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

摘要 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，行为激活(BA)可以有效地针对参与，也可以针对症状 和功能结果。本研究将为FEP开发12个疗程的BA，并将其与常规治疗进行比较 在六个多月的时间里，纵向抽样调查了58名拉丁裔(每种情况29名)及其家庭照顾者 随机对照试验。DYADS还将参加类似的家庭支持小组 按条件分开。为了检查变化的机制，干预调解人之间的关联 将对参与度进行检查，以确定调解人的变化是否先于 随时间推移的参与度。采用混合方法，考察当地/文化因素与参与度之间的关系 将会被探索。将使用定性方法来探讨本地/文化因素如何影响 未来的量化分析，稳健预测因素的具体特征(例如，家庭支持)如何影响 参与度，发现其他关键影响，考虑BA特定因素，并生成 参与FEP护理，关注发育、疾病和治疗阶段。该项目提供了 培训FEP的服务参与和干预，为FEP开发和应用BA，解决 在FEP期间参与具有文化责任感的难以到达的社区，并进行相关研究 方法主要导师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.，Mark Lai，Ph.D.， 朱迪·乌尔曼博士、劳伦斯·帕林卡斯博士和埃塞尔·尼道博士的活动将持续到 与加州州立大学圣贝纳迪诺分校的培训员和资源进行定期交流， 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 推进对来自难以到达的社区的FEP患者的服务参与领域。这个 该项目将加强FEP的参与和干预领域，并支持NIMH改进的目标 早期精神病患者的参与和最大限度的康复。

Abstract 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) 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.