Optimizing Engagement in Services for First-Episode Psychosis (FEP) in the Community Mental Health Setting

脱离服务是首发精神病患者的主要公共卫生问题 (FEP)高达40%的人提前终止早期护理。因此，患有FEP的个人在 持续性症状性和功能性损害的风险增加，长期效果不佳。婚约 可以通过(1)确定务实和有效的循证干预措施，(2)确定 实现参与度变化的机制，以及(3)加强关于 参与度，例如通过制定细致入微的动态参与度概念来指导未来 研究。在美国，对于社区心理来说，尤其需要有效的介入干预 医疗服务，提供大多数精神健康护理，但遇到重大的参与问题，以及对于困难的 触手可及的社区，例如由拉丁裔组成的社区。与具有以下特征的个人进行的研究 精神病研究表明，为治疗抑郁症而设计的行为激活(BA)可能有效 目标参与度以及症状和功能结果。这项研究将制定12个课程的学士学位 FEP，并将其与正常治疗6个月的样本58名(每种情况29名)拉丁裔和 他们的家庭照顾者参加了一项纵向随机对照试验。DYADS也将参加可比的 家庭支持小组按情况单独提供。为了考察变化的机制，该协会 将检查干预调解人和参与度之间的关系，以确定调解人是否发生变化 先于参与度随着时间的推移发生变化。使用混合方法，地方/文化之间的关系 将探讨各种因素和参与度。定性的方法将被用来探索地方/文化因素如何 未来定量分析的影响参与度，稳健预测者的具体特征(例如， 家庭支持)影响参与度，发现其他关键影响，考虑BA特定因素，以及 建立一个关注发育、疾病和治疗阶段的FEP护理模式。 该项目为FEP提供服务参与和干预方面的培训，开发和应用BA FEP，在FEP期间解决难以接触到的社区的参与，具有文化责任感和相关性 研究方法与主要导师Alex Kopelowicz，医学博士，共同导师Steven R.Lopez，Ph.D.，Lisa B。 Dixon，M.D.，M.P.H.和Sona Dimidkin博士，以及顾问Hilary Mair，Ph.D.，Anahi Collado，Ph.D.， 马克·赖博士、朱迪·厄尔曼博士、劳伦斯·帕林卡斯博士和埃塞尔·尼道博士将参加 通过与加州州立大学培训师和资源之间的定期沟通来维持 圣贝纳迪诺大学、南加州大学和相关机构/网站。培训支持 桑托斯博士的长期目标是推动FEP患者的服务参与领域从难以 接触到社区。该项目将加强FEP参与和干预领域，并支持 NIMH的目标是提高早期精神病患者的参与度和最大限度地恢复。

Disengagement from services is a major public health problem for individuals with first-episode psychosis (FEP) as up to 40% of individuals prematurely terminate early care. Individuals with FEP are consequently at increased risk of persistent symptomatic and functional impairment and poor long-term outcomes. Engagement can be improved by (1) identifying pragmatic and effective evidence-based interventions, (2) pinpointing the mechanisms through which change in engagement is achieved, and (3) enhancing the literature on engagement, such as by developing a nuanced and dynamic conceptualization of engagement to guide future research. In the U.S., effective interventions for engagement are particularly needed for community mental health services, which deliver most mental health care and encounter major engagement issues, and for hard- to-reach communities, such as those comprised by Latinos. Research conducted with individuals with psychosis has shown that Behavioral Activation (BA), designed for the treatment of depression, may effectively target engagement and also symptomatic and functional outcomes. This study will develop 12-session BA for FEP and compare it to treatment-as-usual over six months with a sample of 58 (29 per condition) Latinos and their family caregivers in a longitudinal randomized controlled trial. Dyads will also participate in comparable family support groups delivered separately by condition. To examine mechanisms of change, the association between intervention mediators and engagement will be examined to determine whether changes in mediators precede changes in engagement over time. Using mixed-methods, the relationship between local/cultural factors and engagement will be explored. Qualitative methods will be used to explore how local/cultural factors impact engagement for future quantitative analysis, how specific characteristics of robust predictors (e.g., family support) influence engagement, discover other critical influences, consider BA specific factors, and generate a model of engagement in FEP care with attention to stages of development, illness, and treatment. The project provides training in service engagement and intervention for FEP, developing and applying BA for FEP, addressing engagement during FEP in hard-to-reach communities with cultural responsivity, and relevant research methods with primary mentor, Alex Kopelowicz, M.D, co-mentors Steven R. Lopez, Ph.D., Lisa B. Dixon, M.D., M.P.H., and Sona Dimidjian, Ph.D., and consultants Hilary Mairs, Ph.D., Anahi Collado, Ph.D., Mark Lai, Ph.D., Jodie Ullman, Ph.D., Lawrence Palinkas, Ph.D., and Ethel Nicdao, Ph.D. Activities will be sustained through regular communication with and between trainers and resources at California State University San Bernardino, University of Southern California, and relevant institutions/sites. Training supports Dr. Santos’s long-term goal of advancing the field of service engagement for persons with FEP from hard-to- reach communities. The project will enhance the FEP engagement and intervention field and supports the NIMH’s goals of improving engagement and maximizing recovery for persons with early psychotic illness.