-即， 年轻人和照顾者。然而，临床医生在决策中使用这些措施并不标准化或 系统性；因此，利用消费者的观点来为决策提供信息的程度是可变的。 除了使用消费者报告的测量方法外，临床决策也可能受益于所获得的信息 来自与消费者的协作互动。事实上，越来越多的研究表明，临床医生- 消费者协作可以改善年轻人的决策，并提高他们的个性化和有效性 心理治疗。与NIMH的研究优先事项4.1%保持一致，以提高…的有效性已有的心理状态 目前的研究旨在评估两种形式的临床医生-消费者协作：(1)衡量- 基于-即临床医生使用消费者报告的测量来指导决策，以及(2)基于交互的-即， 临床医生努力在比赛过程中让一个或两个消费者参与协作决策。 这项研究将利用一项完成的试验的数据，在该试验中，42名临床医生提供了与200名临床匹配的数据- 转介青年(7-15岁)。使用这些数据，这项研究将评估基于测量的临床医生-消费者 比赛开始时的协作(目标1)和整个比赛过程(目标2)，作为预测 治疗过程和青年临床结果。为了评估基于交互的协作，Aim 3将涉及 临床医生-消费者观察性编码系统的开发、应用与评价 在录音比赛期间进行协作。该编码过程将产生用于测试的数据(目标4) 在整个比赛中基于交互的临床医生-消费者协作，作为相同过程的预测因素 以及目标1和目标2中测试的结果。总体而言，拟议的研究将提供对 护理过程中临床医生-消费者协作的几种形式之间的关联，以及关键 比赛的过程和结果。最终，这项工作的定位是促进我们对 临床医生与消费者在决策过程中的协作，以及它在提高医疗效率方面的潜力 针对青少年的跨诊断、模块化心理治疗。

Project Summary A majority of youths referred to community mental health services shows symptoms of more than one disorder. Transdiagnostic, modular psychotherapies are designed for such youths and have proliferated in recent years, with the most thoroughly-studied being Modular Approach to Therapy for Children with Anxiety, Depression, Trauma, or Conduct Problems (MATCH). MATCH has produced better clinical outcomes than usual and standard evidence-based care in some effectiveness trials, but not others, highlighting the need to identify methods for improving its effectiveness. One such method may be to address a significant challenge of MATCH and modular therapies in general: the requirement that clinicians make numerous and frequent decisions about module selection and application throughout treatment. In MATCH, clinicians are encouraged to make these decisions based on baseline and weekly measurement-based care data from MATCH consumers—i.e., youths and caregivers. However, clinician use of these measures in decision-making is not standardized or systematic; thus, the degree to which consumer perspectives are leveraged to inform decisions is variable. Beyond the use of consumer-reported measures, clinical decisions might also benefit from information derived from collaborative interactions with consumers. Indeed, a growing body of research indicates that clinician- consumer collaboration can improve decision-making in, and the personalization and effectiveness of, youth psychotherapy. In line with the NIMH’s Research Priority 4.1 “to improve the effectiveness…of existing mental health services,” the current study aims to assess both forms of clinician-consumer collaboration: (1) measure- based—i.e., clinician use of consumer-reported measures to guide decisions, and (2) interaction-based–i.e., clinician efforts to engage one or both consumers in collaborative decision-making during MATCH sessions. This study will leverage data from a completed trial, in which 42 clinicians provided MATCH to 200 clinically- referred youths (7-15 years old). Using these data, this study will assess measure-based clinician-consumer collaboration at the start of MATCH (Aim 1), and throughout MATCH sessions (Aim 2), as predictors of treatment processes and youth clinical outcomes. To assess interaction-based collaboration, Aim 3 will involve the development, application, and evaluation of an observational coding system of clinician-consumer collaboration during audio-recorded MATCH sessions. This coding process will yield data to test (Aim 4) interaction-based clinician-consumer collaboration throughout MATCH as a predictor of the same processes and outcomes tested in Aims 1 and 2. Overall, the proposed research will provide multi-method tests of the associations between several forms of clinician-consumer collaboration across the course of care, and key processes and outcomes of MATCH. Ultimately, this work is positioned to advance our understanding of clinician-consumer collaboration in decision-making, as well as its potential to enhance the effectiveness of transdiagnostic, modular psychotherapy for youths.