A Randomized Trial of Family to Family Education

描述(由申请人提供)：家庭在患有严重精神疾病的成年人生活中的重要作用得到了很好的记录。在履行照顾角色时，家庭是应对压力环境的典型，因为他们需要信息和支持。当临床服务不能满足家庭的需求时，以同行和社区为基础的项目就出现了。这些计划包含了自助、赋权、创伤恢复、压力和应对理论以及互助模式的元素，主要侧重于帮助家庭成员，而不是改善消费者的结果。家庭自助计划广泛传播，在参与者中非常受欢迎，并从州和市精神卫生当局获得适度的财政支持。但在这种传播之前，并没有科学证据表明他们实现了目标。我们的项目建议弥补的正是这种知识上的差距。到目前为止，最常见的此类计划是全国精神疾病联盟的家庭到家庭教育计划(通常缩写为ftp)：由训练有素的家庭成员开发和实施的为期12周的课程，具有高度结构化的标准化课程。它提供有关精神疾病的教育，情感和实际支持，以及解决问题和沟通技能。与ftp的创建者Joyce Burland合作，我们进行了两项独立的试点研究，证明ftp在减轻参与者自我报告的主观负担和抑郁以及增加他们的赋权方面是有效的。我们现在建议进行一项随机试验，将完成三个月的ftp课程的个人与参考通常社区资源的个人进行比较。在我们评估家庭成员结果的同时，这项研究提供了一个机会来评估ftp给消费者带来的潜在好处。在压力应对框架的指导下，我们假设ftp参与者将增加以问题和情绪为重点的应对活动，减少抑郁、痛苦和主观疾病负担，并且ftp福利将在ftp计划完成后六个月保留。其次，我们假设，有ftp参与者的家庭中的消费者会有更好的结果。总共将在马里兰州的四个县招募392名家庭成员参加28个不同的班级，在考虑到学习自然减员后，每个研究条件下产生大约150人。在创建ftp计划的随机试验评估的过程中，我们必须在科学严谨性与现实生活中对一些问题的实际和伦理关切之间取得平衡，这造成了某些方法上的限制。然而，这项研究代表的学术/消费者伙伴关系对于创建一个既由消费者和家庭驱动，又以科学证据为基础的医疗保健系统至关重要。

DESCRIPTION (provided by applicant): The important roles of families in the lives of adults with serious mental illnesses are well documented. In fulfilling care-giving roles, families are typical of people coping with stressful circumstances in that they need information and support. When clinical services failed to meet the needs of families, peer- and community-based programs emerged. These programs incorporate elements of self-help, empowerment, trauma recovery, stress and coping theories, as well as mutual assistance models and are primarily focused on helping family members, not improving consumer outcomes. Family self-help programs are widely disseminated, are very popular among their participants and receive modest financial support from state and municipal mental health authorities. But this dissemination was not preceded by scientific evidence that they achieve their goals. It is this gap in knowledge that our project is proposing to remedy. By far the most common such program is the National Alliance for the Mentally Ill's Family-to-Family Education Program (often abbreviated FTP): a 12-week class with a highly-structured standardized curriculum, developed and conducted by trained family members. It provides education about mental illness, emotional and practical support, and problem solving and communication skills. In collaboration with FTP creator, Joyce Burland, we have conducted two independent pilot studies demonstrating that FTP is effective for reducing participants' self-reported subjective burden and depression and increasing their empowerment. We now propose a randomized trial comparing individuals who completed a three-month FTP class to individuals referred to the usual community resources. At the same time that we are evaluating family member outcomes, this study provides an opportunity to evaluate the potential benefit that FTP has for consumers. Guided by a stress-coping framework, we hypothesize that FTP participants will have increased problem- and emotion-focused coping activities, reduced depression, distress, and subjective illness burden and that FTP benefits will be retained six months after FTP program completion. Secondarily, we hypothesize that consumers in families of FTP participants will have improved outcomes. A total of 392 family member participants will be recruited in four Maryland counties over 28 different classes, producing approximately 150 persons in each study condition after accounting for study attrition. In the course of creating a randomized trial evaluation of the FTP program, we have had to balance scientific rigor with real-life practical and ethical concerns on a number of issues, creating certain methodological limitations. Nevertheless, the academic/consumer partnership represented by this study is critical to creating a health care system that is both consumer and family driven, and also based on scientific evidence.