YOUNG ADULTS WITH VIOLENT BEHAVIOR DURING EARLY PSYCHOSIS: A MIXED-METHODS ASSESSMENT AND INTERVENTION TRIAL

项目摘要：尽管严重精神疾病患者的绝对暴力风险(SMI) 在较小的范围内，经历早期精神病的年轻人是暴力风险最高的一个亚群。暴力是一种 导致成年精神分裂症患者健康差距的公共卫生问题，包括 照顾者负担、社会孤立、监禁和随后的早期死亡。认知行为 精神病的治疗(CBT)和类似的行为干预在减少损害和 改善患有早期精神病的年轻人的功能。然而，还没有确定的研究探索 使用行为干预来减少患有早期精神病的年轻人的暴力行为。 在这份申请中，斯蒂芬妮·罗林博士提出了一条全面的独立道路 医生调查员创建和调整基于证据的方法来评估和降低暴力风险。 具体地说，这项建议遵循了疾控中心的适应地图，这是一种基于证据的适应模式 干预措施(EBI)，以适应和评估针对早期干预服务(EIS)的CBT- 以减少暴力为基础的干预措施，其拟议目标符合以下跨诊断性质 研究领域标准(RDoC)。这项研究将在OnTrackNY进行，这是世界上最大的EIS项目 美国；OnTrackNY为1800多人提供了基于证据的协调专科护理 在纽约州的20多家诊所。首先，罗林博士将进行个人半结构化采访 最近有暴力行为的EIS客户(n=20)和曾与EIS合作的临床医生 有暴力行为的当事人(n=10)。这些访谈将使用计划行为理论 确定名为毕加索的现有CBT模型的关键领域(该模型已显示出降低 暴力)，需要适应环境影响报告书的环境。接下来，罗林博士将把毕加索的模型改编成《环境影响报告书》 在开放的试点试验中，通过利用混合方法评估的迭代过程。最后，戴维斯博士说。 罗林将通过一项试验性随机对照试验评估干预的可行性。 为了实现她成为一名独立医生-调查员的长期职业目标，她专注于创造 和调整EBI以降低暴力风险，罗林博士将在以下四个方面进行培训：(1)定性 研究包括混合方法；(2)心理社会干预适应；(3)心理治疗临床试验； (4)授权书写作。本研究的产品将是一台R01的大型RCT，以测试其可行性 CBT的EBI，以减少EIS环境中的暴力。总体而言，这个奖项将确保罗林博士成功地 过渡到独立的医生调查员，研究评估和预防#年的暴力 患有SMI的成年人。

Project Summary: Although the absolute risk of violence among persons with serious mental illnesses (SMI) is small, young people experiencing early psychosis are a subgroup at highest violence risk. Violence is a public health issue that contributes to health disparities experienced by adults with schizophrenia, including caregiver burden, social isolation, and incarceration and subsequent early mortality. Cognitive behavioral therapy (CBT) for psychosis and similar behavioral interventions have had efficacy in reducing impairment and improving functioning among young adults with early psychosis. However, no identified studies have explored using a behavioral intervention to reduce violence among young adults with early psychosis. In this application, Dr. Stephanie Rolin proposes a comprehensive path towards becoming an independent physician investigator creating and adapting evidence-based approaches to assess and reduce violence risk. Specifically, this proposal follows the CDC’s Map of Adaptation, a model for adapting evidence-based interventions (EBI), to adapt and evaluate the feasibility of an early intervention services (EIS)-specific CBT- based intervention to reduce violence with proposed targets consistent with the transdiagnostic nature of Research Domain Criteria (RDoC). This research will occur at OnTrackNY, the largest EIS program in the United States; OnTrackNY has provided evidence-based coordinated specialty care to over 1,800 individuals at more than 20 clinics in New York State. First, Dr. Rolin will conduct individual semi-structured interviews with EIS clients who have engaged in recent violent behavior (n=20) and clinicians who have worked with EIS clients who have engaged in violent behavior (n=10). These interviews will use the Theory of Planned Behavior to identify key areas of an existing CBT model called PICASSO (which has shown efficacy in reducing violence) that require adaptation for the EIS setting. Next, Dr. Rolin will adapt the PICASSO model for the EIS setting in an open pilot trial, through an iterative process that utilizes mixed methods assessment. Finally, Dr. Rolin will evaluate the intervention’s feasibility through a pilot RCT. To further her long-term career goal of becoming an independent physician-investigator focused on creating and adapting EBI to reduce violence risk, Dr Rolin will pursue training in the following four areas: (1) qualitative research including mixed methods; (2) psychosocial intervention adaptation; (3) psychotherapy clinical trials; and (4) grant writing. The product of this study will be an R01 of a large RCT to test the feasibility of the first EBI of CBT to reduce violence in the EIS setting. Overall, this award will ensure Dr. Rolin’s successful transition to an independent physician investigator studying the assessment and prevention of violence among adults with SMI.