Identifying and Managing Threats to Service Delivery in Children's Mental Health

识别和管理儿童心理健康服务提供的威胁

• 批准号: 8968004
• 负责人: BRUCE F CHORPITA
• 金额: $ 22.28万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-07-01 至 2017-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8968004
• 关键词: Acute; Address; Adolescent; Agreement; Algorithms; Archives; Cataloging; Catalogs; Categories; Cessation of life; Child; Child Mental Health; Clinical; Clinical Trials; Code; Communities; Conflict (Psychology); Data; Development; Disclosure; Domestic Violence; Event; Evidence based treatment; Failure; Family; Family health status; Family member; Frequencies; Future; Goals; Health; Health Personnel; Home environment; Housing; Intervention; Interview; Knowledge; Lead; Life; Measures; Mental Health; Mental Health Services; Methods; Mission; Modeling; National Institute of Mental Health; Nature; Outcome; Persons; Pilot Projects; Population; Protocols documentation; Provider; Psychotherapy; Public Health; Randomized; Report (document); Reporting; Research; Sampling; Schools; Security; Services; Severities; Stress; Structure; System; Testing; Therapeutic; Time; Treatment Protocols; Violence; Work; base; design; digital; effectiveness trial; evidence base; improved; indexing; instrumentation; public health relevance; response; satisfaction; stressor; treatment planning; treatment program

 DESCRIPTION (provided by applicant): This project is intended to test a method for measuring the disclosure of stressful emergent life events within psychotherapy encounters as well as therapy providers' responses to those disclosures. Our preliminary data suggest that such events are frequent and unpredictable and that they interfere with providers' ability to follow an evidence-based session plan. Our pilot studies also show that these events are associated with a significantly worse rate of clinical improvement. We therefore propose to measure these events with a high level of precision using an extensive coding system with digital recordings samples from an archive of over 1,200 psychotherapy sessions with children and adolescents treated in community mental health settings in a recent randomized effectiveness trial. We then plan to test whether and how these events significantly impact providers' ability to adhere to their therapy plan, and whether selected aspects of the treatment program (e.g., suitability to address the stressor), the person reporting the event (e.g., timing o emotionality of the disclosure), or the events themselves (e.g., content, severity) influence the nature and degree of the provider response. The project will yield two specific products: (1) reliable instrumentation to code emergent life events in any digital psychotherapy recordings, which will be employed in this proposal, but could be used in nearly any future proposal investigating this important phenomenon (e.g., moderator analyses in studies of clinical outcomes with nearly any treatment model) and (2) a detailed set of findings from the planned research that can inform the subsequent development of an algorithm for providers to anticipate, address, and manage disclosures of such events in a supportive and constructive manner. Such an approach would ideally allow the provider to make appropriate use of the planned evidence-based treatment content to the fullest extent possible. This work is intended to serve the larger mission of NIMH by increasing the potential for scientifically developed mental health interventions to be applied successfully in everyday clinical contexts. By understanding the nature and impact of unanticipated, real-time threats, we hope to inform subsequent practice models that would increase the chance that mental health service providers can stay on plan in the face of common challenges. Such knowledge and the strategies they ultimately produce can directly preserve and enhance the public health impact of evidence-based treatments. In addition, this improved understanding ultimately has the potential to lead to increased provider satisfaction and provider ratings of the feasibility of evidence-based protocols in their actual clinical circumstances, as we better understand how to make treatments more immediately responsive while preserving the core features that make them effective.

 描述（由适用提供）：该项目旨在测试一种衡量心理治疗遭遇中压力大的新兴生活事件的方法，以及治疗提供者对这些披露的反应。我们的初步数据表明，此类事件经常且无法预测，并且它们干扰了提供者遵循基于证据的会话计划的能力。我们的试点研究还表明，这些事件与临床改善率明显较差有关。因此，我们建议使用广泛的编码系统，并在最近的一项随机效能试验中，使用广泛的编码系统，使用广泛的编码系统进行高度精确度衡量这些事件。然后，我们计划测试这些事件是否显着影响提供者遵守其治疗计划的能力，以及治疗计划的某些方面（例如，解决压力源的适用性），报告事件的人（例如，披露的时间情绪）（例如，披露的时间情绪）或事件本身（例如，内容，内容，严重性）会影响供应商的自然和程度。该项目将产生两种特定产品：（1）在任何数字心理治疗记录中可靠的仪器，可靠的仪器，将在本提案中雇用，但几乎可以在调查这种重要现象的几乎任何未来的建议中使用（例如，在与任何治疗模型的临床临床研究中进行的调节器研究中的主持人分析），并将其详细介绍的临床研究人员和（2）详细介绍开发。以支持和建设性的方式预测，解决和管理此类事件的披露。这样的方法理想情况下，提供商可以最大程度地适当使用计划的循证治疗内容。这项工作旨在通过增加科学开发的心理健康干预措施的潜力，以在每天的临床环境中成功应用，以实现NIMH的更大使命。通过了解意外，实时威胁的性质和影响，我们希望告知随后的实践模型，以增加精神卫生服务提供者在面对共同挑战时可以在计划中保持计划的机会。这些知识和最终产生的策略可以直接保留并增强基于证据的治疗的公共卫生影响。此外，这种改善的理解最终有可能提高提供商的满意度和提供商对基于证据的协议在其实际临床情况下的可行性的评级，因为我们更好地了解如何使治疗方法更快地响应，同时保留使其有效的核心特征。