The candidate requests support for a four-year program of research and training to pilot a novel therapeutic approach for working with parents and other concerned significant others (PCSO) of individuals experiencing a first episode of psychosis (FEP) who are not engaged in treatment. The training plan emphasizes areas that are critical toward establishing the candidate as an independent clinical investigator. Young people experiencing FEP have significantly higher mortality than the general population of 16-30 year olds in the United States, but over 30% of individuals diagnosed with a new-onset psychotic disorder do not receive any mental health treatment in the year following their diagnosis, and the vast majority are grossly under-treated.1 Well-intended solutions such as providing education about the nature of psychosis cannot be implemented if the individual at the center of concern ? the person experiencing psychosis ? refuses to meet with providers. Ambivalent and fearful attitudes regarding the role of psychiatric interventions may lead individuals with FEP to decline or drop out of treatment. The development of effective tactics for shortening the duration of untreated psychosis (DUP) has been recognized as a priority area by the NIH.
The research aim of this proposal is to develop and pilot test a brief motivational interviewing (MI) based skills intervention that targets PCSO of individuals with FEP who refuse treatment (hereafter referred to as individuals with psychosis, or IP). Clinician-delivered MI has been identified as an effective technique for enhancing adherence once individuals with psychosis are involved in care,2-3 and may also be useful for engaging those who are not yet interested in treatment. The proposed project will adapt and pilot test an intervention that teaches MI skills to PCSO of IP with the goal of increasing IP engagement with care. The outcomes of interest for this project are the feasibility of the approach, rates of IP enrolling in treatment, and changes in PCSO wellbeing over time. This pilot will yield feasibility and effect size estimates that will be used to inform the design of a randomized clinical trial testing the effectiveness of this approach for facilitating care engagement and shortening DUP among untreated individuals with FEP in the community. The training aim of this proposal is to ensure that the candidate obtains the preparation and mentorship needed to develop an independent program of clinical research in the area of early intervention in psychosis. At this stage, the candidate requests training in clinical trial design and management, analytic techniques relevant to clinical trials, motivational interviewing, and implementation research. The research and training will take place in the Department of Psychiatry of Beth Israel Deaconess Medical Center, a hospital affiliate of Harvard Medical School. The training plan leverages the candidate?s access to leading mentors in the Boston area and Harvard?s clinical science training infrastructure to accomplish these goals.
Young people experiencing a first episode of psychosis are significantly more likely to die than the general population of 16-30 year olds in the United States, but many do not seek mental health treatment. Well- intended solutions such as providing education about the nature of psychosis cannot be implemented if the individual at the center of concern ? the person experiencing psychosis ? is reluctant to meet with providers. This study will develop and test a brief psychotherapeutic intervention that teaches parents and other loved ones strategies for talking with an individual experiencing psychosis about the pros and cons of mental health treatment with the goal of increasing the likelihood that he or she will choose to engage with care.
