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      INdividual Vocational and Educational Support Trial (INVEST) for young people with borderline personality disorder: study protocol for a randomised controlled trial

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          Abstract

          Background

          The clinical onset of borderline personality disorder (BPD) usually occurs in young people (aged 12–25 years) and commonly leads to difficulty achieving and maintaining vocational (education and/or employment) engagement. While current psychosocial interventions lead to improvements in psychopathology, they have little effect upon functioning. Individual Placement and Support (IPS) is a client-driven model that assists individuals with severe mental illness to engage with education and/or employment appropriate to their personal goals, and that provides ongoing support to maintain this engagement. The objective of the INdividual Vocational and Educational Support Trial (INVEST) is to evaluate the effectiveness of adding IPS to an evidence-based early intervention programme for BPD, with the aim of improving vocational outcomes.

          Methods/design

          INVEST is a single-blind, parallel-groups, randomised controlled trial (RCT). The randomisation is stratified by gender and age and uses random permuted blocks. The interventions are 39 weeks of either IPS, or ‘usual vocational services’ (UVS). Participants will comprise 108 help-seeking young people (aged 15–25 years) with three or more DSM-5 BPD features and a desire to study or work, recruited from the Helping Young People Early (HYPE) early intervention programme for BPD at Orygen, in Melbourne, Australia. All participants will receive the HYPE intervention. After baseline assessment, staff who are blind to the intervention group allocation will conduct assessments at 13, 26, 39 and 52 weeks. At the 52-week primary endpoint, the primary outcome is the number of days in mainstream education/employment since baseline. Secondary outcomes include the cost-effectiveness of the intervention, quality of life, and BPD severity.

          Discussion

          Current treatments for BPD have little impact on vocational outcomes and enduring functional impairment is prevalent among this patient group. IPS is a targeted functional intervention, which has proven effective in improving vocational outcomes for adults and young people with psychotic disorders. This trial will investigate whether IPS is effective for improving vocational (employment and educational) outcomes among young people with subthreshold or full-syndrome BPD.

          Trial registration

          Australian New Zealand Clinical Trials Registry, ID: ACTRN12619001220156. 13 September 2019.

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          Most cited references43

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          The age of adolescence

          Adolescence is the phase of life stretching between childhood and adulthood, and its definition has long posed a conundrum. Adolescence encompasses elements of biological growth and major social role transitions, both of which have changed in the past century. Earlier puberty has accelerated the onset of adolescence in nearly all populations, while understanding of continued growth has lifted its endpoint age well into the 20s. In parallel, delayed timing of role transitions, including completion of education, marriage, and parenthood, continue to shift popular perceptions of when adulthood begins. Arguably, the transition period from childhood to adulthood now occupies a greater portion of the life course than ever before at a time when unprecedented social forces, including marketing and digital media, are affecting health and wellbeing across these years. An expanded and more inclusive definition of adolescence is essential for developmentally appropriate framing of laws, social policies, and service systems. Rather than age 10-19 years, a definition of 10-24 years corresponds more closely to adolescent growth and popular understandings of this life phase and would facilitate extended investments across a broader range of settings.
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            Importance of investing in adolescence from a developmental science perspective

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              The short version of the Borderline Symptom List (BSL-23): development and initial data on psychometric properties.

              The full version of the Borderline Symptom List (BSL; for clarification now labeled BSL-95) is a self-rating instrument for specific assessment of borderline-typical symptomatology. The BSL-95 items are based on criteria of the DSM-IV, the revised version of the Diagnostic Interview for Borderline Personality Disorder, and the opinions of both clinical experts and borderline patients. The BSL-95 includes 95 items. In order to reduce patient burden and assessment time, a short version with 23 items (BSL-23) was developed. The development of the BSL-23 was based on a sample of 379 borderline patients, considering the items from the BSL-95 that had the highest levels of sensitivity to change and the highest ability to discriminate borderline patients from other patient groups. In a second step, the psychometric properties of the BSL-23 were investigated and compared with the psychometric properties of the BSL-95 in 5 different samples, including a total of 659 borderline patients. In all of the samples, a high correlation of the sum score was found between the BSL-23 and the BSL-95 (range: 0.958-0.963). The internal consistency was high for both versions (BSL-23/Cronbach's alpha: 0.935-0.969; BSL-95/Cronbach's alpha: 0.977-0.978). Both BSL-23 and BSL-95 clearly discriminated borderline personality disorder patients from patients with an axis I diagnosis (mean effect sizes were 1.13 and 0.96 for the BSL-23 and BSL-95, respectively). In addition, comparisons before and after 3 months of dialectical behavior therapy revealed a numerically larger effect size for the BSL-23 (d = 0.47) compared to the BSL-95 (d = 0.38). The results indicate that the BSL-23 is an efficient and convenient self-rating instrument that displays good psychometric properties comparable to those of the BSL-95. The BSL-23 also demonstrated sensitivity to the effects of therapy. (c) 2008 S. Karger AG, Basel.
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                Author and article information

                Contributors
                andrew.chanen@orygen.org.au
                Journal
                Trials
                Trials
                Trials
                BioMed Central (London )
                1745-6215
                26 June 2020
                26 June 2020
                2020
                : 21
                : 583
                Affiliations
                [1 ]GRID grid.488501.0, Orygen, ; 35 Poplar Road, Parkville, Melbourne, VIC 3052 Australia
                [2 ]GRID grid.1008.9, ISNI 0000 0001 2179 088X, Centre for Youth Mental Health, , The University of Melbourne, ; 35 Poplar Road, Parkville, Melbourne, VIC 3052 Australia
                [3 ]IPS Employment Center, Rockville Institute and Westat Inc., 85 Mechanic Street, Suite C3-1, Box 4A, Lebanon, NH 03766 USA
                [4 ]GRID grid.1021.2, ISNI 0000 0001 0526 7079, Deakin Health Economics, Centre for Population Health Research, , Deakin University, ; Geelong, VIC 3220 Australia
                [5 ]GRID grid.1008.9, ISNI 0000 0001 2179 088X, Melbourne School of Psychological Sciences, Redmond Barry Building, , The University of Melbourne, ; Parkville, Melbourne, VIC 3010 Australia
                [6 ]Travancore School, 35 Poplar Road, Parkville, Melbourne, VIC 3052 Australia
                Author information
                http://orcid.org/0000-0003-4468-622X
                Article
                4471
                10.1186/s13063-020-04471-3
                7320570
                32591007
                211b010a-ac0c-47ac-931f-62e4ae1759c4
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 22 April 2020
                : 30 May 2020
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100000925, National Health and Medical Research Council;
                Award ID: APP1144022
                Categories
                Study Protocol
                Custom metadata
                © The Author(s) 2020

                Medicine
                individual placement and support,borderline personality disorder,youth,early intervention,adolescents,young adults,education,employment

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