YOUNG ADULTS WITH VIOLENT BEHAVIOR DURING EARLY PSYCHOSIS: A MIXED-METHODS ASSESSMENT AND INTERVENTION TRIAL

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Project Summary: Although the absolute risk of violence among persons with serious mental illnesses (SMI) is small, young people experiencing early psychosis are a subgroup at highest violence risk. Violence is a public health issue that contributes to health disparities experienced by adults with schizophrenia, including caregiver burden, social isolation, and incarceration and subsequent early mortality. Cognitive behavioral therapy (CBT) for psychosis and similar behavioral interventions have had efficacy in reducing impairment and improving functioning among young adults with early psychosis. However, no identified studies have explored using a behavioral intervention to reduce violence among young adults with early psychosis. In this application, Dr. Stephanie Rolin proposes a comprehensive path towards becoming an independent physician investigator creating and adapting evidence-based approaches to assess and reduce violence risk. Specifically, this proposal follows the CDC’s Map of Adaptation, a model for adapting evidence-based interventions (EBI), to adapt and evaluate the feasibility of an early intervention services (EIS)-specific CBT- based intervention to reduce violence with proposed targets consistent with the transdiagnostic nature of Research Domain Criteria (RDoC). This research will occur at OnTrackNY, the largest EIS program in the United States; OnTrackNY has provided evidence-based coordinated specialty care to over 1,800 individuals at more than 20 clinics in New York State. First, Dr. Rolin will conduct individual semi-structured interviews with EIS clients who have engaged in recent violent behavior (n=20) and clinicians who have worked with EIS clients who have engaged in violent behavior (n=10). These interviews will use the Theory of Planned Behavior to identify key areas of an existing CBT model called PICASSO (which has shown efficacy in reducing violence) that require adaptation for the EIS setting. Next, Dr. Rolin will adapt the PICASSO model for the EIS setting in an open pilot trial, through an iterative process that utilizes mixed methods assessment. Finally, Dr. Rolin will evaluate the intervention’s feasibility through a pilot RCT. To further her long-term career goal of becoming an independent physician-investigator focused on creating and adapting EBI to reduce violence risk, Dr Rolin will pursue training in the following four areas: (1) qualitative research including mixed methods; (2) psychosocial intervention adaptation; (3) psychotherapy clinical trials; and (4) grant writing. The product of this study will be an R01 of a large RCT to test the feasibility of the first EBI of CBT to reduce violence in the EIS setting. Overall, this award will ensure Dr. Rolin’s successful transition to an independent physician investigator studying the assessment and prevention of violence among adults with SMI.