Family-Based Protocol for Medication Integration in Treatment of Comorbid ASU/ADH

描述(由申请人提供)：这项提案的目标是开发和试点一项简短的方案，旨在系统地将针对ADHD的药理学干预纳入为日常护理中患有ADHD的青少年药物使用者提供的行为治疗服务。ADHD是青少年物质使用(ASU)的一种普遍共存的疾病，可以显著阻碍ASU治疗的成功，但在机构设置的ASU客户中，ADHD被严重低估和治疗。此外，在高危青少年人群中，ADHD药物的接受度和依从性尤其难以实现。拟议的R21研究将使用中断的时间序列设计来测试一项简短的协议，该协议旨在促进循证ADHD药物治疗与亚利桑那州大学常规行为服务的整合：药物整合协议(MIP)。MIP是在ASU治疗的早期阶段提供的基于家庭的5次治疗方案，包含三个基于研究的元素：(1)关于青少年ADHD的标准化精神病学评估和以家庭为中心的心理教育；(2)批准的ADHD用药方案(OROS-MPH)，证明了对ASU/ADHD患者的有效性；(3)基于家庭的干预措施，以支持药物接受(如上所述)以及精神科和行为服务之间的护理协调。MIP将在一个合作临床站点整合到现有的以家庭为基础的服务中：20个ASU/ADHD病例将由SITE家庭治疗师治疗，他们将接受新的MIP培训和监测。合作诊所提供家庭治疗，作为门诊患者行为健康的常规护理标准，并提供现场儿童精神病学服务。主要研究目标将产生关于MIP在日常护理中的可行性和保真度的概念验证数据，以及MIP对精神和行为服务利用、用药接受度和依从性以及对治疗服务满意度的影响的证据。探索性分析将产生MIP对ADHD药物的主要目标：ADHD症状和执行认知功能的短期影响的效果大小。新的研究产品将包括标准化和试点的MIP方案，临床医生培训和保真度监测程序，以及观察保真度仪器。如果得到验证，MIP可以作为日常护理中的独立干预措施，或者与ASU现有的手动治疗相结合，努力开发ASU/ADHD的完全集成治疗模式。此外，MIP可以与基于家庭的治疗或个别治疗相结合，后者可以灵活地在早期阶段包括照顾者。 公共卫生相关性：ADHD是ASU常见的共生疾病，对成功的ASU治疗和维持治疗成果提出了重大挑战。这项R21研究将导致开发一种药物整合方案，旨在将ADHD药物干预整合到社区环境中ASU/ADHD共病患者的门诊行为治疗中。

DESCRIPTION (provided by applicant): The goal of this proposal is to develop and pilot a brief protocol designed to systematically integrate pharmacological interventions for ADHD into behavioral treatment services for adolescent substance users with comorbid ADHD in everyday care. ADHD is a prevalent co-occurring condition for adolescent substance use (ASU) that can significantly impede successful ASU treatment but is vastly under-diagnosed and undertreated among ASU clients in agency settings. Moreover, ADHD medication acceptance and compliance is particularly difficult to achieve in high-risk adolescent populations. The proposed R21 study will use an interrupted time series design to test a brief protocol designed to promote integration of evidence-based ADHD pharmacotherapy into routine behavioral services for ASU: Medication Integration Protocol (MIP). MIP is a 5- session family-based protocol delivered during the early portion of ASU treatment that contains three research- based elements: (1) standardized psychiatric assessment and family-focused psychoeducation about adolescent ADHD; (2) an approved ADHD medication regimen (OROS-MPH) with demonstrated efficacy for ASU/ADHD clients; (3) family-based interventions to support medication acceptance (as indicated) and coordination of care between psychiatric and behavioral services. MIP will be integrated into existing family- based services at one partnering clinical site: 20 ASU/ADHD cases will be treated by site family therapists who will be newly trained and monitored in MIP. The partnering clinic provides family therapy as the routine standard of care for outpatient behavioral health and offers on-site child psychiatry services. Primary study aims will yield proof-of-concept data on MIP feasibility and fidelity in usual care and evidence of MIP impact on psychiatric and behavioral services utilization, medication acceptance and compliance, and satisfaction with treatment services. Exploratory analyses will generate effect sizes for the short-term impact of MIP on the main targets of ADHD medication: ADHD symptoms and executive cognitive functioning. New study products would include a standardized and piloted MIP protocol, clinician training and fidelity monitoring procedures, and an observational fidelity instrument. If validated, MIP could be utilized as a stand-alone intervention in everyday care, or, be combined with existing manualized treatments for ASU in an effort to develop fully integrated treatment models for ASU/ADHD. Also, MIP could be delivered in conjunction with either family- based treatments or individual treatments that can flexibly include caregivers in early sessions. PUBLIC HEALTH RELEVANCE: ADHD is common co-occurring condition for ASU that presents a significant challenge to successful ASU treatment and maintenance of treatment gains. This R21 study will lead to development of a Medication Integration Protocol designed to integrate ADHD pharmacological interventions into outpatient behavioral treatment for comorbid ASU/ADHD cases in community-based settings.