Family-Focused Treatment for Youth with Early-Onset Bipolar or Psychotic Disorder

针对患有早发性双相情感障碍或精神障碍的青少年的以家庭为中心的治疗

• 批准号: 8287440
• 负责人: DAVID Jay MIKLOWITZ
• 金额: $ 23.28万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-04-01 至 2014-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8287440
• 关键词: Adherence; Administrator; Adolescent; Adopted; Adoption; Adult; Aftercare; Age; Age of Onset; Behavior; Behavior Therapy; Bipolar Disorder; Caregivers; Certification; Clinic; Clinical; Clinical Trials; Communication; Communities; Community Mental Health Centers; Competence; Conflict (Psychology); Data; Development; Disease; Doctor of Medicine; Doctor of Philosophy; Educational process of instructing; Educational workshop; Evidence based intervention; Family; Feedback; Individual; Institutes; Internet; Intervention; Laboratories; Lead; Life; Life Style; Manic; Measures; Medical center; Mental Health; Meta-Analysis; Methods; Modeling; Monitor; Mood Disorders; Moods; Online Systems; Outcome; Outcome Assessment; Patient Self-Report; Patients; Pharmaceutical Preparations; Pharmacotherapy; Phase; Phenotype; Population; Prevention; Problem Solving; Procedures; Process; Provider; Psychiatry; Psychotic Disorders; Psychotic Mood Disorders; Randomized; Randomized Controlled Trials; Recording of previous events; Recovery; Recurrence; Relative (related person); Reporting; Research; Risk; Science; Series; Services; Severities; Site; Social Functioning; Structure; Supervision; Symptoms; Teleconferences; Testing; Therapeutic; Time; Training; Training Programs; Translations; Treatment outcome; Validation; Validity and Reliability; Youth; active control; base; community setting; conflict resolution; disorder risk; early onset; effective therapy; evidence base; high risk; improved functioning; instrument; medical schools; medical specialties; medication compliance; meetings; operation; patient population; psychoeducation; psychoeducational; psychosocial; randomized trial; response; skills; skills training; social networking website; socioeconomics; stressor; theories; treatment program; young adult

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. PUBLIC HEALTH RELEVANCE: There is robust evidence from randomized controlled trials for the efficacy of family-focused treatment (FFT) in conjunction with pharmacotherapy in hastening recovery, delaying recurrences and improving functioning among adults and adolescents with bipolar disorder, but there remains a significant "science-to-service" gap in implementing this psychoeducational treatment in community settings. Our main objective is to identify optimal methods of training and monitoring the delivery of FFT among community mental health clinicians who treat young-onset (ages 13-25) bipolar and psychosis spectrum patients. We propose a partnership between the UCLA School of Medicine and three high volume community mental health centers that treat lower socioeconomic, urban, and diverse patient populations, to determine: (1) how to efficiently train community providers in the essential components of FFT, (2) when and under what conditions training leads to sustainable changes in practice, and (3) whether changes in practice lead to better short- and long-term outcomes for patients with early-onset bipolar disorder or psychosis spectrum disorders.

描述（由申请人提供）：本申请是对RFA MH-12-050《优化经验支持行为治疗的保真度》的回应。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着滞后。我们的目标是确定最佳的培训和监测方法，以证据为基础的家庭为中心的治疗（FFT）在社区提供者谁治疗年轻患者（13-25岁）与双相情感障碍（BD），精神病，或“高危”条件。FFT在21个心理教育、沟通培训和解决问题技能培训课程中实施。有6项随机对照试验表明，在患有BD、双相型谱系或精神病风险障碍的成人或青少年中，FFT和药物治疗与1-2年内的比较治疗相比，与症状更快稳定、复发延迟、功能增强、药物依从性更好以及家庭互动改善相关。使用社区合作的参与式方法，我们将在三个社区站点（Harbor-UCLA医疗中心，San Fernando MHC，Didi Hirsch MHC）吸引不同的利益相关者（临床医生，管理人员，护理人员），这些站点治疗早发性，较低的SES，城市以及种族和民族多样化的双相情感障碍和精神病患者。利益相关者将为研究的所有阶段提供投入。在第一阶段，我们将对6项FFT随机对照试验的保真度数据进行荟萃分析， 其中使用了基于个体的治疗师能力和依从性量表，以确定与中期和长期患者和家庭结局差异相关的保真度成分。我们期望关键的忠诚领域包括：治疗师的指导性，熟练的冲突解决策略的教学，鼓励患者的药物依从性和生活方式的适应，以及症状预防计划的熟练方向。我们将开发和试点精简的自我报告措施和基于网络的临床医生培训材料相关的确定保真度组件。在第二阶段，我们将与3个社区网站合作， 分配20名临床医生接受低强度（网络研讨会、基于网络的培训、社交网站、每月一次的小组电话会议）或高强度培训（现场研讨会、基于网络的培训、每周一次的个人监督和保真度反馈）。临床医生将对80名最近发作的躁狂症、精神病或高危疾病患者（13-25岁）进行FFT治疗。因变量将是由主管、护理人员和临床医生测量的随时间推移的模拟导出的保真度分量评分。我们假设，经过培训，临床医生在高和低 强度组将在四个组成部分中达到认证所需的最低保真度。然而，高强度培训的临床医生将在后续治疗病例中保持更高的保真度，并且将更满意，更有可能采用FFT模型。这项研究将有助于翻译的循证干预措施，并确定有效的治疗组成部分，以告知FFT在社区环境中的大规模传播。 公共卫生关系：随机对照试验中有强有力的证据表明，以家庭为中心的治疗（FFT）结合药物治疗在加速双相情感障碍成年人和青少年的康复，延迟复发和改善功能方面的疗效，但在社区环境中实施这种心理教育治疗方面仍然存在显着的“科学到服务”差距。我们的主要目标是确定最佳的方法，培训和监测社区精神卫生临床医生谁治疗双相情感障碍发作（13-25岁）和精神病谱系患者之间的FFT交付。我们建议加州大学洛杉矶分校医学院和三个高容量社区精神卫生中心之间的伙伴关系，这些中心治疗较低的社会经济，城市和多样化的患者人群，以确定：（1）如何有效地培训社区提供者掌握快速家庭教育的基本组成部分，（2）何时以及在何种条件下培训导致实践中的可持续变化，以及（3）对于早发性双相情感障碍或精神病谱系障碍患者，实践中的改变是否会导致更好的短期和长期结局。