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在青少年心理健康护理中培养循证临床推理和行动：触及家庭的多点随机试验 ... ...
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在青少年心理健康护理中培养循证临床推理和行动：触及家庭的多点随机试验
Cultivating evidence-based clinical reasoning and action in youth mental health care: The Reaching Families multisite randomized trial
——《咨商与临床心理学杂志》第93卷第2期，2025年——
<Journal of Counseling and Clinical Psychology> Volume 93, Issue 1, 2025
【摘要】目的：尽管数十年来政策强调证据在指导服务中的作用，但很少有研究试图提高证据在监督和治疗中的使用程度。本研究报告了来自“触及家庭”多点集群随机对照试验的督导员和治疗师结果，该试验测试了协调知识系统 (CKS) 与实践指南 (PG) 对监督和治疗中使用证据的影响，针对位于两个地理位置不同、资源匮乏且服务不平等现象普遍的社区的公共资助青年社区心理健康组织的低治疗参与度。方法：样本包括121名心理健康专业人员（92.6%为女性；81.0%为黑人、土著和有色人种），随机分配到CKS或PG控制条件。我们记录、转录和编码了430次监督和208次治疗课程，涉及221名青少年（Mage=13.1岁，46.2%为女性；78.7%为黑人、土著和有色人种）和/或他们的照顾者，他们在治疗期间报告了参与度问题。结果：与PG条件下的二元组相比，CKS二元组一致显示更多地使用专注于特定客户需求的证据，并且效果大小较大，并且不同站点的条件效果没有差异。二次分析表明，在努力和有效性方面，CKS条件下的工具比PG条件下的工具被认为更为积极，并且两种条件下的监督工作量相同。结论：在高度代表性的社区环境中提供的常规临床护理中，战略性设计的知识资源可以改善基于证据的推理和行动，并被认为易于使用和有用，而不会对工作量产生负面影响。
【关键词】督导；参与；循证实践；临床推理；心理健康服务
[Abstract] Objective: Despite decades of policy emphasizing the role of evidence in guiding services, few studies have sought to improve the degree to which evidence is used in supervision and treatment. This study reports supervisor and therapist outcomes from the Reaching Families multisite cluster-randomized controlled trial, which tested the effects of a coordinated knowledge system (CKS) against practice guidelines (PG) on the use of evidence in supervision and treatment targeting low treatment engagement in publicly funded youth community mental health organizations located in two geographically distinct, underresourced communities where service inequities are common. Method: The sample included 121 mental health professionals (92.6% female; 81.0% Black, Indigenous, and people of color1) randomly assigned to a CKS or PG control condition. We recorded, transcribed, and coded 430 supervision and 208 treatment sessions involving 221 youth (Mage = 13.1 years, 46.2% female; 78.7% Black, Indigenous, and people of color) and/or their caregivers who reported engagement concerns during therapy. Results: CKS dyads showed uniformly greater use of evidence focused on specific client needs relative to dyads in the PG condition, with large effect sizes and no differences in the effect of condition across the sites. Secondary analyses showed that tools in the CKS condition were perceived significantly more positively than those in the PG condition in terms of effort and effectiveness, and supervisory workload was the same across both conditions. Conclusions: In routine clinical care delivered within highly representative community settings, a strategically designed knowledge resource can improve evidence-based reasoning and action and be perceived as easy to use and useful without negatively impacting workload.
[Kew words] supervision; engagement; evidence-based practice; clinical reasoning; mental health services
论文原文：Chorpita, B. F., Becker, K. D., Park, A. L., Lakind, D., Guan, K., Boustani, M. M., Boyd, M. R., Chu, W., Wu, E. G., & Knudsen, K. S. (2025). Cultivating evidence-based clinical reasoning and action in youth mental health care: The Reaching Families multisite randomized trial. Journal of Consulting and Clinical Psychology, Volume 93, Issue 2, Pages 65–82.
https://doi.org/10.1037/ccp0000939
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