Telemental Health Improve Mental Health Care Outcomes Children Underserved Areas

描述(由申请人提供)：在初级保健(PC)中提供精神卫生服务的新模式的需求已经被认识到20年了，但一直缺乏联邦资金来满足这一需求。远程健康(TMH)计划正在全国范围内实施，以解决获得精神健康服务方面的不平等问题，但关于其有效性，特别是对儿童的有效性，几乎没有科学证据可用。这项拟议研究的目标是测试TMH服务提供模式的有效性，以改善太平洋西北部5个服务不足社区的初级保健医生(PCP)治疗的普遍精神疾病儿童的护理和结果。这项研究是一项随机对照试验，对被诊断为注意力缺陷多动障碍(ADHD)的7-11岁儿童(N=250)和PCP通常的治疗方法进行了PCP护理和TMH循证治疗。西班牙裔儿童将占研究样本的30%。实验条件将包括由儿童精神病学家通过视频会议与转诊的PCP一起提供6次药物治疗课程，后者将开出药物处方，以及由一名心理心理学家监督的社区治疗师亲自进行6次家长行为培训。控制条件将包括一如既往的PCP治疗，并增加一次精神咨询，这是参与社区目前的标准护理。对于处于实验和对照条件下的儿童，从基线到25周的随访，将对多动症、注意力不集中、对抗/挑衅和功能障碍以及父母的压力、负担和赋权进行5次评估。在试验组中，将仔细监测家庭、心理医生、当地社区治疗师和儿科医生遵守治疗方案的情况。如果在实验性的提供模式下，临床结果得到了改善，如果循证治疗方案能够被忠实地实施，那么TMH医疗服务提供模式可以自信地部署，以帮助纠正儿科精神健康服务的严重地理分布不均，并在PC内建立新的协作护理模式。这项远程健康(TMH)调查有望在三个方面改善国家的公共健康和福利。首先，TMH通过将专门的精神卫生保健从城市中心重新分配到服务不足的社区，为患有情绪和行为障碍的儿童和家庭提供当地找不到的帮助。其次，TMH提供二级和三级预防，在精神疾病及其相关损害完全演变之前帮助有需要的儿童。第三，TMH为初级保健医生、教师和其他专业人员提供帮助，帮助他们照顾我们国家的儿童。

DESCRIPTION (provided by applicant): The need for new models for delivering mental heath services within primary care (PC) has been recognized for two decades, yet federal funding to address this need has been lacking. Telemental health (TMH) programs are being implemented nationally to address inequities in access to mental health services, but little scientific evidence is available regarding their efficacy, particularly with children. The goal of the proposed research is to test the efficacy of a TMH service delivery model for improving care and outcomes for children with a prevalent psychiatric condition who are treated by primary care physicians (PCPs) in 5 underserved communities in the Pacific Northwest. The research proposed is a randomized controlled trial of PCP care augmented by TMH-delivered evidence- based treatment of children (N=250) 7-11 years old diagnosed with attention-deficit hyperactivity disorder (ADHD) versus treatment as usual by the PCP. Hispanic children will comprise 30% of the study sample. The experimental condition will consist of 6 pharmacotherapy sessions delivered by child psychiatrists through videoconferencing in conjunction with the referring PCP who will prescribe medications and 6 sessions of parent behavioral training delivered in-person by a community therapist supervised by a telepsychologist. The control condition will consist of treatment as usual with the PCP augmented by a single telepsychiatric consultation, which is current standard care in the participating communities. For children in both experimental and control conditions, hyperactivity, inattentiveness, oppositionality/defiance, and functional impairment, as well as parental stress, burden, and empowerment will be assessed 5 times from baseline to 25-week follow- up. In the experimental group, adherence to treatment protocols will be carefully monitored for families, telepsychiatrists, local community therapists, and PCPs. If under the experimental delivery model, improvements in clinical outcomes are demonstrated, and if an evidence-based treatment protocol can be implemented with fidelity, then TMH health service delivery models could be deployed with confidence to help rectify the severe geographic maldistribution of pediatric mental health services and to build new models of collaborative care within PC. This telemental health (TMH) investigation holds promise for improving the nation's public health and welfare in three ways. First, TMH offers children and families suffering with emotional and behavioral disorders help that cannot be found locally by redistributing specialty mental health care from urban centers to underserved communities. Second, TMH offers secondary and tertiary prevention by reaching children's in need prior to the full evolution of mental illness and its associated impairments. Third, TMH offers primary care physicians, teachers, and other professionals' assistance in their efforts to care for our nation's children.