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）测试简短行为疗法（STEP-UP）的有效性 对于从初级保健社区卫生中心 (CHC) 招募的患有焦虑和/或抑郁症的青少年， (b) 评估基于人群的 STEP-UP 实施方法，以及 (c) 探索患者、提供者和 临床反应以确定成功和可持续实施的目标机制。焦虑 青年人的情绪障碍很普遍并且具有损害性，部分原因是当前和终生合并症较高 由于共同的病因。如果不治疗，这些疾病会导致持续的功能障碍并传达 复发性疾病和自杀行为的风险增加。只有五分之一的青少年感到焦虑，五分之二的青少年感到抑郁 报告任何终生心理健康用途，任何青少年心理健康状况的最低治疗率。更远， 护理方面存在显着差异，少数族裔青年获得服务的可能性明显低于非少数族裔青年 西班牙裔白人 (NHW) 青少年，尽管患有类似或更高的疾病发生率。因此，有效 治疗焦虑和抑郁是一项重要的公共卫生优先事项，特别是对于传统的 服务不足的少数族裔青年。 STEP-UP 是一种简化的行为干预措施，旨在有效治疗 通过针对两种疾病常见的回避行为，将焦虑和抑郁作为一个统一的问题领域。 拟议的研究建立在一项多中心随机试验的基础上，该试验证明了 STEP-UP 的有效性，其中 对西班牙裔年轻人的影响尤其强烈。该应用程序响应 RFA-MH-20-400 并重点关注 在 CHC 和联邦的 OCHIN 网络中实施和测试这一有前途的循证实践 合格的医疗中心为不同群体的弱势家庭提供服务。升级已 适应数字健康框架，通过视频访问来提高传播潜力、可扩展性和 成本效益。我们建议进行一项创新的混合有效性实施研究（类型 1) 测试数字化交付的 STEP-UP 与便利转诊传统门诊心理健康的比较 服务（照常治疗，TAU）。青少年（8-17 岁，N = 250）将在 通过电子健康记录 (EHR) 和临床医生直接转诊新病例来了解人口水平。有资格的 青少年将被随机分配到 (a) STEP-UP 或 (b) 协助转介至 TAU。临床结果将是 在第 16 周和第 32 周进行评估，并处理在护理过程中收集的测量结果。定性访谈 将由 20 名青年家长二人组、35 名 CHC 提供者和工作人员以及 20 名管理人员组成 注册诊所。目的包括测试 STEP-UP 的临床有效性和干预措施的参与度 家庭弱势 CHC 人群的机制（目标 1），评估 STEP-UP 对公平的影响 少数民族青年的心理健康成果（目标 2），估计实施成本和增量成本 STEP-UP（目标 3）的有效性，并确定可持续实施 STEP-UP 的目标机制 使用实施研究综合框架（目标 4）在 CHC 中进行 UP。