Improving youth access to behavioral health services through integrated care and task shifting: protocol for a cluster-randomized stepped wedge clinical trial

IF 1.4 Q4 MEDICINE, RESEARCH & EXPERIMENTAL

Contemporary Clinical Trials Communications Pub Date : 2025-06-30 DOI:10.1016/j.conctc.2025.101518

Brigid R. Marriott , Leslie Hulvershorn , Johnathan Oliver , Cara Jones , Lauren M. O'Reilly , Sarah E. Wiehe , Patrick O. Monahan , Sarah Kate Bearman , Lisa Saldana , Matthew C. Aalsma

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引用次数: 0

Abstract

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.

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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：一项集群随机阶梯楔形临床试验方案

背景改善获得精神卫生服务的一个有希望的解决办法是综合行为卫生模式，其中行为卫生提供者在初级保健基础设施内处理精神卫生问题。此外，任务转移，非专业人员代替专业人员提供某些服务，可能非常适合解决精神卫生提供者短缺的问题。目前的研究概述了一项混合III型实施有效性、集群随机阶梯形试验的方案，以评估包括任务转移服务在内的适应性儿科综合行为健康模型（Peds IBH）的实施情况，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保健的联系。该试验将包括一个大型医疗保健系统中13个县的25个儿科初级保健诊所。诊所将被随机分配到三个队列中的一个，每隔6个月介入一次，实施期为12个月。儿科IBH项目将：1)结合任务转移，以治疗轻度至中度焦虑、抑郁和行为问题，由本科水平的干预医生提供灵活的、跨诊断的认知行为疗法；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增加可持续性。定量数据收集将包括调查（初级保健小组成员、行为保健提供者、青年和照顾者）和跟踪实施战略。将对初级保健提供者和工作人员进行定性访谈。本试验将评估儿科IBH项目的实施情况。虽然重点是执行结果，但我们将评估有效性，为今后的传播工作提供信息。审判registrationN /。

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来源期刊

Contemporary Clinical Trials Communications Pharmacology, Toxicology and Pharmaceutics-Pharmacology

CiteScore

2.70

自引率

6.70%

发文量

146

审稿时长

20 weeks

期刊介绍： Contemporary Clinical Trials Communications is an international peer reviewed open access journal that publishes articles pertaining to all aspects of clinical trials, including, but not limited to, design, conduct, analysis, regulation and ethics. Manuscripts submitted should appeal to a readership drawn from a wide range of disciplines including medicine, life science, pharmaceutical science, biostatistics, epidemiology, computer science, management science, behavioral science, and bioethics. Contemporary Clinical Trials Communications is unique in that it is outside the confines of disease specifications, and it strives to increase the transparency of medical research and reduce publication bias by publishing scientifically valid original research findings irrespective of their perceived importance, significance or impact. Both randomized and non-randomized trials are within the scope of the Journal. Some common topics include trial design rationale and methods, operational methodologies and challenges, and positive and negative trial results. In addition to original research, the Journal also welcomes other types of communications including, but are not limited to, methodology reviews, perspectives and discussions. Through timely dissemination of advances in clinical trials, the goal of Contemporary Clinical Trials Communications is to serve as a platform to enhance the communication and collaboration within the global clinical trials community that ultimately advances this field of research for the benefit of patients.