Family-Focused Therapy for Youth with Early-Onset Bipolar or Psychotic Disorders

描述（由申请人提供）：本申请是响应RFA MH-12-050，优化经验支持的行为治疗的保真度。尽管在实验室环境中取得了令人印象深刻的结果，但在社区采用和可持续性家庭干预早发性情绪和精神障碍方面存在显著滞后。我们的目标是确定培训和监测以证据为基础的以家庭为中心的治疗（FFT）的最佳方法，在社区提供者中治疗患有双相情感障碍（BD）、精神病或“高风险”疾病的年轻患者（13-25岁）。FFT在心理教育、沟通训练和问题解决能力训练中进行了21次训练。有6项随机对照试验表明，在患有双相障碍、双相情感障碍或精神病风险障碍的成人或青少年中，相对于1-2年的比较治疗，FFT和药物治疗与更快地稳定症状、延迟复发、增强功能、更好的药物依从性和改善家庭互动有关。采用社区合作参与式方法，我们将在三个社区站点（港-加州大学洛杉矶分校医疗中心、圣费尔南多MHC、迪迪赫希MHC）与不同的利益相关者（临床医生、管理人员、护理人员）合作，治疗早发、低社会地位、城市、种族和民族多样化的双相情感障碍和精神病患者。持份者将为研究的各个阶段提供意见。在第一阶段，我们将对来自6个FFT随机对照试验的保真度数据进行荟萃分析

DESCRIPTION (provided by applicant): This application is in response to RFA MH-12-050, Optimizing Fidelity of Empirically-Supported Behavioral Treatments. Despite impressive results in laboratory settings, there has been a significant lag in the community adoption and sustainability of family interventions for early-onset mood and psychotic disorders. Our objective is to determine the optimal methods of training and monitoring the delivery of an evidence-based family-focused treatment (FFT) in community providers who treat young patients (ages 13-25) with bipolar disorder (BD), psychosis, or "high-risk" conditions. FFT is administered in 21 sessions of psychoeducation, communication training, and problem-solving skills training. There are six RCTs indicating that, among adults or adolescents with BD, bipolar spectrum, or psychosis-risk disorders, FFT and pharmacotherapy are associated with more rapid stabilization of symptoms, delayed recurrences, enhanced functioning, better medication adherence, and improvements in family interaction relative to comparison treatments over 1-2 years. Using a community partnered participatory approach, we will engage diverse stakeholders (clinicians, administrators, caregivers) at three community sites (Harbor-UCLA Medical Center, San Fernando MHC, Didi Hirsch MHC) that treat early-onset, lower SES, urban, and racially and ethnically diverse bipolar and psychosis patients. Stakeholders will provide input into all phases of the study. In Phase I, we will conduct meta-analyses of fidelity data from six RCTs of FFT - all of which used the observer-based Therapist Competence and Adherence scales - to identify fidelity components that are differentially associated with intermediate and long- term patient and family outcomes. We expect key fidelity domains to include: therapist directiveness, skillful teaching of conflict resolution strategies, encouraging patients' medication adherence and lifestyle adaptations, and skillful direction of symptom prevention planning. We will develop and pilot streamlined self-report measures and web-based clinician training materials relevant to the identified fidelity components. In phase II, we will partner with the 3 community sites to randomly assign 20 clinicians to low intensity (webinar, web- based training, social networking site, monthly group teleconferences) or high intensity training (live workshop, web-based training, weekly individual supervision with fidelity feedback). Clinicians will administer FFT to 80 patient (ages 13-25) with recent-onset mania, psychosis or high-risk conditions. Dependent variables will be empirically-derived fidelity component scores over time as measured by supervisors, caregivers, and clinicians. We hypothesize that after training, clinicians in both the high and low intensity groups will attain minimum levels of fidelity required for certification in the four components. However, clinicians in high intensity training will sustain higher levels of fidelity across subsequent treatment cases, and will be more satisfied and more likely to adopt the FFT model. This study will facilitate the translation of an evidence-based intervention and identify effective treatment components to inform larger-scale dissemination of FFT in community settings.