Thomas Elizabeth C, Lucksted Alicia, Siminoff Laura A, Hurford Irene, O'Connell Maria, Penn David L, Casey Irene, Smith Margaret, Suarez John, Salzer Mark S
Department of Social and Behavioral Sciences, College of Public Health, Temple University, 1700 N Broad St., Philadelphia, PA, 19121, USA.
University of Maryland School of Medicine, Baltimore, MD, USA.
Community Ment Health J. 2025 Jan 3. doi: 10.1007/s10597-024-01425-w.
Young adults with early psychosis often disengage from essential early intervention services (i.e., Coordinated Specialty Care or CSC in the United States). While decision support interventions improve service engagement, their use in this population is underexplored. This study evaluated the feasibility, acceptability, fidelity, and potential impact of a decision coaching intervention for young adults with early psychosis in CSC services. Using a mixed-method, longitudinal, collective case study design, we assessed the intervention's impact on decision-making needs through the Decisional Conflict Scale and qualitative interviews. We also evaluated feasibility, fidelity, and acceptability through observations and feedback from interventionists and participants. Eight young adults from three CSC programs participated, showing variable engagement, with generally favorable fidelity and acceptability ratings. The Decisional Conflict Scale revealed mixed findings, while four themes from qualitative interviews emerged: Perspective and Information Seeking, Motivation and Prioritization, Empowerment and Confidence, and Critical Thinking and Evaluation. The findings suggest that training CSC providers-including peer specialists and clinicians-to deliver decision coaching with fidelity is feasible, well-received by young adults, and potentially impactful on decision-making. Replication in a larger controlled trial, addressing observed study limitations, is warranted. This trial was registered with ClinicalTrials.gov (Identifier: NCT04532034) on August 28, 2020, as Temple University Protocol Record 261047, Facilitating Engagement in Evidence-Based Treatment for Early Psychosis (https://clinicaltrials.gov/ct2/show/NCT04532034?term=NCT04532034&draw=2&rank=1).
患有早期精神病的年轻人往往会脱离基本的早期干预服务（即美国的协调专科护理或 CSC）。虽然决策支持干预措施可提高服务参与度，但在这一人群中的应用尚未得到充分探索。本研究评估了针对 CSC 服务中患有早期精神病的年轻人的决策指导干预措施的可行性、可接受性、保真度和潜在影响。我们采用混合方法、纵向、集体案例研究设计，通过决策冲突量表和定性访谈评估了该干预措施对决策需求的影响。我们还通过干预人员和参与者的观察及反馈评估了可行性、保真度和可接受性。来自三个 CSC 项目的八名年轻成年人参与了研究，他们的参与度各不相同，总体保真度和可接受性评分良好。决策冲突量表的结果喜忧参半，而定性访谈则出现了四个主题：观点与信息寻求、动机与优先级排序、赋权与信心以及批判性思维与评估。研究结果表明，培训包括同伴专家和临床医生在内的 CSC 提供者以忠实地提供决策指导是可行的，受到年轻人的欢迎，并且可能对决策产生影响。有必要在更大规模的对照试验中进行重复研究，以解决观察到的研究局限性。该试验于 2020 年 8 月 28 日在 ClinicalTrials.gov 上注册（标识符：NCT04532034），作为天普大学协议记录 261047，促进早期精神病的循证治疗参与（https://clinicaltrials.gov/ct2/show/NCT04532034?term=NCT04532034&draw=2&rank=1）。
