Video-visit behavior therapy for anxiety and depression in youth: A randomized effectiveness-implementation study in low-resource primary care settings.

针对青少年焦虑和抑郁的视频访问行为疗法：在资源匮乏的初级保健机构中进行的一项随机有效性实施研究。

• 批准号: 10266175
• 负责人: FRANCES L LYNCH
• 金额: $ 32.46万
• 依托单位: SAN DIEGO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-18 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10266175
• 关键词: Administrator; Affect; Age; Anxiety; Anxiety Disorders; Area; Behavior Therapy; Caring; Centers for Population Health; Clinic; Clinical; Clinical effectiveness; Community Health Networks; Community Practice; Consolidated Framework for Implementation Research; Data; Depressed mood; Disease; Effectiveness; Electronic Health Record; Enrollment; Etiology; Evidence based practice; Family; Federally Qualified Health Center; Future; Health; Hispanics; Impairment; Improve Access; Individual; Intervention; Interview; Lead; Life; Mental Depression; Mental Health; Mental Health Services; Methods; Minority; Modeling; Mood Disorders; Neighborhood Health Center; Not Hispanic or Latino; Outcome; Outpatients; Parents; Patients; Population; Population Heterogeneity; Primary Health Care; Process Measure; Provider; Public Health; Randomized; Randomized Clinical Trials; Reaction; Recurrence; Reporting; Research Design; Resources; Risk; Sampling; Services; Site; Symptoms; Testing; Underserved Population; Vulnerable Populations; Work; Youth; anxiety treatment; anxious; arm; avoidance behavior; base; comorbidity; cost; cost effective; cost effectiveness; cost estimate; digital; digital health; disparity reduction; effective therapy; effectiveness implementation study; effectiveness testing; evidence base; experience; functional disability; health care disparity; health equity; health service use; implementation cost; implementation framework; incremental cost-effectiveness; innovation; intervention effect; population based; primary care setting; primary outcome; programs; public health priorities; randomized trial; recruit; response; social stigma; suicidal behavior; treatment as usual; treatment program; underserved minority; video visit

The proposed mixed-methods study will (a) test the effectiveness of brief behavioral therapy (STEP-UP) for youths with anxiety and/or depression recruited from primary care community health centers (CHCs), (b) evaluate a population-based method of implementation of STEP-UP, and (c) explore patient, provider, and clinic reactions to identify target mechanisms for successful and sustainable implementation. Anxiety and mood disorders in youth are prevalent and impairing, with a high current and lifetime comorbidity in part due to shared etiologic factors. Untreated, these disorders lead to sustained functional impairment and convey increased risk for recurrent disorder and suicidal behavior. Only 1 in 5 anxious and 2 in 5 depressed youth report any lifetime mental health use, the lowest treatment rates for any youth mental health condition. Further, there are notable disparities in care, with minority youths significantly less likely to receive services than non- Hispanic white (NHW) youths, despite experiencing similar or higher rates of disorder. Therefore, effective treatment of anxiety and depression is a critical public health priority, especially for traditionally underserved minority youths. STEP-UP is a streamlined behavioral intervention developed to efficiently treat anxiety and depression as a unified problem area by targeting avoidance behavior common to both disorders. The proposed study builds on a multi-site randomized trial demonstrating the effectiveness of STEP-UP, with especially strong effects for Hispanic youths. This application responds to RFA-MH-20-400 and focuses on implementing and testing this promising evidence-based practice in the OCHIN network of CHCs and federally qualified health centers which serves a diverse population of vulnerable families. STEP-UP has been adapted to a digital health framework with video visits to increase dissemination potential, scalability, and cost-effectiveness. We propose to conduct an innovative hybrid effectiveness-implementation study (type 1) testing digitally delivered STEP-UP compared to facilitated referral to traditional outpatient mental health services (treatment-as-usual, TAU). Youths (age 8-17, N = 250) will be identified and recruited at the population level through electronic health records (EHR) and direct clinician referral of new cases. Eligible youths will be randomized to (a) STEP-UP or (b) facilitated referral to TAU. Clinical outcomes will be assessed at Weeks 16 and 32 and process measures collected over the course of care. Qualitative interviews will occur with 20 youth-parent dyads, 35 CHC providers and staff, and 20 administrators sampled from enrolled clinics. Aims include testing the clinical effectiveness of STEP-UP and engagement of the intervention mechanism in the vulnerable CHC population of families (Aim 1), evaluating the impact of STEP-UP on equity in mental health outcomes for minority youths (Aim 2), estimating the implementation cost and incremental cost effectiveness of STEP-UP (Aim 3), and identifying target mechanisms for sustainable implementation of STEP- UP in CHCs using the Consolidated Framework for Implementation Research (Aim 4).

拟议的混合方法研究将（a）测试短暂行为疗法的有效性（升级） 对于从初级保健社区卫生中心（CHC）招募的焦虑和/或抑郁症的年轻人， （b）评估一种基于人群的逐步实施方法，（c）探索患者，提供者和 诊所的诊所反应以确定成功实施和可持续实施的目标机制。焦虑 年轻人的情绪障碍是普遍且损害的，急流和终生合并症部分 由于共同的病因因素。这些疾病未经治疗，导致持续的功能障碍并传达 增加复发性疾病和自杀行为的风险。五分之一的焦虑中只有1个，五分之一的年轻人中只有1个 报告任何终生心理健康的使用，这是任何青年心理健康状况的最低治疗率。更远， 护理上有明显的差异，少数族裔青年接受服务的可能性明显少于非非 - 西班牙裔白人（NHW）年轻人，尽管疾病发生率相似或更高。因此，有效 焦虑和抑郁症的治疗是关键的公共健康优先事项，尤其是对于传统上 服务不足的少数民族青年。升级是一种简化的行为干预措施，以有效治疗 焦虑和抑郁是统一问题，通过靶向两种疾病共同的回避行为。 拟议的研究以多站点随机试验为基础，证明了加速的有效性， 对西班牙裔青年特别有力。该应用程序对RFA-MH-20-400响应，重点关注 在CHC和联邦政府的Ochin网络中实施和测试这种有前途的循证实践 合格的卫生中心为各种各样的弱势家庭提供服务。升级已经过去了 通过视频访问适应数字健康框架，以提高传播潜力，可伸缩性和 成本效益。我们建议进行创新的混合有效性研究研究（类型 1）与促进传统门诊精神健康相比，以数字化进行测试进行了升级 服务（治疗 - 公平，tau）。年轻人（8-17岁，n = 250）将在 通过电子健康记录（EHR）和新病例的直接临床医生转诊的人口水平。有资格的 年轻人将被随机分配给（a）加速或（b）促进转介到tau。临床结果将是 在第16和第32周评估，并在护理过程中收集的过程指标。定性访谈 将发生20个青年二元组，35名卫生室提供者和工作人员，以及20名管理员。 注册诊所。目的包括测试升级的临床有效性和干预的参与度 脆弱的家庭卫生室中的机制（AIM 1），评估升级对公平的影响 在少数民族青年的心理健康成果中（AIM 2），估计实施成本和增量成本 升级的有效性（AIM 3），并确定目标机制以可持续实施逐步实施 使用合并框架进行实施研究中的CHC（AIM 4）。