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并试行一个简短的方案，旨在系统地将ADHD的药物干预措施整合到青少年药物使用者的行为治疗服务中，并在日常护理中合并ADHD。ADHD是青少年药物使用（ASU）的一种普遍共存的疾病，它可以显著阻碍成功的ASU治疗，但在机构设置的ASU客户中，ADHD的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药物治疗整合到ASU的常规行为服务中：药物整合方案（MIP）。MIP是在ASU治疗的早期阶段提供的以家庭为基础的5个阶段的协议，包含三个基于研究的元素：(1)标准化的精神病学评估和以家庭为中心的青少年ADHD心理教育；(2)经批准的ADHD药物治疗方案（OROS-MPH），证明对ASU/ADHD患者有效；(3)以家庭为基础的干预措施，以支持药物接受（如所示）和精神科和行为服务之间的护理协调。MIP将整合到一个合作临床站点现有的基于家庭的服务中：20例ASU/ADHD病例将由站点家庭治疗师治疗，他们将在MIP中接受新培训和监测。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。研究的主要目的是获得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对精神病学和行为服务利用、药物接受和依从性以及治疗服务满意度的影响的证据。探索性分析将为MIP对ADHD药物治疗的主要目标（ADHD症状和执行认知功能）的短期影响产生效应量。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可以作为日常护理的独立干预措施，或者与现有的ASU手动治疗相结合，努力开发ASU/ADHD的完全综合治疗模式。此外，MIP可以与基于家庭的治疗或个人治疗相结合，可以灵活地在早期阶段包括护理人员。

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.