Treatment Retention Strategies in Transition Age Youth

描述（由申请人提供）：本申请涉及广泛的挑战领域（04）临床研究和特定的挑战主题，04-MH-105：进行试点研究，以开发和测试发育适当的，以证据为基础的预防干预措施和服务提供模式，用于高风险的青少年，或正在向成年过渡的严重精神疾病患者。当他们进入成年过渡年龄的青年（TAY;年龄17 - 25）有严重的心理健康状况有惊人的功能差;无家可归（30%），逮捕（60%），辍学（42%）和失业率高（见1）。这些问题可以通过良好的心理健康（MH）治疗来减少。然而，在寻求MH治疗的成年人中，TAY始终是最有可能退出治疗的人（例如2），他们在老年人或肥胖者中完成的疗程数量最少。改善TAY功能的一个简单且具有潜在成本效益的步骤是为最常用的MH治疗开发有效的TR干预措施;基于办公室的门诊心理治疗。拟议的研究开发和试点一个新的TR干预办公室为基础的门诊心理治疗量身定制的TAY，和试点测试现有的干预尚未在这个年龄组进行检查。虽然尚未调查TAY治疗脱落的具体原因，但可能是多方面的。在成人中发现了多种治疗退出的原因5，研究中没有出现主要因素。成熟成人和TAY可能有一些共同的提前终止原因，但由于过渡期独特的发育和生命阶段特征（见6），在成人中成功的TR干预不太可能对TAY有效。可能导致TAY TR受损的一些独特发育特征包括："不成熟--典型的拒绝权威，可能会干扰治疗关系，不成熟的认知发展，可能会干扰治疗目标设定的抽象任务"不成熟的责任承担，可能会干扰参加会议和接受治疗工作，特别是因为在向成年的过渡期间，父母的影响会减少。"由于同龄人的接受和在这些年龄段追求浪漫关系的中心地位，需要心理健康治疗的耻辱感会被强烈地感受到，并且可能会降低TR。拟议的研究将开始测试动机面试（MI）7作为一个TR干预TAY的工作。MI是一种广泛使用的干预措施，用于增强动机并减少对变化的矛盾心理，这增加了老年和年轻年龄组的治疗依从性。MI是另外有吸引力的，因为它可以很容易地添加到标准治疗。此外，还将开发第二种TR干预措施，其靶向可能是TAY独有的TR机制，与MI中的靶向机制不同。拟议的研究进行了初步的步骤，以确定这两种方法在增加TAY TR的有效性。该研究将启动开发和可行性评估的发展量身定制的TR干预，以及可行性的研究设计，以试点测试两个TR干预相比，"服务照常。“这是确定是否可以找到足够的证据来证明全面临床试验的初步步骤。TR的两项干预措施是："同伴治疗教练（PTC）;这种基于网络的同伴干预，重点是支持参与门诊心理治疗将在拟议的研究"动机访谈（MI）中开发;这种治疗师实施的干预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，但尚未专门作为过渡年龄青年的TR策略进行测试。目标1.指定一个新的门诊MH心理治疗TR干预（PTC）的实施和培训协议和保真度措施。目标2.确定PTC方法和随机临床试验研究设计的可行性，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量身定制的TR干预措施和测试在该年龄组中未尝试过的成功干预措施，在广泛使用的治疗中保留更多的过渡年龄青年。它将与总统的恢复和再投资法保持一致，将97%的直接成本预算用于人员，并为精神残疾青年提供就业机会。在向成年过渡期间有心理健康需求的青少年在工作、独立生活和远离法律麻烦方面的功能受到了极大的损害。每年有760 000名过渡年龄青年（17 - 25岁）获得基于心理健康的治疗，但这种广泛提供的治疗在这个年龄组的影响受到损害，因为他们特别容易放弃治疗。如果在拟议的研究中测试的两种有希望的治疗辍学预防干预措施取得成功，未来更多的过渡年龄青年将继续接受治疗，以便对症状产生有益的影响，并通过扩展功能。

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.