Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O'Hara St, Pittsburgh, PA 15213, USA.
Adm Policy Ment Health. 2011 Nov;38(6):486-94. doi: 10.1007/s10488-011-0335-2.
We examined trajectories of symptom reduction during the course of on-site treatment for behavior problems in pediatric primary-care settings for a subset of children from a larger clinical trial. Participants (N = 80) were children (ages 6-11) referred for treatment due to moderate elevations (≥75th percentile) on the externalizing subscale of the Pediatric Symptom Checklist (PSC-17). The sample was recruited from six pediatric practices in an urban setting. The treatment (Protocol for an Office-based Nurse-administered Intervention; PONI) was administered on-site by trained nurses over the course of 3-6 months. Overall, symptom reduction from the first session to last session was moderate (ES = 0.61) and gradual. Roughly two-thirds (72%) of symptom reduction took place over the first 8 weeks of treatment. The average trajectory of symptom reduction was characterized by a negative slope that flattened over time, consistent with a quadratic growth model. Initial symptom severity predicted final symptom severity (r = .36, P < .01), even though patients with greater initial symptom severity remained in treatment for a significantly greater number of sessions (r = .24, P < .05). The implications of these findings for enhancing the efficiency and effectiveness of treatment are discussed.
我们考察了在儿科初级保健环境中对行为问题进行现场治疗过程中症状减轻的轨迹，这是对来自更大临床试验的一部分儿童的子样本进行的研究。参与者（N=80）是因外部症状子量表（PSC-17）的中等升高（≥第 75 个百分位）而被推荐接受治疗的儿童（年龄 6-11 岁）。该样本是从城市环境中的六个儿科诊所招募而来的。治疗（基于办公室的护士管理干预方案；PONI）由经过培训的护士在 3-6 个月的时间内进行现场管理。总体而言，从第一次治疗到最后一次治疗的症状减轻幅度适中（ES=0.61），且呈渐进性。大约三分之二（72%）的症状减轻发生在治疗的前 8 周内。症状减轻的平均轨迹以负斜率为特征，随着时间的推移逐渐趋于平缓，符合二次增长模型。初始症状严重程度预测最终症状严重程度（r=.36，P<.01），尽管初始症状严重程度较高的患者接受治疗的次数明显更多（r=.24，P<.05）。讨论了这些发现对提高治疗效率和效果的意义。
