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

描述（由申请人提供）：本提案的目标是制定和试行一项简短的方案，旨在将ADHD的药物干预系统地整合到日常护理中合并ADHD的青少年物质使用者的行为治疗服务中。ADHD是青少年物质使用（ASU）的一种普遍并发症，可以显著阻碍成功的ASU治疗，但在机构环境中ASU客户中诊断和治疗严重不足。此外，ADHD药物的接受和依从性在高危青少年人群中尤其难以实现。拟议的R21研究将使用中断的时间序列设计来测试一个简短的方案，该方案旨在促进将循证ADHD药物治疗纳入ASU的常规行为服务：药物整合方案（MIP）。MIP是在ASU治疗的早期阶段提供的5个疗程的以家庭为基础的方案，包含三个基于研究的要素：（1）关于青少年ADHD的标准化精神病评估和以家庭为中心的心理教育;（2）批准的ADHD药物治疗方案。（OROS-MPH），对ASU/ADHD患者有明显疗效;（3）以家庭为基础的干预措施，以支持药物接受（如所示）和精神病和行为服务之间的护理协调。MIP将被整合到现有的家庭为基础的服务在一个合作的临床网站：20个ASU/多动症病例将由现场家庭治疗师谁将在MIP新的培训和监测。合作诊所提供家庭治疗作为门诊行为健康护理的常规标准，并提供现场儿童精神病学服务。主要研究目的将产生关于MIP在常规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、药物接受和依从性以及治疗服务满意度的影响的证据。探索性分析将产生MIP对ADHD药物主要目标的短期影响的效应量：ADHD症状和执行认知功能。新的研究产品将包括标准化和试点MIP协议，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，或者与现有的ASU手动治疗相结合，以开发完全集成的ASU/ADHD治疗模式。此外，MIP可以与基于家庭的治疗或个体治疗结合使用，这些治疗可以灵活地将护理人员纳入早期治疗。 公共卫生相关性：ADHD是ASU的常见并发症，对成功的ASU治疗和维持治疗收益提出了重大挑战。这项R21研究将导致药物整合方案的开发，旨在将ADHD药物干预整合到社区环境中合并ASU/ADHD病例的门诊行为治疗中。

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.