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

早期精神病期间有暴力行为的年轻人：混合方法评估和干预试验

• 批准号: 10812063
• 负责人: Stephanie Rolin
• 金额: $ 1.8万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-13 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10812063
• 关键词: Adult; Area; Award; Behavior; Behavior Therapy; Caregiver Burden; Client; Clinic; Clinical Trials; Cognitive Therapy; Coordinated Specialty Care; Diagnostic; Early Intervention; Ensure; Evidence based intervention; Goals; Grant; Impairment; Imprisonment; Individual; Intervention; Intervention Trial; Interview; Maps; Methods; Modeling; Nature; New York; Persons; Physicians; Planning Theory; Population; Process; Psychoses; Psychotherapy; Public Health; Qualitative Research; Research; Research Domain Criteria; Research Personnel; Risk; Schizophrenia; Service setting; Social isolation; Structure; Subgroup; Testing; Training; United States; Violence; Work; Writing; career; early experience; early psychosis; evidence base; experience; feasibility testing; functional improvement; health disparity; mortality; pilot trial; psychosocial; service intervention; service programs; severe mental illness; violence prevention; young adult

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.

项目摘要：尽管严重精神疾病患者 (SMI) 遭受暴力的绝对风险 虽然规模较小，但经历早期精神病的年轻人是暴力风险最高的亚群体。暴力是一种 导致成年精神分裂症患者出现健康差异的公共卫生问题，包括 照顾者负担、社会孤立、监禁以及随后的早期死亡。认知行为 精神病疗法（CBT）和类似的行为干预措施在减少损伤和 改善患有早期精神病的年轻人的功能。然而，尚无明确的研究探讨过 使用行为干预来减少患有早期精神病的年轻人的暴力行为。 在此申请中，Stephanie Rolin 博士提出了一条成为独立人士的综合路径 医师调查员创建和采用基于证据的方法来评估和减少暴力风险。 具体来说，该提案遵循疾病预防控制中心的适应地图，这是一个适应基于证据的模型 干预（EBI），以适应和评估早期干预服务（EIS）特定的 CBT 的可行性 减少暴力的干预措施，其拟议目标与跨诊断性质相一致 研究领域标准 (RDoC)。这项研究将在 OnTrackNY 进行，这是美国最大的 EIS 项目 美国; OnTrackNY 已为 1,800 多人提供基于证据的协调专业护理 纽约州 20 多家诊所。首先，Rolin 博士将对以下人员进行单独的半结构化访谈： 最近有过暴力行为的 EIS 客户 (n=20) 以及曾与 EIS 合作过的临床医生 有过暴力行为的客户（n=10）。这些访谈将使用计划行为理论 确定现有 CBT 模型（称为 PICASSO）的关键领域（该模型在减少 暴力），需要适应 EIS 设置。接下来，Rolin 博士将针对 EIS 调整 PICASSO 模型 通过利用混合方法评估的迭代过程进行公开试点试验。最后，博士。 罗林将通过试点随机对照试验评估干预措施的可行性。 为了进一步实现她成为一名独立的医师研究员的长期职业目标，专注于创造 并调整 EBI 来降低暴力风险，Rolin 博士将在以下四个领域进行培训：(1) 定性 研究包括混合方法； (2)心理社会干预适应； (3)心理治疗临床试验； (4) 拨款写作。本研究的产品将是大型RCT的R01，以测试第一个的可行性 CBT 的 EBI 旨在减少 EIS 环境中的暴力。总的来说，这个奖项将确保罗林博士的成功 过渡为独立医师调查员，研究评估和预防暴力行为 患有 SMI 的成人。