InVEST: Individualized Vocational and Educational Support and Training for Clinical High Risk for Psychosis (CHR-P)

项目摘要 尽管强调在早期精神病治疗中靶向功能障碍的重要性， 目前没有对精神病临床高危人群的学业功能进行循证干预（CHR-P） 阶段鉴于有证据表明功能下降开始，功能障碍应该是一个关键的治疗优先事项 在CHR-P阶段，影响治疗参与，并可能影响其他症状。我们寻求发展 “InVEST”（个性化职业和教育支持与培训），一项干预措施，重点是 改善12-18岁表现出CHR-P的客户的教育功能。 作为CHR-P青年协调专科护理的组成部分，InVEST建立在先前的研究基础上， 支持就业，沿着真实的世界经验，帮助CHR-P的年轻人接受教育， 在CHR-P专业诊所的职业目标。InVEST单独实施（亲自或通过 视频会议）由学士水平的临床医生“教练”谁担任CSC团队的成员。投资是 旨在利用据信会相互作用并产生负面影响的下列机制 CHR-P阶段的教育和职业功能：1）执行功能困难（a） 认知机制），2）压力敏感性（情绪机制），和3）任务启动困难（ 行为机制）。InVEST是一种用于优先治疗结果的新型干预措施（即，作用 功能）在高风险人群中，并且与其他经验性检查方法不同， CHR-P阶段，包括精神病的认知行为治疗。投资考虑到不同的 通过以下方式满足CHR-P青年的需求：1）以个性化的方式优先考虑客户的偏好; 2） 旨在独立使用的战略，以最大限度地扩大访问。该项目将测试InVEST在两个 阶段：1）8名受试者的开放试验，2）30名受试者的小型随机对照试验 将InVEST与常规治疗等待列表对照进行比较。我们的治疗开发目标与 NIMH的战略目标3.2（“制定方法来调整现有的和新的干预措施， 3.3（社区实践环境中测试干预措施的有效性）。根据建议，我们 通过针对疾病早期的个人， 进展此外，我们寻求在现实世界的社区实践环境中研究InVEST。导频数据可以 支持未来更大规模研究的基础，充分检查InVEST在改善 职能成果，并审查潜在的变革机制。这次干预特别及时 在COVID-19大流行期间，由于CHR-P的年轻人可能特别容易受到学业失败的影响， 脱离接触，没有与学校工作人员亲自联系的结构，以支持学习需求。

Project Summary Despite emphasis on the importance of targeting functional impairments in early psychosis treatments, there is no current evidence-based intervention for academic functioning in the clinical high risk for psychosis (CHR-P) stage. Functional impairments should be a key treatment priority, given evidence that functional decline begins during the CHR-P stage, impacts treatment engagement, and may impact other symptoms. We seek to develop “InVEST” (Individualized Vocational and Educational Support and Training), an intervention focused on improving educational functioning in clients ages 12-18 that are exhibiting CHR-P. Conceptualized as a component of coordinated specialty care (CSC) for youth at CHR-P, InVEST builds on prior research on supported employment, along with real world experience helping youth at CHR-P to pursue educational/ vocational goals within a CHR-P specialty clinic. InVEST is implemented individually (in person or via videoconference) by bachelor's level clinician “coaches” who serve as members of a CSC team. InVEST is designed to engage the following mechanisms which are believed to interact and to negatively impact educational and vocational functioning during the CHR-P stage: 1) executive functioning difficulties (a cognitive mechanism), 2) stress sensitivity (an emotional mechanism), and 3) task initiation difficulties (a behavioral mechanism). InVEST is a novel intervention for a prioritized treatment outcome (i.e., role functioning) in a high-risk population, and is distinct from other empirically examined approaches during the CHR-P stage, including cognitive behavioral therapy for psychosis. InVEST takes into account the diverse needs of youth at CHR-P by 1) prioritizing client preferences in a personalized approach and 2) teaching strategies designed to be used independently to maximize broad access. The project will test InVEST in two phases: 1) an open trial with 8 participants, and 2) a small randomized control trial with 30 participants comparing InVEST against a treatment as usual waitlist control. Our treatment development objectives align with NIMH's strategic objectives 3.2 (“Develop ways to tailor existing and new interventions and to optimize outcomes”) and 3.3 (Test interventions for effectiveness in community practice settings). As recommended, we are specifically optimizing supported employment programs by targeting individuals earlier in their disease progression. Furthermore, we seek to study InVEST in a real-world community practice setting. Pilot data may support the basis for a future, larger study, adequately powered to examine efficacy of InVEST in improving functional outcomes and to examine potential mechanisms of change. This intervention is particularly timely during the COVID-19 pandemic, as youth at CHR-P may be particularly vulnerable to school failure and disengagement without the structure of in-person connection with school staff for supporting learning needs.