Study protocol for a multi-level cross-sectional study on the equitable reach and implementation of coordinated specialty care for early psychosis.
Study protocol for a multi-level cross-sectional study on the equitable reach and implementation of coordinated specialty care for early psychosis.
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DOI：
10.1186/s43058-023-00476-6
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发表时间：
2023-08-08
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在美国，每年大约有115，000名年轻人将经历他们的第一次精神病发作（FEP）。早期精神病的协调专科护理（CSC）是一种循证早期干预模式，通过改善生活质量和减少许多人的精神症状，已证明有效性。在过去的十年里，美国各地CSC项目的实施显着增加。然而，先前的研究表明，个人及其家庭成员难以获得CSC。研究还表明，CSC计划经常报告其计划对服务不足的人群和社区的覆盖范围有限（例如，少数民族、农村和社会经济地位低下的社区）。需要进行传播和执行研究，重点是公平普及和执行社区支助服务，以解决个人一级的差距。拟议的研究将创建一个新的综合多级地理空间数据库的CSC计划在整个美国实施，将包括程序级数据（例如，地理编码的位置、容量、设置、角色可用性），提供者级数据（种族、民族、专业证书），以及街区级普查数据（例如，居住隔离、种族密度、地区剥夺、城乡连续、公共交通时间）。该数据库将用于描述CSC计划的地理位置变化，并检查CSC计划对特定社区的整体影响。定量数据将与来自国家管理人员、提供商和服务用户的定性数据相结合，这些数据将为开发交互式仪表板等传播工具提供信息，以帮助决策。这项研究的结果将突出外部环境的决定因素对实施和精神卫生服务的影响，并将有助于告知未来实施的CSC计划的主要重点是公平。
Approximately 115,000 young adults will experience their first episode of psychosis (FEP) each year in the USA. Coordinated specialty care (CSC) for early psychosis is an evidence-based early intervention model that has demonstrated effectiveness by improving quality of life and reducing psychiatric symptoms for many individuals. Over the last decade, there has significant increase in the implementation of CSC programs throughout the USA. However, prior research has revealed difficulties among individuals and their family members accessing CSC. Research has also shown that CSC programs often report the limited reach of their program to underserved populations and communities (e.g., ethnoracial minorities, rural and low socioeconomic neighborhoods). Dissemination and implementation research focused on the equitable reach and implementation of CSC is needed to address disparities at the individual level. The proposed study will create a novel integrative multi-level geospatial database of CSC programs implemented throughout the USA that will include program-level data (e.g., geocoded location, capacity, setting, role availability), provider-level data (race, ethnicity, professional credentials), and neighborhood-level census data (e.g., residential segregation, ethnic density, area deprivation, rural-urban continua, public transit time). This database will be used to characterize variations in CSC programs by geographical location and examine the overall reach CSC programs to specific communities. The quantitative data will be combined with qualitative data from state administrators, providers, and service users that will inform the development of dissemination tools, such as an interactive dashboard, that can aid decision making. Findings from this study will highlight the impact of outer contextual determinants on implementation and reach of mental health services, and will serve to inform the future implementation of CSC programs with a primary focus on equity.