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的响应，优化了经验性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成果，但在社区对早发性情绪和精神障碍的家庭干预措施的采用和可持续性方面存在显著滞后。我们的目标是确定在治疗患有双相情感障碍(BD)、精神病或高危疾病的年轻患者(13-25岁)的社区提供者中，培训和监测循证家庭为重点的治疗(FFT)的最佳方法。FFT包括21个心理教育、沟通训练和解决问题的技能训练。有6项随机对照试验表明，在患有BD、躁郁症或精神疾病风险障碍的成年人或青少年中，FFT和药物治疗与1-2年内的对比治疗相比，症状更快地稳定、复发延迟、功能增强、服药依从性更好以及家庭互动的改善有关。使用社区合作的参与式方法，我们将在三个社区地点(港湾-加州大学洛杉矶分校医疗中心、圣费尔南多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)，治疗早发性、较低SES、城市以及种族和民族多样化的躁郁症和精神病患者。利益攸关方将为研究的所有阶段提供投入。在第一阶段，我们将对FFT-ALL的六个RCT的保真度数据进行荟萃分析 其中使用了基于观察者的治疗师能力和依从性量表-以确定与患者和家庭的中期和长期结果有不同关联的保真度成分。我们预计关键的忠诚度领域包括：治疗师的指导性，熟练地教授冲突解决策略，鼓励患者坚持服药和生活方式适应，以及熟练的症状预防规划指导。我们将开发和试点简化的自我报告措施和与已确定的保真度组件相关的基于网络的临床医生培训材料。在第二阶段，我们将与3个社区网站合作，随机 将20名临床医生分配到低强度(网络研讨会、网络培训、社交网站、每月小组电话会议)或高强度培训(现场研讨会、网络培训、每周个人监督和保真度反馈)。临床医生将对80名新近发病的躁狂症、精神病或高危疾病患者(年龄13-25岁)进行FFT。因变量将是由监督者、护理者和临床医生测量的随时间推移的经验性的保真度分量分数。我们假设，经过培训后，临床医生无论是高还是低 强度组将达到四个组成部分认证所需的最低保真度。然而，在高强度培训中，临床医生将在随后的治疗病例中保持更高水平的保真度，并且将更满意，更有可能采用FFT模式。这项研究将促进以证据为基础的干预措施的翻译，并确定有效的治疗成分，以便在社区环境中更大范围地传播FFT。

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.