通过综合护理和任务转移改善青少年获得行为健康服务的机会：一项整群随机阶梯式楔形临床试验方案
Improving youth access to behavioral health services through integrated care and task shifting: protocol for a cluster-randomized stepped wedge clinical trial.
作者信息
Marriott Brigid R, Hulvershorn Leslie, Oliver Johnathan, Jones Cara, O'Reilly Lauren M, Wiehe Sarah E, Monahan Patrick O, Bearman Sarah Kate, Saldana Lisa, Aalsma Matthew C
机构信息
Adolescent Behavioral Health Research Program, Indiana University School of Medicine, Indianapolis, IN, USA.
Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA.
出版信息
Contemp Clin Trials Commun. 2025 Jun 30;46:101518. doi: 10.1016/j.conctc.2025.101518. eCollection 2025 Aug.
BACKGROUND
One promising solution for improving access to mental health services is integrated behavioral health models, in which behavioral health providers address mental health problems within the primary care infrastructure. Additionally, task-shifting, where non-specialists deliver certain services in the place of specialists, may be well-suited to address mental health provider shortages. The current study outlines the protocol for a hybrid type III implementation-effectiveness, cluster-randomized stepped wedge trial to evaluate the implementation of an adapted pediatric integrated behavioral health model (Peds IBH) that includes task-shifting services, explore the facilitators and barriers to the implementation of Peds IBH, and examine connection to behavioral health care pre- and post-implementation.
METHODS
The trial will include 25 pediatric primary care clinics across 13 counties in a large healthcare system. Clinics will be randomized to one of three cohorts, stepped in at 6-month intervals, with a 12-month implementation period. The Peds IBH program will: 1) incorporate task-shifting to treat mild to moderate anxiety, depression, and conduct problems with flexible, transdiagnostic cognitive-behavior therapy to be delivered by bachelor's level interventionists, 2) leverage existing child psychiatry provider consultation programs, and 3) increase sustainability through a different billing model. Quantitative data collection will include surveys (primary care team members, behavioral health providers, and youth and caregivers) and tracking of implementation strategies. Qualitative interviews will be conducted with primary care providers and staff.
DISCUSSION
This trial will evaluate the implementation of the Peds IBH program. While the focus is implementation outcomes, we will assess effectiveness to inform future dissemination efforts.
TRIAL REGISTRATION
N/A.
背景
改善心理健康服务可及性的一个有前景的解决方案是综合行为健康模式，即行为健康服务提供者在初级保健基础设施内处理心理健康问题。此外，任务转移（由非专科医生代替专科医生提供某些服务）可能非常适合解决心理健康服务提供者短缺的问题。本研究概述了一项混合型III期实施-效果、整群随机阶梯楔形试验的方案，以评估一种经过调整的儿科综合行为健康模式（Peds IBH）的实施情况，该模式包括任务转移服务，探索实施Peds IBH的促进因素和障碍，并检查实施前后与行为健康护理的联系。
方法
该试验将纳入一个大型医疗系统中13个县的25家儿科初级保健诊所。诊所将被随机分为三个队列之一，每隔6个月加入一个队列，实施期为12个月。Peds IBH项目将：1）采用任务转移，通过由本科水平的干预人员提供的灵活的跨诊断认知行为疗法来治疗轻度至中度焦虑、抑郁和行为问题；2）利用现有的儿童精神病学提供者咨询项目；3）通过不同的计费模式提高可持续性。定量数据收集将包括调查（初级保健团队成员、行为健康服务提供者以及青少年和照顾者）和实施策略的跟踪。将对初级保健提供者和工作人员进行定性访谈。
讨论
本试验将评估Peds IBH项目的实施情况。虽然重点是实施结果，但我们将评估效果，为未来的推广工作提供信息。
试验注册
无。
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