StepWell: Stepped Care Mental Health and Substance Use Telehealth Services for COVID-19 Affected Patients

StepWell：为受 COVID-19 影响的患者提供阶梯式护理心理健康和药物使用远程医疗服务

• 批准号: 10198125
• 负责人: Maria A Oquendo
• 金额: $ 41.16万
• 依托单位: NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-05-01 至 2022-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10198125
• 关键词: 2019-nCoV; Address; Affect; Africa South of the Sahara; Alcohol or Other Drugs use; Anxiety; COVID-19; COVID-19 pandemic; Caring; Categories; Cessation of life; Clinic; Cohort Studies; Complex; Coupling; Data; Development; Diagnostic; Disease; Disease Outbreaks; Ecological momentary assessment; Economics; Evidence based treatment; Family; Family member; Health; Health Personnel; Health Services Accessibility; Health system; Healthcare; Healthcare Systems; Hospitals; Household and Family; Human; Medical; Mental Depression; Mental Health; Mental Health Services; Methods; Modeling; Monitor; New York; New York City; Outcome; Patient Preferences; Patient Triage; Patients; Preparation; Presbyterian Church; Primary Health Care; Provider; Proxy; Psyche structure; Psychiatric therapeutic procedure; Qualitative Methods; Research; Research Support; Resources; Safety; Services; Social isolation; Specificity; Substance Use Disorder; Substance abuse problem; Survivors; Technology; Testing; Time; Training; Triage; Work; behavioral health; care delivery; care systems; cohort; collaborative care; coronavirus disease; cost effective; design; emotional abuse; ethnic minority population; health disparity; implementation science; implementation strategy; novel strategies; pandemic disease; parent grant; patient engagement; patient screening; preference; primary care setting; provider-level barriers; psychoeducation; psychologic; racial and ethnic; scale up; screening; shared decision making; social; social determinants; system-level barriers; telehealth; tool; treatment effect; trend

Social isolation, economic insecurity, and rapid increases in numbers of COVID-19 cases and deaths are resulting in alarming rates of mental health and substance use disorders. Furthermore, existing social, health, and mental health (MH) disparities among racial/ethnic minorities have exacerbated . MH care systems and collaborative care systems, which integrate MH into primary care settings, have been hard pressed to provide psychiatric care to new patients with MH and substance use (SU) disorders (MHSUDs) arising from the pandemic – including patients recovered/ recovering from COVID-19 (“COVID survivors”) and their families. The necessity of using telehealth strategies to protect patients and providers has posed additional challenges for MH/SU care systems. Although telehealth may increase patient engagement, no research has identified optimal, resource- efficient strategies for its use in MHSUD screening and care delivery. Thus, a novel approach that meets both the demand and the safety challenges of the COVID-19 era is required to address the burgeoning COVID-related MHSUD care needs. Coupling a stepped-care strategy with automated triage, psychoeducation, and shared decision-making can not only address capacity and system-level barriers, but also potentiate treatment effects and address patient/provider-level barriers to engagement. To meet the critical MH challenges presented by the COVID-19 pandemic, the proposed supplement research will adapt and apply a technology developed in the parent grant, the Electronic Mental Wellness Tool (EmwT), that guides providers in screening patients for any MHSUDs using 3 validated items with high sensitivity and then, using another 9 validated items, triages patients to specific evidence-based treatments according to diagnostic categories with good specificity. The initial 3 items also can detect, by proxy and with high sensitivity, any MHSUDs among relatives. We will extend this work to develop and implement StepWell, a telehealth stepped-care approach to MHSUD treatment that integrates the EmwT with an electronic patient-facing depression and anxiety care shared decision-making tool in use at New York Presbyterian Hospital (NYPH). In a new cohort of 1,000 recently discharged COVID patients being followed by NYPH for one year, we will test the feasibility of using StepWell to identify MHSUD problems among COVID survivors and their families and address their MHSUD treatment needs while monitoring MH outcomes for 1 year. We will use human-centered design principles to integrate the eSDM (patient preference) and EmwT (assessment and treatment) technologies to develop StepWell. In a mixed-methods pilot test, we will examine feasibility, acceptability, and factors influencing StepWell implementation in preparation for a larger implementation science R01 proposal. This project addresses calls to monitor and address the MH impact of COVID-19 infected and affected patients, while expanding the ability of the health systems to address the existing treatment gap to provide a sustainable, generalizable MH services solution beyond the COVID-19 crisis.

社会孤立、经济不安全以及COVID-19病例和死亡人数的迅速增加令人担忧

项目成果

Implementation Planning for Integrating Depression Screening in Diabetes Mellitus and HIV Clinics in Botswana.

博茨瓦纳糖尿病和艾滋病毒诊所整合抑郁症筛查的实施计划。

• DOI: 10.1007/978-3-319-91376-6_62
• 发表时间: 2022
• 期刊: Global implementation research and applications
• 作者: Molebatsi K

Editorial Perspective: Reaching beyond the clinic: leveraging implementation science to improve access to child and adolescent mental health services.

编辑观点：超越临床：利用实施科学改善儿童和青少年心理健康服务的获取。

• DOI: 10.1111/jcpp.13017
• 发表时间: 2019
• 期刊: Journal of child psychology and psychiatry, and allied disciplines
• 作者: Scorza,Pamela;Duarte,Cristiane;Lovero,Kathryn;Carlson,Catherine;Mootz,Jennifer;Johnson,Karen;Wainberg,Milton
• 通讯作者: Wainberg,Milton

Excess mortality associated with mental illness in people living with HIV in Cape Town, South Africa: a cohort study using linked electronic health records.

• DOI: 10.1016/s2214-109x(20)30279-5
• 发表时间: 2020-10
• 期刊: The Lancet. Global health
• 作者: Haas AD;Ruffieux Y;van den Heuvel LL;Lund C;Boulle A;Euvrard J;Orrell C;Prozesky HW;Tiffin N;Lovero KL;Tlali M;Davies MA;Wainberg ML;IeDEA Southern Africa collaboration
• 通讯作者: IeDEA Southern Africa collaboration

Opportunities for Improving Access to Evidence-Based Treatments of Depression.

改善抑郁症循证治疗的机会。

• DOI: 10.1176/appi.ajp.2019.19010098
• 发表时间: 2019
• 期刊: The American journal of psychiatry
• 作者: Weissman,MyrnaM;Wainberg,MiltonL;Olfson,Mark
• 通讯作者: Olfson,Mark