Adapting Coordinated Specialty Care in the Post COVID-19 Era

协调专科护理（CSC）计划为年轻人提供循证服务， 近期出现精神紊乱纽约州的项目OnTrackNY是全国公认的典范 CSC治疗。OnTrackNY提供协调的、基于团队的服务，并已证明 症状、功能、住院治疗和工作/学校参与的改善。的迅速崛起 COVID-19对医疗保健系统造成了冲击，在行为上产生了许多迅速的变化， 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。是 不清楚这些变化将如何影响精神病护理的需求和提供以及客户结果。 OnTrack Central是一个中介组织，负责培训和实施 OnTrackNY计划，创建了多层次的利益相关者参与系统，集中的数据 质量改进和程序保真度评估的收集协议，以及支持 基于实践的研究。我们对OnTrackNY网络的日常参与揭示了最近的变化 对CSC服务产生了巨大影响。 2019年，OnTrackNY被授予早期精神病干预网络（EPINET）的中心， 建立学习型医疗保健系统（LHS）。OnTrackNY站点的广度加上OnTrack Central 监督提供了一个机会，以检查新冠肺炎危机在纽约州的影响。的 遍布全州的23个OnTrackNY团队的多样性使得能够检查具有高 以及COVID-19感染的低流行率和多样化的监管和劳动力环境。的 OnTrackNY网络包括在可变法规范围内运营的计划（社区门诊诊所 城市、郊区和农村的政府机构、国营机构以及社区和学术医院 参与者群体非常多样化。 本项目将研究OnTrackNY LHS内服务交付修改的影响 在COVID-19危机期间和之后。我们将使用实施科学框架， 报告适应和修改-增强（FRAME），以系统地评估所做的修改 并确定其影响。我们将利用综合的混合方法，包括定性访谈和重点 与利益攸关方（客户、家庭、提供者以及州和地方各级的决策者）的团体， OnTrackNY项目数据分析该项目旨在评估：1）政府和 机构层面的政策变化以及这些决定如何影响团队人员配置和运作; 2）对 CSC服务的提供;以及3）对客户层面护理流程的影响（例如服务的利用），以及 结果。其目标是制定一个符合商业标准的CSC模型适应指南， 与一致的参与、服务利用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.