培训社区治疗师提供个体化孤独症谱系障碍心理健康干预：对儿童结局的 caregiver 结局改变及中介作用。
Training Community Therapists to Deliver an Individualized Mental Health Intervention for Autism Spectrum Disorder: Changes in Caregiver Outcomes and Mediating Role on Child Outcomes.
机构信息
Child and Adolescent Services Research Center, San Diego, California; University of California, San Diego; Rady Children's Hospital, San Diego, California.
Child and Adolescent Services Research Center, San Diego, California; University of California, San Diego.
出版信息
J Am Acad Child Adolesc Psychiatry. 2021 Mar;60(3):355-366. doi: 10.1016/j.jaac.2020.07.896. Epub 2020 Aug 2.
OBJECTIVE
This study examines the impact of training therapists to deliver "An Individualized Mental Health Intervention for Autism Spectrum Disorder (ASD)" (AIM HI) for children with autism spectrum disorder on caregiver outcomes and the mediating role of changes in caregiver outcomes on child outcomes.
METHOD
Data were drawn from a cluster randomized trial conducted in 29 publicly funded mental health programs randomized to receive AIM HI training or usual care. Therapists were recruited from enrolled programs and child/caregiver participants enrolled from therapists' caseloads. Participants included 202 caregivers of children 5 to 13 years of age with autism spectrum disorder. Caregiver strain and sense of competence were assessed at baseline and 6 month postbaseline. Child behaviors were assessed at baseline and 6, 12, and 18 months postbaseline. Therapist delivery of evidence-based intervention strategies were assessed between baseline and 6 months.
RESULTS
A significant training effect was observed for caregiver sense of competence, with AIM HI caregivers reporting significantly greater improvement relative to usual care. There was no significant training effect for caregiver strain. Observer-rated therapist delivery of evidence-based interventions strategies over 6 months mediated training effects for sense of competence at 6 months. Changes in sense of competence from baseline to 6 months was associated with reduced child challenging behaviors at 6 months and mediated child outcomes at 12 and 18 months.
CONCLUSION
Combined with research demonstrating effectiveness of therapist AIM HI training on child outcomes, this study provides further evidence of the positive impact of training community therapists in the AIM HI intervention.
CLINICAL TRIAL REGISTRATION INFORMATION
Effectiveness and Implementation of a Mental Health Intervention for ASD (AIM HI); https://clinicaltrials.gov/; NCT02416323.
目的
本研究考察了培训治疗师为自闭症谱系障碍（ASD）儿童提供“自闭症谱系障碍个体化心理健康干预（AIM HI）”对照顾者结果的影响，以及照顾者结果变化对儿童结果的中介作用。
方法
数据来自在 29 个公共资助的心理健康项目中进行的一项集群随机试验，这些项目随机接受 AIM HI 培训或常规护理。治疗师从参与的项目中招募，儿童/照顾者参与者从治疗师的病例中招募。参与者包括 202 名 5 至 13 岁自闭症谱系障碍儿童的照顾者。基线和基线后 6 个月评估照顾者的压力和能力感。基线和基线后 6、12 和 18 个月评估儿童行为。基线和 6 个月之间评估治疗师提供循证干预策略的情况。
结果
观察到照顾者能力感的显著培训效果，AIM HI 照顾者报告的改善明显优于常规护理。照顾者压力没有显著的培训效果。在 6 个月内，观察到的治疗师提供循证干预策略的情况在 6 个月时中介了能力感的培训效果。从基线到 6 个月，能力感的变化与 6 个月时儿童挑战性行为的减少有关，并在 12 个月和 18 个月时中介了儿童结果。
结论
结合研究证明治疗师 AIM HI 培训对儿童结果的有效性，本研究进一步证明了在 AIM HI 干预中培训社区治疗师的积极影响。
临床试验注册信息
自闭症谱系障碍的心理健康干预措施的有效性和实施（AIM HI）；https://clinicaltrials.gov/；NCT02416323。
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