Treatment Retention Strategies in Transition Age Youth

描述（由申请人提供）：该申请涉及广泛的挑战领域（04）临床研究和具体挑战主题，04- MH-105：开展试点研究，开发和测试适合发展的、基于证据的预防干预措施和服务提供模式，为青少年提供高风险的，或经历严重的精神疾病，正在过渡到成年。当他们进入成年期时，有严重精神健康问题的过渡年龄青年（TAY； 17-25岁）的功能差得惊人；无家可归者（30%）、被捕者（60%）、辍学率（42%）和失业率高（见1）。这些问题可以通过良好的心理健康治疗得到缓解。然而，在寻求MH护理的成年人中，TAY始终是最有可能退出治疗的（例如2），并且他们在老年人或年轻人中完成的治疗次数最少没有处理保留（TR）就没有MH处理。改善TAY功能的一个简单且可能具有成本效益的步骤是为最常用的MH治疗制定有效的TR干预措施；3 .门诊心理治疗目前尚无针对TAY的临床试验或已发表的TR干预措施。提出的研究开发并试点了一种针对TAY的基于办公室的门诊心理治疗的新的TR干预措施，并试点测试了尚未在该年龄组中检查的现有干预措施。虽然TAY中治疗退出的具体原因尚未调查，但它们可能是多方面的。成人放弃治疗的多种原因已被确定，但没有从研究中发现主要因素。成熟成人和TAY可能有一些共同的过早终止原因，但由于过渡期独特的发育和生命阶段特征（见6），成人成功的TR干预不太可能与TAY一样有效。一些独特的发育特征可能导致TAY的TR受损，包括：“年龄典型的对权威的排斥会影响治疗关系，不成熟的认知发展会影响制定治疗目标的抽象任务”不成熟的责任承担会影响参加治疗和接受治疗工作，由于同伴接受和追求浪漫关系在这些年龄段的中心地位，需要心理健康治疗的耻辱感被强烈地感受到，并可能减少TR。拟议的研究将开始测试动机访谈（MI）7作为TAY的TR干预。MI是一种广泛使用的干预措施，用于增强动机和减少对改变的矛盾心理，这增加了老年人和年轻人的治疗依从性。心肌梗死的另一个吸引力在于它可以很容易地添加到标准治疗中。此外，将开发第二种TR干预措施，其针对的TR机制可能是TAY独有的，与MI的目标不同。拟议的研究将初步确定这两种方法在增加TAY TR方面的功效。该研究将启动针对发展的TR干预措施的开发和可行性评估。以及将两种TR干预措施与“照旧服务”进行试点测试的研究设计的可行性。这是确定是否能找到足够的证据来证明进行全面临床试验是合理的初步步骤。两种TR干预措施是：“同伴治疗教练（PTC）；这种基于网络的同伴干预，侧重于支持参与门诊心理治疗，将在拟议的研究“动机访谈（MI）”中发展；这种由治疗师实施的干预措施已被用于增加成人和青少年在成瘾、健康和MH治疗中的治疗依从性，但尚未专门在过渡年龄青年中作为TR策略进行测试。目的1。为新的门诊MH心理治疗TR干预（PTC）指定实施和培训方案以及保真度措施。目标2。确定PTC方法的可行性和随机临床试验研究设计，将动机性访谈和PTC与常规服务进行比较。这项研究将通过同时开发一种量身定制的TR干预措施和测试一种未在该年龄组中尝试过的成功的TR干预措施，推动在广泛使用的治疗中保留更多过渡年龄青年的进展。它将与总统的《复苏与再投资法案》相一致，将97%的直接成本预算用于人事，并为患有精神残疾的青少年提供就业机会。在向成年过渡期间，有心理健康需求的青年在工作、独立生活和远离法律麻烦方面的功能受到极大损害。每年有76万过渡年龄青年（17- 25岁）接受以办公室为基础的心理健康治疗，但这种广泛提供的治疗对这一年龄组的影响不大，因为他们特别容易退出治疗。如果在拟议的研究中试验的两种有希望的治疗辍学预防干预措施取得成功，未来将有更多的过渡年龄青年继续接受治疗，使其对症状产生有益的影响，进而对功能产生有益的影响。

DESCRIPTION (provided by applicant): This application addresses broad Challenge Area (04) Clinical Research and specific Challenge Topic, 04- MH-105: Conduct pilot studies to develop and test developmentally appropriate, evidence-based prevention interventions and service delivery models for youth with who are at high risk for, or experiencing severe mental illnesses who are transitioning to adulthood. As they move into adulthood transition age youth (TAY; ages 17-25) with serious mental health conditions have alarmingly poor functioning; high rates of homelessness (30%), arrests (60%), school dropout (42%), and unemployment (see1). These problems could be reduced by good mental health (MH) treatment. However, among adults who seek MH care, TAY are consistently the most likely to drop out of treatment (e.g.2), and they complete the fewest number of sessions among those older or younger.3 There is no MH treatment without treatment retention (TR). A simple and potentially cost-effective step to improving TAY functioning is to develop effective TR interventions for the most commonly used MH treatment; office-based outpatient psychotherapy.4 There are currently no clinical trials underway or published TR interventions for TAY. The proposed study develops and pilots a new TR intervention for office-based outpatient psychotherapy tailored for TAY, and pilot tests an existing intervention not yet examined in this age group. Though the specific causes of treatment dropout in TAY have not been investigated, they are likely manifold. Multiple causes of treatment dropout have been identified in adults5 with no predominant factor emerging from the research. Mature adults and TAY likely share some causes of premature termination, but because of the unique developmental and life stage features of the transition period (see6) it is unlikely that successful TR interventions in adults are as effective with TAY. Some of the unique developmental characteristics that can contribute to compromised TR in TAY include: " Age-typical rejection of authority that can interfere with therapeutic relationships, and immature cognitive development that can interfere with the abstract task of therapeutic goal-setting " Immature responsibility-taking that may interfere with attending sessions and embracing the work of therapy, especially since parental influence diminishes during the transition to adulthood " The stigma of needing mental health treatment is keenly felt because of the centrality of peer acceptance and pursuit of romantic relationships at these ages, and may reduce TR. The proposed research will begin the work of testing Motivational Interviewing (MI)7 as a TR intervention in TAY. MI is a widely used intervention to enhance motivation and reduce ambivalence about change, that has increased treatment adherence in older and younger age groups. MI is additionally appealing because it can readily be added to standard therapy. In addition, a second TR intervention will be developed that targets mechanisms of TR that are likely unique to TAY and are different than those targeted in MI. The proposed research undertakes the initial steps towards determining the efficacy of these two approaches in increasing TAY TR. The research will initiate development and feasibility assessment of the developmentally tailored TR intervention, and feasibility of the research design to pilot test both TR interventions in comparison to "services as usual." It is the preliminary step to determine whether sufficient evidence can be found to justify a full scale clinical trial. The two TR interventions are: " Peer Therapy Coach (PTC); this web-based peer intervention that focuses on supporting participation in outpatient psychotherapy will be developed in the proposed research " Motivational Interviewing (MI); this therapist-implemented intervention has been used to increase treatment adherence among adults and adolescents in addictions, health, and MH treatment, but has not specifically been tested as a TR strategy in transition age youth. Aim 1. Specify implementation and training protocols and a fidelity measure for a new outpatient MH psychotherapy TR intervention (PTC). Aim 2. Determine the feasibility of the PTC approach and randomized clinical trial research design comparing Motivational Interviewing and PTC to services as usual. This research will jump start progress towards retaining more transition age youth in widely used treatments by simultaneously developing a tailored TR intervention and testing a successful one not tried in this age group. It will be consistent with the President's Recovery and Reinvestment Act by putting 97% of its direct cost budget towards personnel, and providing jobs for youth with psychiatric disabilities. Youth with mental health needs during the transition to adulthood have tremendously compromised functioning in working, living independently, and staying out of trouble with the law. Office-based mental health treatment is accessed by 760,000 transition age youth (ages 17- 25) each year, but the impact of this widely available treatment is compromised in this age group because they are particularly prone to drop out of treatment. If the two promising treatment dropout prevention interventions pilot tested in the proposed research are successful, more transition age youth in the future will remain in treatment long enough for it to have its beneficial impact on symptoms and by extension, functioning.