Family‐focused therapy for individuals at clinical high risk for psychosis: treatment fidelity within a multisite randomized trial

Abstract

Aim Family psychoeducation is an effective adjunct to pharmacotherapy in delaying relapse among patients with schizophrenia and bipolar disorder. This study tested the treatment adherence and competence of newly trained clinicians to an adaptation of family-focused therapy for individuals at clinical high risk for psychosis (FFT-CHR). Methods The sample included 103 youth or young adults (ages 12–30 years) who had attenuated positive symptoms of psychosis. Families participated in a randomized trial comparing two psychosocial interventions: FFT-CHR (18 sessions over 6 months) and enhanced care (EC; 3 sessions over 1 month). Following a 1.5-day training seminar, 24 clinicians from eight study sites received teleconference supervision in both treatment protocols for the 2-year study period. Treatment fidelity was rated with the 13-item Therapy Competence and Adherence Scales, Revised. Results Supervisors classified 90% of treatment sessions as above acceptable fidelity thresholds (ratings of 5 or better on a 1–7 scale of overall fidelity). As expected, fidelity ratings indicated that FFT-CHR included a greater emphasis on communication and problem-solving skills training than EC, but ratings of non-specific clinician skills, such as maintaining rapport and appropriately pacing sessions, did not differ between conditions. Treatment fidelity was not related to the severity of symptoms or family conflict at study entry. Conclusions FFT-CHR can be administered with high levels of fidelity by clinicians who receive training and supervision. Future studies should examine whether there are more cost-effective methods for training, supervising and monitoring the fidelity of FFT-CHR.

Factor structure of therapist fidelity to individual resiliency training in the Recovery After an Initial Schizophrenia Episode Early Treatment Program

“…Client characteristics were not correlated with factor scores or overall fidelity ratings, suggesting that clinician implementation of the IRT treatment was not significantly associated with client's baseline symptoms. These findings are consistent with those found in a sample with prodromal symptoms (Marvin et al, ), and inconsistent with those found in a chronic population (Carlson & Weisman de Mamani, ) suggesting that the symptom presentation of the current first episode group may be more closely aligned with that of a prodromal population than that of a chronic population.…”

Family-Focused Treatment for Adolescents and Young Adults at High Risk for Psychosis: Results of a Randomized Trial

“…The key difference in session content between the two treatments is the emphasis on communication and problem-solving skills in FFT-CHR. 24 Increases in the individual’s use of positive communication strategies with parents or siblings may lead to reciprocal increases in these family members’ use of constructive communication, which may in turn increase the individual’s self-efficacy regarding managing peer and work relationships. Young adult participants may be better able to generalize the use of skill training to their school and work settings than adolescent participants.…”

“…As expected, clinicians were significantly more likely to provide communication enhancement training (χ 2 (3)=17.36, p =.001) and problem solving skills training (χ 2 (3)=7.27, p =.03) in the FFT-CHR than the EC sessions. 24 …”

Early referral and comorbidity as possible causes of the declining transition rate in subjects at clinical high risk for psychosis

“…Second, randomized controlled trial is usually needed in the comparison of interventions; however, this study compared the medication under the natural and longitudinal study condition. Third, we did not review compliance and non‐pharmacological treatments, including cognitive behavioural therapy (CBT) and family psychoeducation, which are considered as effective therapies for CHR individuals . Because all CHR subjects receive psychoeducation, supportive psychotherapy and short‐term CBT in the Seoul Youth Clinic, we did not compare these therapies.…”