ABSTRACT

Objective: We examined the acceptability, integrity, and symptom trajectories associated with FIRST, a principle-guided treatment for youth internalizing and externalizing problems designed to support efficient uptake and implementation.

Method: We conducted two open trials of an adapted FIRST, focusing on uptake and implementation by novice trainees in a university-affiliated clinic, limiting treatment duration to six sessions, and benchmarking findings against a 2017 FIRST trial with community therapists. In Study 1, trainees received a two-day training and weekly two-hour supervision (N = 22 youths, ages 7–17, 50% female, 54.54% Caucasian, 4.55% Latinx). In Study 2, trainees received a one-day training and weekly one-hour supervision, delivering the six-session FIRST in a predetermined sequence (N = 26 youths, ages 11–17, 42.31% female, 65.38% Caucasian, 7.69% Latinx). In Study 3, the original study therapists – now practitioners – evaluated FIRST’s effectiveness and implementation difficulty, and reported their own post-study FIRST use.

Results: Acceptability (treatment completion, session attendance, caregiver participation) and integrity (adherence, competence) were comparable across Study 1, Study 2 and the 2017 trial. Improvement effect sizes across ten outcome measures were in the large range in all three trials: M ES = 1.10 in the 2017 trial, 0.83 in Study 1, and 0.81 in Study 2. Study 3 showed high effectiveness ratings, low difficulty ratings, and continued use of FIRST by a majority of clinicians.

Conclusions: Across two open trials and a follow-up survey, FIRST showed evidence of acceptability and integrity, with youth symptom reduction comparable to that in prior research.

摘要

目标：我们检查了与 FIRST 相关的可接受性、完整性和症状轨迹，FIRST 是一种针对青年内化和外化问题的原则指导治疗，旨在支持有效的吸收和实施。

方法：我们对经过调整的 FIRST 进行了两次公开试验，重点是大学附属诊所的新手学员的吸收和实施，将治疗持续时间限制为 6 次，并将结果与​​ 2017 年与社区治疗师进行的 FIRST 试验相比较。在研究 1 中，受训者接受了为期两天的培训和每周两小时的监督（N = 22 名青年，年龄在 7-17 岁之间，50% 是女性，54.54% 是白种人，4.55% 是拉丁裔）。在研究 2 中，受训者接受了为期一天的培训和每周 1 小时的督导，按照预定的顺序提供了六节课的 FIRST（N= 26 名青年，年龄在 11-17 岁之间，女性占 42.31%，白种人占 65.38%，拉丁裔占 7.69%）。在研究 3 中，最初的研究治疗师——现在是从业者——评估了 FIRST 的有效性和实施难度，并报告了他们自己的研究后 FIRST 使用情况。

结果：在研究 1、研究 2 和 2017 年试验中，可接受性（治疗完成、会议出席、护理人员参与）和完整性（依从性、能力）具有可比性。在所有三项试验中，十项结果测量的改进效果大小都在很大范围内：2017 年试验中的M ES = 1.10，研究 1 中为 0.83，研究 2 中为 0.81。研究 3 显示出高有效性评级、低难度评级和持续大多数临床医生使用 FIRST。

结论：在两项公开试验和一项后续调查中，FIRST 显示出可接受性和完整性的证据，青少年症状的减少与之前的研究相当。