Community Implementation of Psychosocial Treatment for Bipolar Disorder

描述（由申请人提供）：双相情感障碍是一种破坏性的，慢性复发的疾病，具有重大的公共卫生影响，以高自杀率和高水平的功能和职业损害为特征。在过去的15年中，在一些对照试验中发现，社会心理干预和药物结合可以加速急性症状的缓解，延缓复发，并减少发作间症状，然而这些有效的社会心理干预很少在社区精神卫生机构中实施。该提案旨在通过制定和试行一种全面的实施方法来解决这些挑战，该方法将支持在社区精神卫生机构中实施双相情感障碍的循证心理治疗（EBP）。该建议建立在一项大型多地点双相情感障碍有效性试验（STEP-BD）中开发的方法基础上。它通过开发一种综合的实施方法来加强这些方法，该方法结合了针对与有效实施相关的关键组织因素和个体临床医生因素的技术支持实施援助。然后，该项目将在可行性和可接受性方面，将这种旨在改进有效实施的综合实施方法与常规实施策略进行比较。研究结果将用于支持拟订一项更大的赠款提案，以审查综合执行办法的有效性，并向该领域更广泛地提供有关在社区精神卫生环境中有效实施干预措施的相关因素的重要信息。

DESCRIPTION (provided by applicant): Bipolar disorder is a devastating, chronically recurring condition with significant public health impact, characterized high rates of suicide and high levels of functional and occupational impairment. In the last 15 years, combined psychosocial intervention and medication has been found to speed remission of acute symptoms, delay recurrences, and reduce inter-episode symptoms in a number of controlled trials, yet these effective psychosocial interventions are seldom implemented in community mental health settings. The proposal seeks to address these challenges by developing and piloting a comprehensive approach to implementation that will support the implementation of an evidence-based psychotherapy (EBP) for bipolar disorder in community mental health settings. The proposal builds on approaches developed during a large multi-site bipolar effectiveness trial (STEP-BD). It enhances those approaches through developing a comprehensive approach to implementation that incorporates technology-supported implementation assistance that targets key organizational factors and individual clinician factors associated with effective implementation. The project will then compare this comprehensive approach to implementation designed to improve effective implementation to an implementation-as-usual strategy in terms of feasibility and acceptability. The results will be used to support the development of a larger grant proposal to examine the effectiveness of a comprehensive approach to implementation, as well as provide important information to the field more generally regarding factors associated with effective implementation of interventions in community mental health settings. PUBLIC HEALTH RELEVANCE: Bipolar disorder is a devastating, chronically recurring condition with significant public health impact, characterized high rates of suicide, and high levels of functional and occupational impairment. In the last 15 years, combined psychosocial intervention and medication has been found to speed remission of acute symptoms, delay recurrences, and reduce inter-episode symptoms in a number of controlled trials, yet these effective psychosocial interventions are seldom implemented in community mental health settings. This project seeks to develop and examine the feasibility, acceptability, and preliminary impact of a comprehensive approach to supporting the implementation of an effective psychosocial intervention for bipolar disorder in community mental health settings. If successful, the resulting intervention could substantially lower the public health impact of bipolar disorder.