目的:治疗病灶弥散(TFD),在治疗期间将焦点分散在多个问题上,在公共精神卫生保健中很常见,与文献中报道的针对青年的更狭窄的经验支持治疗方法不同。本研究检查了在治疗过程中TFD是否以及在多大程度上与青年功能改善相关。
方法:本研究利用多层次建模技术分析了连续12年的标准化常规临床服务数据,这些数据来自在两种密集的家庭服务环境之一中接受治疗的年轻人:(a)多系统治疗(MST;n=776名年轻人,99名治疗师),一种基于生态行为理论的基于证据的治疗方法,其中治疗师使用年轻人与之互动的多个系统(学校,社区,family),和(B)基于标准的服务(n=1854名青年,413治疗师)。这两种服务都是在公共资助的精神卫生保健系统的背景下运作的,该系统为通常来自服务不足和低收入背景的青年和家庭提供服务。这个样本中的大多数年轻人被确定为多种族和男性,而他们,平均而言,大约13岁,有三个共同发生的诊断。
结果:通过服务格式对青年功能改善的显着TFD(单独和在整体模型中)和后续简单效果表明,较高的TFD与MST的显着较差结果相关。在基于标准的服务格式中,关于功能改进的TFD的参数估计是相同的方向,但没有统计学意义。
结论:我们的研究结果表明,保持狭窄的治疗重点可能对患者有益,特别是在实施循证治疗方面。同样,TFD可能是临床医生有用的病例监测工具,supervisors,和系统领导者在审查密集的家庭案例时。
Treatment focus diffusion (TFD), dividing focus across multiple concerns during treatment, is common in public mental health care and differs from the more narrowly focused empirically supported treatments for youth reported in the literature. The present study examined whether and to what extent TFD is associated with youth functional improvement over the course of therapy.
This study utilized multi-level modeling techniques to analyze 12 consecutive years of standardized routine clinical service data from youth receiving treatment in one of two intensive in-home service settings: (a) Multisystemic Therapy (MST; n = 776 youths, 99 therapists), an implemented evidence-based treatment based on ecological theories of behavior in which therapists work with the multiple systems a youth interacts with (school, community, family), and (b) a standards-based service (n = 1854 youth, 413 therapists). Both service settings operate in the context of a publicly funded mental health care system which serves youth and families who are typically from underserved and low-income backgrounds. Majority of youth in this sample identified as multi-ethnic and male, and they, on average, were approximately 13 years old with three co-occurring diagnoses.
A significant TFD by service format interaction on youth functional improvement (alone and in the overall model) and follow up simple effects indicated that higher TFD was associated with significantly poorer outcomes in MST. The parameter estimate for TFD on functional improvement in the standards-based service format was in the same direction, but not statistically significant.
Our findings suggest that maintaining a narrower treatment focus might be beneficial to clients, particularly in implemented evidence-based treatments. Likewise, TFD could be a helpful case monitoring tool for clinicians, supervisors, and systems leaders when reviewing intensive-in-home cases.