{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T19:16:53Z","timestamp":1790363813880,"version":"4.1.0"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T00:00:00Z","timestamp":1784592000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Digit. Health"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The uptake of Family Interventions for psychosis (FIp) in routine settings has been limited across high-, middle-, and low-income countries due to geographic, systemic, and socioeconomic barriers. Psychosis REACH is a FIp that addresses these barriers by using a direct-to-family model co-facilitated by licensed mental health practitioners with expertise in Cognitive Behavioral Therapy for psychosis and family members with lived experience. While prior delivery relied on in-person training, this approach does not adequately address structural access challenges. The aim of this investigation was to evaluate caregiver outcomes of a hybrid asynchronous-synchronous version of Psychosis REACH consisting of (a) an online course, (b) a live virtual skills workshop, and (c) follow-along skills coaching from a trained family peer (Psychosis REACH Family Ambassador; pRFA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>Psychosis REACH was delivered via a hybrid digital format to 275 caregivers of individuals with psychosis, the majority of whom were parents (61.2%). We evaluated feasibility, acceptability, and participant characteristics, along with outcomes including depression, anxiety, caregiver burden, expressed emotion, attitudes toward psychosis, and self-perceived CBT skillfulness at post-training and 4-month follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Both asynchronous and synchronous components were rated as highly feasible and acceptable. Nearly all participants completed the online course; 85% went on to complete the virtual workshop, of which 66.7% endorsed intention to follow-up with a pRFA. Participants demonstrated significant improvements across multiple domains, including reduced psychiatric symptoms, caregiver burden, stigmatizing attitudes, and expressed emotion, along with increased confidence in CBT-informed skills.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Findings suggest that this hybrid digital training is both acceptable and feasible, offering a promising approach for disseminating evidence-based family support in psychosis. Clinical and educational outcomes were comparable to in-person delivery, underscoring its potential to reduce access barriers for some caregivers. Future research should prioritize randomized trials and active engagement of diverse and underserved families.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fdgth.2026.1662969","type":"journal-article","created":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T05:35:52Z","timestamp":1784612152000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Evaluation of a hybrid asynchronous-synchronous delivery model for family intervention in psychosis: the psychosis REACH program"],"prefix":"10.3389","volume":"8","author":[{"given":"Sarah L.","family":"Kopelovich","sequence":"first","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine","place":["Seattle, WA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Blank","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine","place":["Seattle, WA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akansha","family":"Vaswani-Bye","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine","place":["Seattle, WA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria","family":"Shepard","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine","place":["Seattle, WA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen Teresa","family":"Buckland","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine","place":["Seattle, WA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kate","family":"Hardy","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine","place":["Palo Alto, CA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas","family":"Turkington","sequence":"additional","affiliation":[{"name":"Cumbria Northumberland Tyne and Wear NHS Foundation Trust","place":["Sunderland, Tyne and Wear, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,21]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"969","DOI":"10.1016\/S2215-0366(21)00243-1","article-title":"Psychosocial and psychological interventions for relapse prevention in schizophrenia: a systematic review and network meta-analysis","volume":"8","author":"Bighelli","year":"2021","journal-title":"Lancet Psychiatry"},{"key":"B2","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1016\/S2215-0366(21)00437-5","article-title":"Family interventions for relapse prevention in schizophrenia: a systematic review and network meta-analysis","volume":"9","author":"Rodolico","year":"2022","journal-title":"Lancet Psychiatry"},{"key":"B3","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1016\/J.SCHRES.2025.01.006","article-title":"Systematic review and meta-analysis of family-based interventions for early psychosis: carer and patient outcomes","volume":"276","author":"Gleeson","year":"2025","journal-title":"Schizophr Res"},{"key":"B4","year":"2017"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1254","DOI":"10.1176\/appi.ps.202000740","article-title":"Psychosis REACH: effects of a brief CBT-informed training for family and caregivers of individuals with psychosis","volume":"72","author":"Kopelovich","year":"2021","journal-title":"Psychiatr Serv"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1497749","DOI":"10.1080\/23311908.2018.1497749","article-title":"A training model for relatives and friends in cognitive behaviour therapy (CBT) informed care for psychosis","volume":"5","author":"Turkington","year":"2018","journal-title":"Cogent Psychol"},{"key":"B7","author":"Kopelovich","year":"2020","journal-title":"Psychosis REACH Family Ambassador Manual"},{"key":"B8","doi-asserted-by":"publisher","first-page":"233","DOI":"10.2147\/NDT.S432255","article-title":"A thematic analysis investigating the inaugural psychosis REACH family ambassador peer training program","volume":"20","author":"Vaswani-Bye","year":"2024","journal-title":"Neuropsychiatr Dis Treat"},{"key":"B9","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1111\/jrh.12229","article-title":"Task-sharing approaches to improve mental health care in rural and other low-resource settings: a systematic review","volume":"34","author":"Hoeft","year":"2018","journal-title":"J Rural Health"},{"key":"B10","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/978-3-319-30521-9","volume-title":"Brief Interventions for Psychosis: Overview and Future Directions","author":"Pradhan","year":"2016"},{"key":"B11","doi-asserted-by":"publisher","first-page":"12","DOI":"10.4103\/0253-7176.96149","article-title":"Expressed emotion in schizophrenia: an overview","volume":"34","author":"Amaresha","year":"2012","journal-title":"Indian J Psychol Med"},{"key":"B12","doi-asserted-by":"publisher","first-page":"81","DOI":"10.3102\/003465430298487","article-title":"The power of feedback","volume":"77","author":"Hattie","year":"2007","journal-title":"Rev Educ Res"},{"key":"B13","doi-asserted-by":"publisher","first-page":"280","DOI":"10.1177\/0963721411421922","article-title":"Deliberate practice: necessary but not sufficient","volume":"20","author":"Campitelli","year":"2011","journal-title":"Curr Dir Psychol Sci"},{"key":"B14","author":"Woodall","year":"2004"},{"key":"B15","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1002\/PFI.20018","article-title":"The present and future state of blended learning in workplace learning settings in the United States","volume":"47","author":"Kim","year":"2008","journal-title":"Perform Improv"},{"key":"B16","first-page":"247","article-title":"The present and future state of blended learning at workplace-learning settings in adult education: a systematic review","volume":"9","author":"Mubayrik","year":"2018","journal-title":"J Soc Stud Educ Res"},{"key":"B17","doi-asserted-by":"publisher","first-page":"e63743","DOI":"10.2196\/63743","article-title":"Digital health interventions for informal family caregivers of people with first-episode psychosis: systematic review on user experience and effectiveness","volume":"11","author":"M\u00fcnchenberg","year":"2024","journal-title":"JMIR Ment Health"},{"key":"B18","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1007\/s10488-010-0319-7","article-title":"Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda","volume":"38","author":"Proctor","year":"2011","journal-title":"Adm Policy Ment Health"},{"key":"B19","doi-asserted-by":"publisher","first-page":"100879","DOI":"10.1016\/J.IHEDUC.2022.100879","article-title":"Bichronous online learning: award-winning online instructor practices of blending asynchronous and synchronous online modalities","volume":"56","author":"Martin","year":"2023","journal-title":"Internet High Educ"},{"key":"B20","author":"Martin Florence","year":"2023"},{"key":"B21","author":"Henry","year":"2005"},{"key":"B22","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1016\/J.COMPPSYCH.2018.07.003","article-title":"The development and validation of the brief experience of caregiving inventory (BECI)","volume":"86","author":"O\u2019Driscoll","year":"2018","journal-title":"Compr Psychiatry"},{"key":"B23","volume-title":"Statistical Power Analysis for the Behavioral Sciences","author":"Cohen","year":"1988"},{"key":"B24","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1037\/prj0000515","article-title":"Measuring practitioner attitudes toward psychosis and recovery: exploratory factor analysis of the psychosis attitudes scale","volume":"45","author":"Kopelovich","year":"2022","journal-title":"Psychiatr Rehabil J"},{"key":"B25","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1111\/j.1600-0447.1983.tb09716.x","article-title":"The hospital anxiety and depression scale","volume":"67","author":"Zigmond","year":"1983","journal-title":"Acta Psychiatr Scand"},{"key":"B26","doi-asserted-by":"publisher","first-page":"552","DOI":"10.7334\/psicothema2016.383","article-title":"Non-normal data: is ANOVA still a valid option?","volume":"4","author":"Blanca","year":"2017","journal-title":"Psicothema"},{"key":"B27","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1016\/S0165-1781(97)00033-4","article-title":"The family attitude scale: reliability and validity of a new scale for measuring the emotional climate of families","volume":"70","author":"Kavanagh","year":"1997","journal-title":"Psychiatry Res"},{"key":"B28","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1177\/109830070200400204","article-title":"Parent education for families of children with autism living in geographically distant areas","volume":"4","author":"Koegel","year":"2002","journal-title":"J Posit Behav Interv"},{"key":"B29","doi-asserted-by":"publisher","first-page":"591","DOI":"10.1007\/S10597-015-9848-6","article-title":"Quality of life and social isolation among caregivers of adults with schizophrenia: policy and outcomes","volume":"51","author":"Hayes","year":"2015","journal-title":"Community Ment Health J"},{"key":"B30","doi-asserted-by":"publisher","first-page":"100205","DOI":"10.1016\/j.ssmmh.2023.100205","article-title":"Cycles of reform in the history of psychosis treatment in the United States","volume":"3","author":"George","year":"2023","journal-title":"SSM Ment Health"},{"key":"B31","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1080\/17522439.2021.1971744","article-title":"Preliminary point prevalence of cognitive behavioral therapy for psychosis (CBTp) training in the U. S. And Canada","volume":"14","author":"Kopelovich","year":"2022","journal-title":"Psychosis"},{"key":"B32","doi-asserted-by":"publisher","first-page":"633","DOI":"10.1016\/S0272-7358(99)00008-2","article-title":"A review of expressed emotion research in health care","volume":"20","author":"Wearden","year":"2000","journal-title":"Clin Psychol Rev"},{"key":"B33","doi-asserted-by":"publisher","first-page":"365","DOI":"10.1017\/S0033291721000209","article-title":"The predictive power of expressed emotion and its components in relapse of schizophrenia: a meta-analysis and meta-regression","volume":"51","author":"Ma","year":"2021","journal-title":"Psychol Med"},{"key":"B34","first-page":"916","article-title":"Evaluating response to a CBT for psychosis-informed caregiver training among families at variable durations of illness","volume":"21","author":"Stiles","year":"2025","journal-title":"Early Interv Psychiatry"}],"container-title":["Frontiers in Digital Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fdgth.2026.1662969\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T05:35:54Z","timestamp":1784612154000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fdgth.2026.1662969\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,21]]},"references-count":34,"alternative-id":["10.3389\/fdgth.2026.1662969"],"URL":"https:\/\/doi.org\/10.3389\/fdgth.2026.1662969","relation":{},"ISSN":["2673-253X"],"issn-type":[{"value":"2673-253X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,21]]},"article-number":"1662969"}}