Adapting Coordinated Specialty Care in the Post COVID-19 Era

协调专业护理（CSC）项目为患有自闭症的年轻人提供循证服务

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.