伦敦治疗评估试验：在有自伤行为的青少年中，治疗评估与标准心理社会评估的随机对照试验。

Trial of Therapeutic Assessment in London: randomised controlled trial of Therapeutic Assessment versus standard psychosocial assessment in adolescents presenting with self-harm.

机构信息

King's College London, Child and Adolescent Psychiatry, Institute of Psychiatry, London, UK.

出版信息

Arch Dis Child. 2011 Feb;96(2):148-53. doi: 10.1136/adc.2010.188755. Epub 2010 Oct 27.

DOI:10.1136/adc.2010.188755

PMID:21030367

Abstract

OBJECTIVE

To determine whether Therapeutic Assessment (TA) versus assessment as usual (AAU) improves engagement with follow-up in adolescents presenting with self-harm.

DESIGN

Randomised controlled trial with 3 months naturalistic follow-up.

SETTING

Child and adolescent mental health services in two London National Health Service Trusts.

PARTICIPANTS

26 clinicians randomised into TA and AAU groups recruited 70 newly referred adolescents with self-harm.

INTERVENTIONS

TA, a manualised procedure including a basic psychosocial assessment and a 30 min therapeutic intervention; AAU, standard psychosocial assessment.

MAIN OUTCOME MEASURES

Attendance at the first follow-up session; number of the follow-up sessions attended and changes in Strengths and Difficulties Questionnaire and Children's Global Assessment Scale scores. All measures were adjusted for clustering, social class, changes of therapist and previous contact with services.

RESULTS

Using the data on all participants (n=70), those in the TA group were significantly more likely to attend the first follow-up appointment: 29 (83%) versus 17 (49%), OR 5.12, 95% CI (1.49 to 17.55) and more likely to attend four or more treatment sessions: 14 (40%) versus 4 (11%), OR 5.19, 95% CI (2.22 to 12.10). Three months after the initial assessment there were no statistically significant differences between the groups on Strengths and Difficulties Questionnaire scores: 15.6 versus 16.0, mean difference -0.37, 95% CI (-3.28 to 2.53) or Children's Global Assessment Scale scores: 64.6 versus 60.1, mean difference 4.49, 95% CI (-0.98 to 9.96).

CONCLUSIONS

TA was associated with statistically significant improvement in engagement. TA could be usefully applied at the point of initial assessment for adolescents with self-harm.

TRIAL REGISTRATION

ISRCTN 81605131 http://www.controlled-trials.com/ISRCTN81605131/.

摘要

目的

确定治疗性评估（TA）与常规评估（AAU）相比是否能提高有自伤行为的青少年接受后续治疗的参与度。

设计

3 个月自然随访的随机对照试验。

地点

伦敦两家国家卫生服务信托机构的儿童和青少年心理健康服务机构。

参与者

26 名临床医生被随机分为 TA 组和 AAU 组，招募了 70 名新转诊的有自伤行为的青少年。

干预措施

TA 是一种手册化的程序，包括基本的心理社会评估和 30 分钟的治疗性干预；AAU，标准的心理社会评估。

主要观察指标

第一次随访的就诊情况；参加随访的次数以及 Strengths and Difficulties Questionnaire（长处与困难问卷）和 Children's Global Assessment Scale（儿童总体评估量表）评分的变化。所有措施均针对聚类、社会阶层、治疗师变更和以前与服务的接触进行了调整。

结果

根据所有参与者（n=70）的数据，TA 组的患者更有可能参加第一次随访预约：29 人（83%）比 17 人（49%），比值比（OR）5.12，95%置信区间（CI）（1.49 至 17.55），更有可能参加 4 次或更多的治疗：14 人（40%）比 4 人（11%），OR 5.19，95% CI（2.22 至 12.10）。初次评估后 3 个月，两组在 Strengths and Difficulties Questionnaire（长处与困难问卷）评分上没有统计学上的显著差异：15.6 分比 16.0 分，差值-0.37，95%CI（-3.28 至 2.53），或 Children's Global Assessment Scale（儿童总体评估量表）评分：64.6 分比 60.1 分，差值 4.49，95% CI（-0.98 至 9.96）。