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Intervention Summary

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Functional Adaptation Skills Training (FAST)

Functional Adaptation Skills Training (FAST) is an intervention for adult patients 40 years and older living in board-and-care facilities who have been diagnosed with schizophrenia or schizoaffective disorder. The goal of FAST is to improve patients' independence and quality of life. The intervention is manualized and based on social cognitive theory and independent living skills programs. FAST targets six areas of everyday functioning: medication management, social skills, communication skills, organization and planning, transportation, and financial management. Participants in FAST meet once per week, in a group format, over the course of 24 weeks. Each session lasts approximately 2 hours and is led by a master's- or doctoral-level therapist or by a nursing paraprofessional in the board-and-care facility.

Descriptive Information

Areas of Interest Mental health promotion
Outcomes Review Date: March 2007
1: Everyday living skills
2: Social and communication skills
Outcome Categories Quality of life
Social functioning
Ages 26-55 (Adult)
55+ (Older adult)
Genders Male
Female
Races/Ethnicities American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
White
Race/ethnicity unspecified
Settings Residential
Geographic Locations Urban
Implementation History In 2001-2006, FAST was delivered at approximately 15 board-and-care homes in San Diego County, California; each intervention lasted 18 months, and a total of 124 individuals received the intervention. As of 2010, FAST was being provided in five agencies in San Diego County as part of another ongoing research study; through this implementation, a total of 44 individuals have received or are receiving the intervention.
NIH Funding/CER Studies Partially/fully funded by National Institutes of Health: Yes
Evaluated in comparative effectiveness research studies: Yes
Adaptations The FAST intervention was replicated by the original research team for a Spanish-speaking population in a pilot study that came to be known as PEDAL.
Adverse Effects No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories Selective

Quality of Research
Review Date: March 2007

Documents Reviewed

The documents below were reviewed for Quality of Research. The research point of contact can provide information regarding the studies reviewed and the availability of additional materials, including those from more recent studies that may have been conducted.

Study 1

Patterson, T. L., McKibbin, C., Taylor, M., Goldman, S., Davila-Fraga, W., Bucardo, J., et al. (2003). Functional Adaptation Skills Training (FAST): A pilot psychosocial intervention study in middle-aged and older patients with chronic psychotic disorders. American Journal of Geriatric Psychiatry, 11(1), 17-23.  Pub Med icon

Study 2

Patterson, T. L., Mausbach, B. T., McKibbin, C., Goldman, S., Bucardo, J., & Jeste, D. V. (2006). Functional Adaptation Skills Training (FAST): A randomized trial of a psychosocial intervention for middle-aged and older patients with chronic psychotic disorders. Schizophrenia Research, 86, 291-299.  Pub Med icon

Supplementary Materials

Bowie, C. R., Reichenberg, A., Patterson, T. L., Heaton, R. K., & Harvey, P. D. (2006). Determinants of real-world functioning performance in schizophrenia subjects: Correlations with cognition, functional capacity, and symptoms. American Journal of Psychiatry, 163(3), 418-425.  Pub Med icon

Mausbach, B. T., Bowie, C. R., Harvey, P. D., Twamley, E. W., Goldman, S. R., Jeste, D. V., et al. (2007). Usefulness of the UCSD Performance-Based Skills Assessment (UPSA) for predicting residential independence in patients with chronic schizophrenia. Journal of Psychiatric Research, Feb 13 [Epub ahead of print].  Pub Med icon

Patterson, T. L., Bucardo, J., McKibbin, C. L., Mausbach, B. T., Moore, D., Barrio, C., et al. (2005). Development and pilot testing of a new psychosocial intervention for older Latinos with chronic psychosis. Schizophrenia Bulletin, 31(4), 922-930.  Pub Med icon

Patterson, T. L., Goldman, S., McKibbin, C. L., Hughs, T., & Jeste, D. V. (2001). UCSD Performance-Based Skills Assessment: Development of a new measure of everyday functioning for severely mentally ill adults. Schizophrenia Bulletin, 27(2), 235-245.  Pub Med icon

Patterson, T. L., Lacro, J., McKibbin, C. L., Moscona, S., Hughs, T., & Jeste, D. V. (2002). Medication management ability assessment: Results from a performance-based measure in older outpatients with schizophrenia. Journal of Clinical Psychopharmacology, 22(1), 11-19.  Pub Med icon

Patterson, T. L., Moscona, S., McKibbin, C. L., Davidson, K., & Jeste, D. V. (2001). Social skills performance assessment among older patients with schizophrenia. Schizophrenia Research, 48(2-3), 351-360.  Pub Med icon

Outcomes

Outcome 1: Everyday living skills
Description of Measures The University of California, San Diego (UCSD) Performance-Based Skills Assessment (UPSA) was used to assess everyday living skills. UPSA requires participants to role-play a variety of complex situations, including management of finances, social and communication skills, transportation, and household chores. Participants were given a score by the clinician in each functional area, and all scores were summed. Higher total scores indicated better functioning and improved everyday living skills.
Key Findings FAST participants showed improved performance on everyday living skills, compared with patients who only received their usual medications. Everyday functioning remained significantly better through a 3-month maintenance follow-up period (p < .0016).

In another evaluation, FAST participants had significantly improved everyday living skills at 6-month follow-up, compared with patients who received medications as usual and participated in sessions addressing personal problems (p = .046).
Studies Measuring Outcome Study 1, Study 2
Study Designs Experimental
Quality of Research Rating 3.2 (0.0-4.0 scale)
Outcome 2: Social and communication skills
Description of Measures Social and communication skills were assessed using the clinician-rated Social Skills Performance Assessment (SSPA). Participants engaged in two 3-minute role-plays simulating interactions with a new neighbor and a landlord, respectively. For each role-play, participants were rated from 1 (low) to 5 (high) on a number of domains including interest, fluency, clarity, affect, and social appropriateness. All scores were then summed. A higher total score indicated improved social and communication skills.
Key Findings FAST participants demonstrated significant improvement in social and communication skills at 6-month follow-up, compared with patients who received medications as usual and participated in sessions addressing personal problems (p = .003).
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 3.4 (0.0-4.0 scale)

Study Populations

The following populations were identified in the studies reviewed for Quality of Research.

Study Age Gender Race/Ethnicity
Study 1 26-55 (Adult)
55+ (Older adult)
68.8% Male
31.3% Female
78.1% White
12.5% Black or African American
3.1% Asian
3.1% Hispanic or Latino
3.1% Race/ethnicity unspecified
Study 2 26-55 (Adult)
55+ (Older adult)
65% Male
35% Female
53.3% White
25% Hispanic or Latino
13.8% Black or African American
3.8% Asian
3.3% American Indian or Alaska Native
0.8% Race/ethnicity unspecified

Quality of Research Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the Quality of Research for an intervention's reported results using six criteria:

  1. Reliability of measures
  2. Validity of measures
  3. Intervention fidelity
  4. Missing data and attrition
  5. Potential confounding variables
  6. Appropriateness of analysis

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome Reliability
of Measures
Validity
of Measures
Fidelity Missing
Data/Attrition
Confounding
Variables
Data
Analysis
Overall
Rating
1: Everyday living skills 3.5 4.0 3.5 3.5 2.0 2.8 3.2
2: Social and communication skills 3.5 4.0 3.5 4.0 2.5 3.0 3.4

Study Strengths

The intervention was well conceived. The outcome measures appear to be well established, and their psychometric properties were well addressed in the supporting documents. The studies accounted for most confounding factors.

Study Weaknesses

The studies did not adequately account for initial group differences and did not have a sufficient number of older adults (persons over 60 years old) to clearly support findings for that age group.

Readiness for Dissemination
Review Date: March 2007

Materials Reviewed

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can provide information regarding implementation of the intervention and the availability of additional, updated, or new materials.

FAST prescription labels

Mausbach, B. T., Bowie, C. R., Harvey, P. D., Twamley, E. W., Goldman, S. R., Jeste, D. V., et al. (2007). Usefulness of the UCSD Performance-Based Skills Assessment (UPSA) for predicting residential independence in patients with chronic schizophrenia. Journal of Psychiatric Research, Feb 13 [Epub ahead of print].  Pub Med icon

Modules 1-6 from Functional Adaptation Skills Training (FAST) Intervention Manual

Patterson, T., & Goldman, S. (2001). Social Skills Performance Assessment (SSPA) Manual.

Patterson, T., & Goldman, S. (2001). The UCSD Performance-Based Skills Assessment (UPSA) Manual.

Patterson, T., & Goldman, S. (2003). Medication Management Ability Assessment (MMAA) Manual.

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the intervention's Readiness for Dissemination using three criteria:

  1. Availability of implementation materials
  2. Availability of training and support resources
  3. Availability of quality assurance procedures

For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

Implementation
Materials
Training and Support
Resources
Quality Assurance
Procedures
Overall
Rating
2.5 0.5 2.3 1.8

Dissemination Strengths

Intervention manual modules are clearly structured and detailed with session-by-session agendas and instructions for group leaders. Outcome measures assessing change in functional capabilities are provided to support quality assurance.

Dissemination Weaknesses

No program overview or discussion of intended outcomes is provided. Program materials do not speak to the variability of skills and abilities among adults with schizophrenia. No information is provided on required experience and qualifications of group leaders. Though some materials and embedded information may support training, no clear training or support resources are provided to implementers. The relationship between the assessment measures and the intervention modules is not clear. No measures or indicators for fidelity are provided to support quality assurance.

Costs

The cost information below was provided by the developer. Although this cost information may have been updated by the developer since the time of review, it may not reflect the current costs or availability of items (including newly developed or discontinued items). The implementation point of contact can provide current information and discuss implementation requirements.

Item Description Cost Required by Developer
Treatment manual $300 for a set of 12 Yes
Props $370 Yes
2-day, on- or off-site training workshop $1,600 per workshop (plus travel expenses if applicable) Yes
Phone consultation with training staff $100 per hour Yes

Additional Information

The cost for training and delivering the intervention to a group of 10 patients is estimated at $4,500, plus fees for technical assistance (if applicable). This estimate includes the cost of treatment materials (treatment manuals and props) as well as fees and travel costs for two trainers conducting a 2-day, on-site training workshop. The total cost per patient is estimated at $450.

Contact Information

To learn more about implementation, contact:
Brian Kelly
(858) 534-3354
brkelly@ucsd.edu

To learn more about research, contact:
Thomas L. Patterson, Ph.D.
(858) 534-3354
tpatterson@ucsd.edu

Dilip V. Jeste, M.D.
(858) 534-4020
djeste@ucsd.edu

Consider these Questions to Ask (PDF, 54KB) as you explore the possible use of this intervention.