Kolko David J, Campo John V, Kilbourne Amy M, Kelleher Kelly
Special Services Unit, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
Arch Pediatr Adolesc Med. 2012 Mar;166(3):224-31. doi: 10.1001/archpediatrics.2011.201. Epub 2011 Nov 7.
To evaluate the feasibility and clinical benefits of an integrated mental health intervention (doctor-office collaborative care [DOCC]) vs enhanced usual care (EUC) for children with behavioral problems.
Cases were assigned to DOCC and EUC using a 2:1 randomization schedule that resulted in 55 DOCC and 23 EUC cases.
Preassessment was conducted in 4 pediatric primary care practices. Postassessment was conducted in the pediatric or research office. Doctor-office collaborative care was provided in the practice; EUC was initiated in the office but involved a facilitated referral to a local mental health specialist.
Of 125 referrals (age range, 5-12 years), 78 children participated.
Children and their parents were assigned to receive DOCC or EUC.
Preassessment diagnostic status was evaluated using the Schedule for Affective Disorders and Schizophrenia for School-aged Children. Preassessment and 6-month postassessment ratings of behavioral and emotional problems were collected from parents using the Vanderbilt Attention-Deficit/Hyperactivity Disorder Diagnostic Parent Rating Scale, as well as individualized goal achievement ratings forms. At discharge, care managers and a diagnostic evaluator completed the Clinical Global Impression Scale, and pediatricians and parents completed satisfaction and study feedback measures.
Group comparisons found significant improvements for DOCC over EUC in service use and completion, behavioral and emotional problems, individualized behavioral goals, and overall clinical response. Pediatricians and parents were highly satisfied with DOCC.
The feasibility and clinical benefits of DOCC for behavioral problems support the integration of collaborative mental health services for common mental disorders in primary care.
评估综合心理健康干预措施（医生办公室协作护理[DOCC]）与强化常规护理（EUC）对有行为问题儿童的可行性和临床益处。
采用2:1随机分组方案将病例分配至DOCC组和EUC组，最终DOCC组有55例，EUC组有23例。
在4家儿科初级保健机构进行预评估。在儿科或研究办公室进行后评估。DOCC在初级保健机构实施；EUC在办公室启动，但包括协助转诊至当地心理健康专家。
125例转诊儿童（年龄范围5 - 12岁）中，78名儿童参与。
儿童及其父母被分配接受DOCC或EUC。
使用学龄儿童情感障碍和精神分裂症检查表评估预评估诊断状态。使用范德比尔特注意力缺陷/多动障碍诊断家长评定量表以及个体化目标达成评定表，从家长处收集行为和情绪问题的预评估及6个月后评估评分。出院时，护理经理和诊断评估人员完成临床总体印象量表，儿科医生和家长完成满意度及研究反馈测量。
组间比较发现，DOCC组在服务使用和完成情况、行为和情绪问题、个体化行为目标以及总体临床反应方面比EUC组有显著改善。儿科医生和家长对DOCC高度满意。
DOCC对行为问题的可行性和临床益处支持在初级保健中整合针对常见精神障碍的协作心理健康服务。
