Family-Focused Treatment for Youth with Early-Onset Bipolar or Psychotic Disorder

针对患有早发性双相情感障碍或精神障碍的青少年的以家庭为中心的治疗

• 批准号: 8287440
• 负责人: DAVID Jay MIKLOWITZ
• 金额: $ 23.28万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-04-01 至 2014-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8287440
• 关键词: Adherence; Administrator; Adolescent; Adopted; Adoption; Adult; Aftercare; Age; Age of Onset; Behavior; Behavior Therapy; Bipolar Disorder; Caregivers; Certification; Clinic; Clinical; Clinical Trials; Communication; Communities; Community Mental Health Centers; Competence; Conflict (Psychology); Data; Development; Disease; Doctor of Medicine; Doctor of Philosophy; Educational process of instructing; Educational workshop; Evidence based intervention; Family; Feedback; Individual; Institutes; Internet; Intervention; Laboratories; Lead; Life; Life Style; Manic; Measures; Medical center; Mental Health; Meta-Analysis; Methods; Modeling; Monitor; Mood Disorders; Moods; Online Systems; Outcome; Outcome Assessment; Patient Self-Report; Patients; Pharmaceutical Preparations; Pharmacotherapy; Phase; Phenotype; Population; Prevention; Problem Solving; Procedures; Process; Provider; Psychiatry; Psychotic Disorders; Psychotic Mood Disorders; Randomized; Randomized Controlled Trials; Recording of previous events; Recovery; Recurrence; Relative (related person); Reporting; Research; Risk; Science; Series; Services; Severities; Site; Social Functioning; Structure; Supervision; Symptoms; Teleconferences; Testing; Therapeutic; Time; Training; Training Programs; Translations; Treatment outcome; Validation; Validity and Reliability; Youth; active control; base; community setting; conflict resolution; disorder risk; early onset; effective therapy; evidence base; high risk; improved functioning; instrument; medical schools; medical specialties; medication compliance; meetings; operation; patient population; psychoeducation; psychoeducational; psychosocial; randomized trial; response; skills; skills training; social networking website; socioeconomics; stressor; theories; treatment program; young adult

DESCRIPTION (provided by applicant): This application is in response to RFA MH-12-050, Optimizing Fidelity of Empirically-Supported Behavioral Treatments. Despite impressive results in laboratory settings, there has been a significant lag in the community adoption and sustainability of family interventions for early-onset mood and psychotic disorders. Our objective is to determine the optimal methods of training and monitoring the delivery of an evidence-based family-focused treatment (FFT) in community providers who treat young patients (ages 13-25) with bipolar disorder (BD), psychosis, or "high-risk" conditions. FFT is administered in 21 sessions of psychoeducation, communication training, and problem-solving skills training. There are six RCTs indicating that, among adults or adolescents with BD, bipolar spectrum, or psychosis-risk disorders, FFT and pharmacotherapy are associated with more rapid stabilization of symptoms, delayed recurrences, enhanced functioning, better medication adherence, and improvements in family interaction relative to comparison treatments over 1-2 years. Using a community partnered participatory approach, we will engage diverse stakeholders (clinicians, administrators, caregivers) at three community sites (Harbor-UCLA Medical Center, San Fernando MHC, Didi Hirsch MHC) that treat early-onset, lower SES, urban, and racially and ethnically diverse bipolar and psychosis patients. Stakeholders will provide input into all phases of the study. In Phase I, we will conduct meta-analyses of fidelity data from six RCTs of FFT - all of which used the observer-based Therapist Competence and Adherence scales - to identify fidelity components that are differentially associated with intermediate and long- term patient and family outcomes. We expect key fidelity domains to include: therapist directiveness, skillful teaching of conflict resolution strategies, encouraging patients' medication adherence and lifestyle adaptations, and skillful direction of symptom prevention planning. We will develop and pilot streamlined self-report measures and web-based clinician training materials relevant to the identified fidelity components. In phase II, we will partner with the 3 community sites to randomly assign 20 clinicians to low intensity (webinar, web- based training, social networking site, monthly group teleconferences) or high intensity training (live workshop, web-based training, weekly individual supervision with fidelity feedback). Clinicians will administer FFT to 80 patient (ages 13-25) with recent-onset mania, psychosis or high-risk conditions. Dependent variables will be empirically-derived fidelity component scores over time as measured by supervisors, caregivers, and clinicians. We hypothesize that after training, clinicians in both the high and low intensity groups will attain minimum levels of fidelity required for certification in the four components. However, clinicians in high intensity training will sustain higher levels of fidelity across subsequent treatment cases, and will be more satisfied and more likely to adopt the FFT model. This study will facilitate the translation of an evidence-based intervention and identify effective treatment components to inform larger-scale dissemination of FFT in community settings. PUBLIC HEALTH RELEVANCE: There is robust evidence from randomized controlled trials for the efficacy of family-focused treatment (FFT) in conjunction with pharmacotherapy in hastening recovery, delaying recurrences and improving functioning among adults and adolescents with bipolar disorder, but there remains a significant "science-to-service" gap in implementing this psychoeducational treatment in community settings. Our main objective is to identify optimal methods of training and monitoring the delivery of FFT among community mental health clinicians who treat young-onset (ages 13-25) bipolar and psychosis spectrum patients. We propose a partnership between the UCLA School of Medicine and three high volume community mental health centers that treat lower socioeconomic, urban, and diverse patient populations, to determine: (1) how to efficiently train community providers in the essential components of FFT, (2) when and under what conditions training leads to sustainable changes in practice, and (3) whether changes in practice lead to better short- and long-term outcomes for patients with early-onset bipolar disorder or psychosis spectrum disorders.

描述（由申请人提供）：本申请是对 RFA MH-12-050“优化经验支持行为治疗的保真度”的回应。尽管实验室环境取得了令人瞩目的成果，但针对早发情绪和精神障碍的家庭干预措施的社区采用和可持续性仍存在明显滞后。我们的目标是确定在社区提供者中培训和监测以证据为基础的以家庭为中心的治疗 (FFT) 的最佳方法，这些治疗者治疗患有双相情感障碍 (BD)、精神病或“的年轻患者（13-25 岁）”高风险”的情况。 FFT 分为 21 个课程，包括心理教育、沟通培训和解决问题技能培训。有六项随机对照试验表明，在患有双相情感障碍、双相情感障碍或精神病风险障碍的成人或青少年中，FFT 和药物治疗与更快地稳定症状、延迟复发、增强功能、更好的药物依从性和改善家庭互动有关相对于 1-2 年的比较治疗。使用社区合作参与方法，我们将在三个社区站点（Harbor-UCLA 医疗中心、圣费尔南多 MHC、迪迪赫希 MHC）吸引不同的利益相关者（临床医生、管理人员、护理人员）参与治疗早发型、低社会经济地位、城市和社区疾病。种族和民族多样化的双相情感障碍和精神病患者。利益相关者将为研究的所有阶段提供意见。在第一阶段，我们将对六个 FFT 随机对照试验的保真度数据进行荟萃分析 - 所有 其中使用基于观察者的治疗师能力和依从性量表 - 来识别与中长期患者和家庭结果有差异相关的保真度成分。我们期望关键的保真度领域包括：治疗师的指导、冲突解决策略的熟练教学、鼓励患者坚持服药和生活方式适应，以及症状预防计划的熟练指导。我们将制定并试点简化的自我报告措施以及与已确定的保真度组成部分相关的基于网络的临床医生培训材料。在第二阶段，我们将与 3 个社区网站合作，随机抽取 分配 20 名临床医生进行低强度（网络研讨会、基于网络的培训、社交网站、每月小组电话会议）或高强度培训（现场研讨会、基于网络的培训、每周进行保真反馈的个人监督）。临床医生将对 80 名近期发作的躁狂症、精神病或高危病症患者（13-25 岁）进行 FFT。因变量将是由主管、护理人员和临床医生测量的随时间推移凭经验得出的保真度成分分数。我们假设，经过培训后，高水平和低水平的临床医生 强度组将达到四个部分认证所需的最低保真度水平。然而，接受高强度培训的临床医生将在后续治疗案例中保持更高水平的保真度，并且会更加满意并且更有可能采用 FFT 模型。这项研究将促进基于证据的干预措施的转化，并确定有效的治疗成分，为社区环境中更大规模的 FFT 传播提供信息。 公共卫生相关性：随机对照试验提供了强有力的证据，证明以家庭为中心的治疗 (FFT) 与药物治疗相结合可有效加速双相情感障碍成人和青少年的康复、延缓复发和改善功能，但仍存在显着的“在社区环境中实施这种心理教育治疗时存在科学与服务之间的差距。我们的主要目标是确定治疗年轻发病（13-25 岁）双相情感障碍和精神病谱系患者的社区心理健康临床医生的 FFT 培训和监测实施的最佳方法。我们建议加州大学洛杉矶分校医学院与三个治疗低社会经济、城市和多样化患者群体的高容量社区心理健康中心建立伙伴关系，以确定：（1）如何有效地培训社区提供者了解 FFT 的基本组成部分，（ 2）何时以及在什么条件下训练会导致实践中的可持续变化，以及（3）实践中的变化是否会为早发性双相情感障碍或精神病谱系障碍患者带来更好的短期和长期结果。