Family-Focused Therapy for Youth With Early-Onset Bipolar or Psychotic Disorders
Condition: Mood Disorders; Psychotic Disorders
MeSH terms: Mental Disorders; Psychotic Disorders; Mood Disorders
Study type: Interventional
Phase: Phase 2

Summary: 
      The present study aims to :

        1. compare different approaches (high intensity vs. low intensity) to training community
           providers (those who routinely treat young patients with bipolar disorder, psychosis, or
           sub-threshold high-risk conditions) on the implementation of family-focused treatment
           (FFT);

        2. assess the cost of FFT training and implementation support; and

        3. determine whether these different forms of clinician training are associated with
           different outcomes over 1 year among patients with early-onset mood and psychotic
           disorders.
    

Detailed description: 
      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 12 sessions of psychoeducation, communication
      training, and problem-solving skills training. There are six randomized controlled trials
      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 Mental Health Center, Didi Hirsch Mental Health Center) that treat early-onset,
      lower socioeconomic status, urban, and racially and ethnically diverse bipolar and psychosis
      patients. We will partner with these 3 community sites to randomly assign 30 clinicians to
      low intensity (web-based training plus low intensity supervision) or high intensity training
      (live workshop and higher intensity supervision, i.e., weekly individual supervision with
      fidelity feedback). Clinicians will administer FFT to up to 120 patients (ages 13-25) with
      recent-onset mania, psychosis or high-risk conditions. We expect that 20 clinicians will
      complete the treatment with 80 patients. Dependent variables will be empirically-derived
      fidelity component scores over time as measured by supervisors 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.
    

Intervention name(s): High Intensity Training; Low Intensity Training
Intervention type(s): Behavioral; Behavioral
Intervention description(s): This is a training method involving a live workshop followed by high intensity technical consultation.; Clinicians complete an online workshop in family-focused therapy, followed by technical consultation sessions after every third session.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Mood Disorders; Psychosis; Subthreshold; Bipolar Disorder