Myers Kathleen, Vander Stoep Ann, Lobdell Caitlin
Department of Psychiatry and Behavioral Medicine, Seattle Children's Hospital, Seattle, Washington 98105, USA.
J Child Adolesc Psychopharmacol. 2013 Aug;23(6):372-8. doi: 10.1089/cap.2013.0020.
Telemental health (TMH), the use of videoteleconferencing to provide care that is usually delivered in person, is increasingly used to rectify disparities in access to care. Few studies, however, have been conducted to demonstrate the effectiveness of TMH as a service delivery model. The Children's Attention-Deficit/Hyperactivity Disorder (ADHD) Telemental Health Treatment Study (CATTS) is a randomized clinical trial (RCT) of TMH conducted in multiple underserved communities. This article reports on the feasibility of conducting an effectiveness trial of TMH with children.
The CATTS trial used videoteleconferencing to provide guideline-based care and secure web sites to coordinate key aspects of trial implementation, such as participant recruitment and retention, intervention fidelity, and completion of assessments.
The CATTS trial engaged seven communities and 150 primary care providers as partners in the study, and enrolled 223 children 5.5-12.9 years old. The intervention group completed an average of 5.3 of 6.0 planned sessions and 96% of controls completed a TMH consultation. Both groups completed an average of 4.8 of the 5.0 assessments. Clinicians demonstrated high fidelity to their treatment protocols. Minor technical difficulties did not interfere with providing care.
The CATTS trial demonstrated the feasibility of conducting an RCT of TMH with children living in multiple underserved communities. Telecommunications technologies can facilitate the coordination of research activities across sites and clinicians. Future trials should work closely with study partners to ensure referral of a representative study sample. Further trials are needed to help establish the effectiveness of TMH as a service delivery model.
远程心理健康（TMH），即使用视频电话会议提供通常需面对面提供的护理，越来越多地被用于纠正医疗服务获取方面的差异。然而，很少有研究来证明TMH作为一种服务提供模式的有效性。儿童注意力缺陷/多动障碍（ADHD）远程心理健康治疗研究（CATTS）是在多个服务不足社区进行的一项关于TMH的随机临床试验（RCT）。本文报告了对儿童进行TMH有效性试验的可行性。
CATTS试验使用视频电话会议提供基于指南的护理，并利用安全网站来协调试验实施的关键方面，如参与者的招募与保留、干预的保真度以及评估的完成情况。
CATTS试验让七个社区和150名初级保健提供者作为研究伙伴参与其中，招募了223名5.5至12.9岁的儿童。干预组平均完成了6.0次计划疗程中的5.3次，96%的对照组完成了一次TMH咨询。两组平均完成了5.0次评估中的4.8次。临床医生对其治疗方案表现出高度的保真度。轻微的技术困难并未干扰护理的提供。
CATTS试验证明了对生活在多个服务不足社区的儿童进行TMH随机对照试验的可行性。电信技术可以促进跨地点和临床医生的研究活动协调。未来的试验应与研究伙伴密切合作，以确保推荐具有代表性的研究样本。需要进一步的试验来帮助确定TMH作为一种服务提供模式的有效性。
