title: Family-focused therapy for individuals at clinical high risk for psychosis: treatment fidelity within a multisite randomized trial.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Psychology, University of California at Los Angeles, Los Angeles, California, USA.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Marvin
authors.affiliation: Department of Psychiatry, UCLA Semel Institute, Los Angeles, California, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Miklowitz
authors.affiliation: Department of Psychiatry, UCLA Semel Institute, Los Angeles, California, USA.
authors.forename: Mary P
authors.initials: MP
authors.lastname: O'Brien
authors.affiliation: Department of Psychology, University of California at Los Angeles, Los Angeles, California, USA.|Department of Psychology, Psychiatry, and Human Genetics, University of California at Los Angeles, Los Angeles, California, USA.
authors.forename: Tyrone D
authors.initials: TD
authors.lastname: Cannon
mesh_terms: D000328:Adult; D002648:Child; D002983:Clinical Competence; D061345:Early Medical Intervention; D005196:Family Therapy / Q000379:methods*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D010349:Patient Compliance / Q000523:psychology*; D011618:Psychotic Disorders / Q000517:prevention & control / Q000523:psychology* / Q000628:therapy*; D055815:Young Adult
keywords: clinical high risk for psychosis; family therapy; treatment fidelity; treatment integrity
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