Feasible Delivery of CBT for Rural Latino Youth with Anxiety

为焦虑的农村拉丁裔青年提供 CBT 的可行方案

基本信息

批准号：
8270522
负责人：
DENISE A CHAVIRA
金额：
$ 21.8万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN DIEGO
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-07-01 至 2014-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8270522
关键词：
Address Aftercare Age Anxiety Anxiety Disorders Behavior Behavior Therapy Bibliotherapy Caring Child Clinical Cognitive Cognitive Therapy Communities Comprehension County Data Drops Effectiveness Effectiveness of Interventions Evidence based intervention Evidence based treatment Family Focus Groups Generalized Anxiety Disorder Geographic Locations Goals Health Health Personnel Health Services Research Healthcare Improve Access Individual Intervention Interview Language Latino Lead Literature Locales Measures Medical Mental Depression Mental Health Mental Health Services Mental disorders Methodology Methods Outcome Parents Participant Perception Pilot Projects Poverty Primary Health Care Procedures Quality of Care Randomized Recruitment Activity Research Research Personnel Research Project Grants Rural Safety Separation Anxiety Disorder Services Specialist Specific Phobia Stigmata Symptoms Telephone Training Translating Translations Youth base cost effectiveness effectiveness trial ethnic minority population experience improved meetings named group novel strategies outreach program primary care setting programs public health relevance rural area self help social social stigma

项目摘要

DESCRIPTION (provided by applicant): Children with anxiety disorders are often characterized by an unmet need for treatment however, in special populations such as Latino and rural youth, such disparities are compounded by the effects of culture and geographic isolation. More specifically, barriers related to language, stigma, and access often lead to lower rates of utilization and poorer outcomes among children in need of mental health services (Alvidrez and Azocar, 1999; McCabe et al., 2002; Myers et al., 2008; Vega et al., 2001). These findings are disappointing given abundant data supporting the effectiveness of cognitive behavior and behavior therapies for children with anxiety disorders (Barrett et al., 1996; Beidel et al., 2007; Kendall & Southam-Gerow, 1996; Walkup et al., 2008). Efforts to examine feasible methods to deliver evidence-based treatments to children with anxiety disorders are critical in order to extend quality care to underserved groups. The goal of this R34 is to address these disparities, by translating and tailoring an existing child anxiety cognitive behavior therapy program (The Cool Kids Outreach Program; Lyneham and Rapee, 2006), to fit the needs of Spanish-speaking rural families and examining the feasibility, acceptability, tolerability and safety of implementing this intervention using varying modes of delivery. Qualitative methodologies which include focus groups with bicultural and bilingual mental health providers and individual interviews with rural Latino parents will be used to examine the acceptability and cultural appropriateness of the intervention. Using these findings and other extant literature, an expert panel guided by a cultural adaptation framework (Lau, 2006), will determine the extent to which tailoring of the Cool Kids Outreach Program is necessary. Next, a pilot study for children (age 8-13) with anxiety disorders (i.e., separation anxiety disorder, generalized anxiety disorder, social anxiety disorder, and specific phobias) will be conducted and 40 children will be randomized to two service delivery modes which represent varying levels of therapist contact: 1) 20 families will be randomized to a telephone-based, therapist- supported CBT program, and; 2) 20 families will be randomized to a more minimal contact bilbiotherapy condition (primarily CBT self-help materials). All families will be recruited from primary care settings, given its defacto mental health service status. Feasibility and clinical outcomes will be measured at baseline, midtreatment and post-treatment. Additionally, during exit interviews, participants (as well as those who may have dropped out of the program) will be asked to discuss the perceived usefulness, acceptability, and impact of the intervention. This pilot study will provide important data regarding the feasibility, acceptability, tolerability and safety of the intervention conditions as well as the opportunity to pilot procedures that will be used in a larger effectiveness trial with rural Latino youth. PUBLIC HEALTH RELEVANCE: This R34 proposal will incorporate the perspectives of family and community mental health providers, to tailor, as necessary, an evidence based treatment for child anxiety disorders, in order to meet the needs of a hard-to- reach group (i.e., rural Latino youth). The pilot study will examine the feasibility of new modes of service delivery (e.g., a minimal therapist contact, self-help program, and a more intensive therapist supported, telephone-based approach) that may ultimately improve access to evidence based treatments and mental health outcomes among underserved groups. These findings will ultimately inform a larger program of research focusing on effectiveness and dissemination efforts for children with anxiety disorders, using service delivery approaches that allow for the personalization of mental health care.

描述（由申请人提供）：患有焦虑症的儿童的特点通常是治疗需求未得到满足，然而，在拉丁裔和农村青年等特殊人群中，文化和地理隔离的影响加剧了这种差异。更具体地说，与语言、耻辱和获取相关的障碍往往会导致需要心理健康服务的儿童的利用率较低和结果较差（Alvidrez 和 Azocar，1999 年；McCabe 等人，2002 年；Myers 等人，2008 年）维加等人，2001）。鉴于大量数据支持认知行为和行为疗法对焦虑症儿童的有效性，这些发现令人失望（Barrett 等，1996；Beidel 等，2007；Kendall 和 Southam-Gerow，1996；Walkup 等，2008））。为了向服务不足的群体提供优质护理，努力研究为焦虑症儿童提供循证治疗的可行方法至关重要。 R34 的目标是通过翻译和定制现有的儿童焦虑认知行为治疗计划（The Cool Kids Outreach Program；Lyneham 和 Rapee，2006）来解决这些差异，以满足西班牙语农村家庭的需求，并检查使用不同的交付方式实施这种干预措施的可行性、可接受性、耐受性和安全性。定性方法包括双文化和双语心理健康服务提供者的焦点小组以及对农村拉丁裔父母的个人访谈，将用于检查干预措施的可接受性和文化适当性。利用这些发现和其他现有文献，一个在文化适应框架（Lau，2006）指导下的专家小组将确定酷童外展计划的定制程度。接下来，将对患有焦虑症（即分离焦虑症、广泛性焦虑症、社交焦虑症和特定恐惧症）的儿童（8-13岁）进行试点研究，40名儿童将被随机分配到两种服务提供模式，代表治疗师接触的不同水平：1) 20 个家庭将被随机分配到基于电话、治疗师支持的 CBT 计划，以及； 2) 20 个家庭将被随机分配到接触性更小的胆生物治疗条件（主要是 CBT 自助材料）。鉴于初级保健机构事实上的精神卫生服务状况，所有家庭都将从初级保健机构招募。将在基线、治疗中期和治疗后测量可行性和临床结果。此外，在退出访谈期间，参与者（以及可能退出该计划的人）将被要求讨论干预措施的感知有用性、可接受性和影响。这项试点研究将提供有关干预条件的可行性、可接受性、耐受性和安全性的重要数据，以及试点程序的机会，这些程序将用于对农村拉丁裔青年进行更大规模的有效性试验。公共卫生相关性：本 R34 提案将纳入家庭和社区心理健康提供者的观点，根据需要定制针对儿童焦虑症的循证治疗方法，以满足难以接触到的群体（即，儿童焦虑症）的需求。，农村拉丁裔青年）。该试点研究将探讨新的服务提供模式的可行性（例如，最少的治疗师接触、自助计划以及更深入的治疗师支持、基于电话的方法），这些模式可能最终改善获得循证治疗和心理健康的机会服务不足群体的结果。这些发现最终将为更大的研究计划提供信息，该计划重点关注焦虑症儿童的有效性和传播工作，使用允许个性化心理保健的服务提供方法。

项目成果

期刊论文数量（3）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Telephone-assisted, parent-mediated CBT for rural Latino youth with anxiety: A feasibility trial.

针对患有焦虑症的农村拉丁裔青年的电话辅助、家长介导的 CBT：一项可行性试验。

DOI：
发表时间：
2018
期刊：
影响因子：
3.3
作者：
Chavira, Denise A;Bustos, Cristina;Garcia, Maritza;Reinosa Segovia, Francisco;Baig, Afshan;Ng, Bernardo;Camacho, Alvaro
通讯作者：
Camacho, Alvaro

Crisis visits and psychiatric hospitalizations among patients attending a community clinic in rural Southern California.

南加州农村社区诊所就诊的患者的危机就诊和精神病住院情况。