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

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.