Adapting Coordinated Specialty Care in the Post COVID-19 Era

协调专科护理(CSC)计划为患有以下疾病的年轻人提供循证服务 最近出现的一种精神障碍。纽约州的OnTrackNY项目是全国公认的模式 对CSC治疗的影响。OnTrackNY提供协调的、基于团队的服务，并展示了 在症状、功能、住院和工作/学校参与度方面有所改善。迅速崛起的 新冠肺炎对医疗保健系统造成了冲击，在行为上产生了无数迅速的变化 在缺乏证据或经验指导的情况下，提供保健服务，包括远程保健。它是 不清楚这些变化将如何影响对精神护理和患者结果的需求和提供。 OnTrack Central，一个负责培训和实施支持的中介组织 OnTrackNY计划，为多层次的利益相关者参与创建了系统，集中了数据 质量改进和程序保真度评估的收集协议，以及支持的机制 实践性研究。我们对OnTrackNY网络的日常参与揭示了最近的变化 正在极大地影响CSC服务。 2019年，OnTrackNY被授予早期精神病干预网络(EPINET)的枢纽 推进学习型卫生保健系统(LHS)。OnTrackNY网站的广度与OnTrack Central相结合 《监督》为审视纽约州新冠肺炎危机的影响提供了机会。这个 分布在全州的23支OnTrackNY团队的多样性使人们能够检查具有高 新冠肺炎感染率低，以及多样化的监管和劳动力环境。这个 OnTrackNY网络包括在可变法规范围内运行的计划(社区门诊 城市、郊区和农村的机构、国营机构以及社区和学术医院 地区)，参与人群非常多样化。 该项目将研究修改OnTrackNY LHS内的服务交付的影响 在新冠肺炎危机期间和之后。我们将使用实施科学框架，框架 报告改编和修改-增强(框架)以系统地评估所做的修改 并确定它们的影响。我们将使用综合的混合方法，包括定性访谈和焦点 与利益攸关方(州和地方各级的客户、家庭、提供者和决策者)和 对OnTrackNY计划数据的分析该项目旨在评估：1)政府和 机构一级的政策变化以及这些决定如何影响团队的人员配置和运作；2)对 CSC服务的提供；以及3)对客户级护理流程的影响(例如，服务的利用)和 结果。目标是制定一份CSC模型适应指南，该指南将与保真度保持一致，并 与一致的参与度、服务利用率或良好的护理结果相关。

Coordinated Specialty Care (CSC) programs provide evidence-based services for young people with recent onset of a psychotic disorder. New York State's program, OnTrackNY is a nationally recognized model of CSC treatment. OnTrackNY provides coordinated, team-based services and has demonstrated improvements in symptoms, functioning, hospitalization, and work/school participation. The rapid rise of COVID-19 has created shocks to the health care system, producing numerous rapid changes in behavioral health service delivery, including telehealth, in the absence of guidance from evidence or experience. It is unclear how these changes will impact the need for and delivery of psychiatric care and client outcomes. OnTrack Central, an intermediary organization responsible for training and implementation support of OnTrackNY programs, has created systems for multi-level stakeholder engagement, a centralized data collection protocol for quality improvement and evaluation of program fidelity, and a mechanism to support practice based-research. Our daily engagement of the OnTrackNY network has revealed how recent changes are dramatically impacting CSC services. In 2019, OnTrackNY was awarded a hub within the Early Psychosis Intervention Network (EPINET) to advance a learning health care system (LHS). The breadth of OnTrackNY sites coupled with OnTrack Central oversight provides an opportunity to examine the impacts of the COVID-19 crisis in New York State. The diversity of the 23 OnTrackNY teams located throughout the state enables examination of settings with high and low prevalence of COVID-19 infections and diverse regulatory and workforce environments. The OnTrackNY network includes programs that operate within variable regulations (outpatient clinics at community agencies, state-operated facilities, and community and academic hospitals in urban, suburban, and rural areas) with very diverse participant populations. This project will examine the implications of modifications to service delivery within the OnTrackNY LHS during and after the COVID-19 crisis. We will use the implementation science framework, Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) to systematically evaluate modifications made and ascertain their impact. We will utilize integrative mixed methods, including qualitative interviews and focus groups with stakeholders (clients, families, providers and decision makers at the state and local levels) and analysis of OnTrackNY program data The project aims to assess: 1) the implications of governmental and agency level policy changes and how these decisions impact team staffing and functioning; 2) implications for delivery of CSC services; and 3) impact on client-level care processes (e.g. utilization of services) and outcomes. The goal is to develop a CSC Model Adaptation Guide that will be fidelity-consistent, and associated with consistent engagement, service utilization or favorable outcomes of care.