Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
J Pediatr Psychol. 2011 Aug;36(7):753-65. doi: 10.1093/jpepsy/jsr006. Epub 2011 Feb 19.
To evaluate putative moderator, predictor, and treatment parameter variables in relation to three outcomes in a clinical trial that compared a modular protocol for on-site, nurse-administered intervention (PONI) and enhanced usual care (EUC) for pediatric behavioral problems in primary care.
Patients were 163 clinically referred children for behavior problems in six primary care offices. PONI consisted of seven treatment modules adapted from prior treatment trials with this population, whereas EUC involved a facilitated referral to a community provider. Outcome measures were based on standardized scales reflecting one parent-rated aggregate (child dysfunction) and one child-rated aggregate (child health), and diagnostic interviews with both informants (remission in oppositional defiant disorder).
Moderator analyses revealed that PONI was more effective than EUC in reducing child dysfunction by 12-month follow-up among Caucasian children, whereas EUC was more effective than PONI among non-Caucasian children. In the full sample, child health improvement was predicted by the severity of the child's depression and anxiety, and level of family conflict. Duration of child exposure to cognitive-behavioral treatment in PONI was related to greater improvement in overall child health, but other treatment parameters were unrelated to outcome.
These few significant relationships notwithstanding the findings indicate that the two treatments had robust effects on several outcomes and across selected child, parent, family, and treatment variables. The findings extend efforts to incorporate mental health services in pediatric practice.
评估在一项临床试验中，与现场护士管理干预（PONI）和增强常规护理（EUC）比较儿科行为问题的模块化方案相关的三个结果的潜在调节、预测和治疗参数变量。
患者为来自六个初级保健办公室的 163 名临床转介的行为问题儿童。PONI 包括从针对该人群的先前治疗试验中改编的七个治疗模块，而 EUC 涉及促进向社区提供者转介。结果测量基于反映一个家长评定综合指标（儿童功能障碍）和一个儿童评定综合指标（儿童健康）的标准化量表，以及两个信息提供者的诊断访谈（对立违抗性障碍的缓解）。
调节分析显示，在 12 个月随访时，PONI 比 EUC 更有效地减少了白人儿童的儿童功能障碍，而 EUC 比 PONI 更有效地减少了非白人儿童的儿童功能障碍。在全样本中，儿童的抑郁和焦虑严重程度以及家庭冲突水平预测了儿童健康的改善。PONI 中儿童暴露于认知行为治疗的持续时间与整体儿童健康的改善相关，但其他治疗参数与结果无关。
尽管存在这些显著关系，但这些发现表明，两种治疗方法对几个结果以及选定的儿童、父母、家庭和治疗变量具有强大的影响。这些发现扩展了将心理健康服务纳入儿科实践的努力。
