Engagement intervention versus treatment as usual for young adults with serious mental illness: a randomized pilot trial
Engagement intervention versus treatment as usual for young adults with serious mental illness: a randomized pilot trial
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DOI：
10.1186/s40814-020-00650-w
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发表时间：
2020-01-01
影响因子：
1.7
通讯作者：
Amaro, Angel
中科院分区：
文献类型：
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作者：
Munson, Michelle R.;Jaccard, James J.;Amaro, Angel
背景年轻人精神健康障碍的发病率较高，但他们往往得不到持续的护理。继续吸引年轻人参与的挑战在世界范围内普遍存在。很少有针对患有严重精神疾病的年轻人设计的参与干预措施。 Just Do You 是一种理论上指导的参与干预。它使用创新方式（即技术、表现性艺术活动、叙事表达、指导）让参与者参与有关服务及其工作方式的对话，同时引导他们接受治疗。方法/设计这项试点和可行性研究采用混合研究设计，在实施的同时检查可行性、可接受性和初步影响。该研究结合了定性方法、小型试点随机试验和小型成本效益分析。受访者是初次接触个性化康复服务 (PROS) 计划的诊所工作人员和年轻人。定量调查数据在基线、两周（干预后）、1 个月和 3 个月收集。评估的重点是衡量可行性、可接受性、参与度和心理健康结果。医疗记录提取将用于对自我报告数据进行三角测量。我们将进行单自由度对比，以检查“Just Do You”相对于“照常治疗”是否会改善结果，对每个结果指标使用稳健回归。我们将使用类似的对比策略来检查所提出的中介变量的变化是否发生在各组之间。此外，我们将使用结构方程模型来检查中介对最终结果的贡献。最后，我们将使用不断的比较编码技术进行定性分析。讨论本研究的目的是通过密集的初步试点试验来检验年轻人参与元干预的可行性，并通过与利益相关者的合作进行学习。 “Just Do You”有望填补针对患有严重精神疾病的年轻人的服务体系的空白，改善看似棘手的脱离问题。该计划采用文化响应策略，以恢复为导向，并以迄今为止最好的证据为基础。我们的努力与地方和国家医疗保健改革努力相一致，让有生活经验的人融入其中。试验注册该试验于 2018 年 4 月 18 日在 ClinicalTrials.gov（标识符：NCT03423212）注册，作为协议记录 R34 MH111861-01，纽约大学，作为针对患有严重精神疾病的年轻人的 Just Do You 计划
BackgroundYoung adults have elevated rates of mental health disorders, yet they often do not receive consistent care. The challenge of continuing to engage young adults has been pervasive worldwide. Few engagement interventions have been designed for young adults with serious mental illness. Just Do You is a theoretically guided engagement intervention. It uses innovative modalities (i.e., technology, expressive arts activities, narrative expression, mentoring) to engage participants in conversations about services and how they work, while simultaneously orienting them to treatment.Methods/designThis pilot and feasibility study utilizes a hybrid research design, examining feasibility, acceptability, and preliminary impact, alongside implementation. The study combines qualitative methods, a small pilot randomized trial, and a small cost-benefit analysis. Respondents are clinic staff and young adults who have made initial contact with the Personalized Recovery Oriented Services (PROS) program. Quantitative survey data are collected at baseline, 2weeks (post-intervention), 1month, and 3months. The assessments focus on measuring feasibility, acceptability, engagement, and mental health outcomes. Medical record extraction will be used to triangulate self-report data. We will conduct single degree of freedom contrasts to examine whether Just Do You leads to improved outcomes relative to Treatment-As-Usual using robust regression for each outcome measure. We will examine whether changes in the proposed mediating variables occur across groups using a similar contrast strategy. In addition, we will use structural equation modeling to examine the contribution of mediators to ultimate outcomes. Finally, we will use constant comparison coding techniques for qualitative analyses.DiscussionThe aim of this study is to examine the feasibility of a young adult engagement meta-intervention through an intensive preliminary pilot trial, learning through collaboration with stakeholders. Just Do You has the potential to fill a gap in the service system for young adults with serious mental illnesses, improving the seemingly intractable problem of disengagement. The program uses culturally responsive strategies, is recovery-oriented, and builds upon the best evidence to date. Our efforts align with local and national health care reform efforts embedding people with lived experience.Trial registrationThis trial was registered with ClinicalTrials.gov (Identifier: NCT03423212) on April 18, 2018, as Protocol Record R34 MH111861-01, New York University, as the Just Do You Program for Young Adults with Serious Mental Illness