Department of Psychology, University of California.
J Consult Clin Psychol. 2013 Dec;81(6):999-1009. doi: 10.1037/a0034200. Epub 2013 Aug 26.
This article reports outcomes from the Child STEPs randomized effectiveness trial conducted over a 2-year period to gauge the longer term impact of protocol design on the effectiveness of evidence-based treatment procedures.
An ethnoracially diverse sample of 174 youths ages 7- 13 (N = 121 boys) whose primary clinical concerns involved diagnoses or clinical elevations related to anxiety, depression, or disruptive behavior were treated by community therapists randomly assigned to 1 of 3 conditions: (a) standard, which involved the use of 1 or more of 3 manualized evidence-based treatments, (b) modular, which involved a single modular protocol (Modular Approach to Treatment of Children With Anxiety, Depression, or Conduct Problems; MATCH) having clinical procedures similar to the standard condition but flexibly selected and sequenced using a guiding clinical algorithm, and (c) usual care.
As measured with combined Child Behavior Checklist and Youth Self-Report Total Problems, Internalizing, and Externalizing scales, the rate of improvement for youths in the modular condition was significantly better than for those in usual care. On a measure of functional impairment (Brief Impairment Scale), no significant differences were found among the 3 conditions. Analysis of service utilization also showed no significant differences among conditions, with almost half of youths receiving some additional services in the 1st year after beginning treatment, and roughly one third of youths in the 2nd year.
Overall, these results extend prior findings, supporting incremental benefits of MATCH over usual care over a 2-year period.
本文报告了儿童 STEPs 随机有效性试验的结果，该试验持续了 2 年，旨在评估方案设计对循证治疗程序有效性的长期影响。
本研究纳入了 174 名年龄在 7 至 13 岁（N=121 名男孩）的族裔多样化的青少年，其主要临床问题涉及与焦虑、抑郁或破坏性行为相关的诊断或临床升高，他们由社区治疗师随机分配到 3 种条件之一进行治疗：（a）标准条件，包括使用 1 种或多种手册化的循证治疗方法；（b）模块条件，涉及单一的模块方案（儿童焦虑、抑郁或行为问题的治疗方法模块；MATCH），该方案具有与标准条件相似的临床程序，但使用指导临床算法灵活选择和排序；（c）常规护理。
根据儿童行为检查表和青少年自我报告的总问题、内部问题和外部问题量表的测量结果，模块条件下的青少年改善率明显优于常规护理条件下的青少年。在功能障碍测量（简要障碍量表）上，3 种条件之间没有发现显著差异。对服务利用的分析也显示出 3 种条件之间没有显著差异，几乎一半的青少年在开始治疗后的第 1 年接受了一些额外的服务，大约三分之一的青少年在第 2 年接受了额外的服务。
总体而言，这些结果扩展了先前的发现，支持 MATCH 比常规护理在 2 年期间具有额外的益处。
