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

项目摘要 尽管在早期精神病治疗中强调以功能障碍为目标的重要性，但 目前对精神病临床高危人群(CHR-P)的学习功能没有循证干预 舞台。鉴于有证据表明功能开始衰退，功能障碍应该是一个关键的治疗重点 在CHR-P阶段，影响治疗参与度，并可能影响其他症状。我们寻求发展 “投资”(个人化职业和教育支持和培训)，这是一种侧重于 改善12-18岁患有慢性阻塞性肺疾病的客户的教育功能被概念化为 作为CHR-P青年协调专科护理(CSC)的组成部分，Invest建立在之前的研究基础上 支持就业，以及帮助CHR-P青年追求教育/教育的真实世界经验 CHR-P专科诊所的职业目标。投资是单独实施的(亲自或通过 视频会议)由担任CSC团队成员的学士级别的临床医生“教练”主持。投资就是 旨在利用下列机制，这些机制被认为相互作用并产生负面影响 CHR-P阶段的教育和职业职能：1)执行职能困难(a 认知机制)，2)压力敏感性(一种情绪机制)，以及3)任务启动困难(a 行为机制)。INVITE是一种针对优先治疗结果(即角色)的新型干预措施 在高危人群中发挥作用)，不同于在 CHR-P期，包括精神病的认知行为疗法。投资考虑到多样性 CHR-P青年的需求：1)以个性化的方法优先考虑客户的喜好；2)教学 旨在独立使用的战略，以最大限度地扩大获取机会。该项目将对两个项目进行测试投资 阶段：1)8名参与者的开放试验；2)30名参与者的小型随机对照试验 将投资与通常的等待名单控制待遇进行比较。我们的治疗开发目标一致 根据NIMH的战略目标3.2(“制定方法，量身定制现有和新的干预措施，并优化 结果“)和3.3(在社区实践环境中测试干预措施的有效性)。按照我们的建议，我们 正在通过针对疾病早期的个人来具体优化支持就业计划 进步。此外，我们寻求在现实世界的社区实践环境中学习投资。试点数据可以 为未来更大规模的研究奠定基础，提供足够的动力来检查投资改进的有效性 功能结果，并检查潜在的变化机制。这一干预特别及时 在新冠肺炎大流行期间，由于CHR-P的青年可能特别容易受到学业失败和 脱离与学校教职员工面对面联系的结构，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.