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、长期复发的疾病，具有显著的公共卫生影响，其特征是高自杀率和高水平的功能和职业损害。在过去的15年里，在一些对照试验中，已经发现心理社会干预和药物治疗相结合可以加速急性症状的缓解，延迟复发，减少发作间症状，但这些有效的心理社会干预很少在社区精神卫生环境中实施。该提案旨在通过制定和试行一种全面的实施方法来应对这些挑战，该方法将支持在社区精神卫生环境中实施双相情感障碍的循证心理治疗（EBP）。该提案基于大型多部位双极有效性试验（STEP-BD）期间开发的方法。它通过制定一个全面的实施方法来加强这些方法，该方法包括技术支持的实施援助，目标是与有效实施相关的关键组织因素和个体临床医生因素。然后，本项目将在可行性和可接受性方面，将这一旨在提高有效执行的全面执行办法与“照常执行”战略进行比较。调查结果将用于支持制定更大规模的赠款提案，以审查全面实施方法的有效性，并向实地提供更广泛的重要信息，说明与社区精神卫生环境中有效实施干预措施有关的因素。 公共卫生相关性：双相情感障碍是一种毁灭性的、长期复发的疾病，具有显著的公共卫生影响，其特征是高自杀率以及高水平的功能和职业损害。在过去的15年里，在一些对照试验中，已经发现心理社会干预和药物治疗相结合可以加速急性症状的缓解，延迟复发，减少发作间症状，但这些有效的心理社会干预很少在社区精神卫生环境中实施。该项目旨在开发和研究的可行性，可接受性和初步的影响，一个全面的方法来支持实施有效的心理社会干预双相情感障碍在社区精神卫生设置。如果成功的话，由此产生的干预措施可以大大降低双相情感障碍对公共卫生的影响。

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.