Project CARE: An Integrated Treatment Adherence Program for Bipolar Disorder at the Time of Prison Release - Open Trial

Bipolar Disorder Clinical Trial

Official title:

Project CARE (Community Treatment Adherence at Re-Entry): An Integrated Treatment Adherence Program for Bipolar Disorder at the Time of Prison Release - Open Trial

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT03825640
• Other study ID #: 1806002090
• Secondary ID: R34MH117198
• Status: Completed
• Phase: N/A
• Start date: January 14, 2019
• Est. completion date: January 15, 2020

Study information

• Verified date: February 2020
• Source: Brown University
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The aim of this program of research is to develop and pilot the CARE (Community treatment Adherence at Re-Entry) program, an adjunctive intervention for incarcerated individuals with bipolar disorder (BD) transitioning from prison to the community.

The purpose of this proposed project is to establish the feasibility, acceptability, and preliminary effects of this newly developed intervention on symptom outcomes.

Description:

Bipolar disorder (BD) is a serious, disabling, and highly recurrent illness that is disproportionately represented in the criminal justice system. BD increases risk for several adverse outcomes for prisoners, including mood instability, suicide attempts, substance use relapse, and high rates of repeat incarceration. Despite these serious negative consequences, up to 70% of prisoners with BD do not receive mental health treatment upon prison release. Lack of engagement in ongoing mental health treatment for BD upon community re-entry represents one potent factor that perpetuates risk for adverse outcomes, and consequences of untreated BD (e.g., impulsivity, substance use) may greatly exacerbate difficulties in establishing stable living conditions (e.g., adequate housing, legal employment) at community re-entry. Thus, there is a critical need for interventions to facilitate engagement with treatment for BD during this vulnerable transition.

To that end, the primary aim of this study is to develop and establish the feasibility and acceptability of the Community treatment Adherence at Re-Entry (CARE) program. CARE is an innovative intervention that will combine evidence-based cognitive-behavioral, family, and telephone outreach strategies to promote treatment engagement and improve clinical outcomes for prisoners with BD during the period of community re-entry. CARE will include 3 individual and 1 family session, followed by 11 brief telephone contacts for up to 6 months post-release. Given its moderate intensity, adjunctive nature, use of community mental health counselors, and use of telephone administration for post-release follow-up, CARE has been designed with an eye toward community implementation. Its proposed mechanisms of action (i.e., increasing values-action consistency, enhancing social supports, and linkage to community treatment services) are further well matched to the practical and clinical needs of re-entering individuals.

The aim of this research is to conduct a small open trial (n=12) of the CARE intervention. Assessments will occur at baseline, immediately pre-release, 4 weeks post-release, and 24 weeks post-release (post-treatment). This study will examine the feasibility and acceptability of CARE (e.g., uptake, adherence to, and completion of the CARE intervention, satisfaction with the intervention, understanding of intervention principles) and of this research design. This study will also examine treatment effects (within relevant confidence intervals) on outcomes (e.g., mood symptoms). Change in potential mechanisms (i.e., values-action consistency derived from intervention principles) will be examined.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 12
• Est. completion date: January 15, 2020
• Est. primary completion date: January 15, 2020
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• DSM-5 diagnosis of bipolar I, bipolar II, or bipolar disorder not elsewhere classified

• Anticipated prison release within 4-10 weeks

• Expected release to locations anywhere within RI or to locations in other states within a 30 mile radius of Providence

• Aged 18 or older

• Willingness to sign an informed consent document that describes study procedures

Exclusion Criteria:

• Presence of current psychiatric symptoms severe enough to warrant separation from the general prison population

• Cognitive impairment sufficient to prevent successful completion of the baseline interview.

• Inability to understand sufficiently well to understand the consent form or assessment instruments when they are read aloud.

Related Conditions & MeSH terms

• Bipolar Disorder

Intervention

Behavioral:
• CARE
Hybrid in-person and telephone-based adjunctive intervention for bipolar disorder across the transition from prison to the community.

Locations

Country	Name	City	State
United States	Rhode Island Department of Corrections	Cranston	Rhode Island
United States	Brown University	Providence	Rhode Island

Sponsors (2)

Lead Sponsor	Collaborator
Brown University	National Institute of Mental Health (NIMH)

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Client Satisfaction Questionnaire-8 (CSQ-8)	Intervention feasibility and acceptability; Total satisfaction scores range from 8 (low) to 32 (high)	24 weeks post-release
Secondary	Quick Inventory of Depressive Symptomatology - Self-Report (QIDS-SR)	depressive symptom severity; Total depressive symptom severity scores range from 0 (none) to 27 (very severe)	24 weeks post-release
Secondary	Altman Self-Rating Scale for Mania (ASRM)	manic symptom severity; Total manic symptom severity scores range from 0 (none) to 20 (severe)	24 weeks post-release