Assisted Identification and Navigation of Early Mental Health Symptoms in Children

摘要 约55%有严重心理健康困难的儿童接受治疗，高达80%的儿童接受治疗 有亚临床症状的患者不接受治疗。治疗通常不会开始，直到问题明显 影响到孩子和家庭。本研究的目的是在两个非学术领域进行一项实用型随机试验 卫生保健系统测试精神健康家庭导航器模式，以促进及早获得、参与、 以及协调为儿童提供所需的心理健康服务。研究的第一项任务将集中在 实施预测模型来识别无心理健康诊断的有症状儿童 精神障碍(S)或启动治疗。该工具通过记录精神健康症状来识别患者 或在最近的初级保健或紧急护理访问的进展说明的免费文本中的投诉。使用这个 预测算法，我们将进行一项务实的随机试验，比较干预和常规护理组 患者来自Kaiser Permanente(KP)华盛顿州和KP North California。这次试行将招收200人 每臂病例数(n=400)。有(1)新的精神健康诊断但没有开始治疗的儿童；(2)新的 在没有精神健康诊断的情况下订购精神健康药物；以及(3)由 未启动新的心理健康诊断或治疗的预测模型将被招募。这项研究 干预将由一名心理健康导航员(社会工作者)为家庭提供6个月的支持。这个 导航员将与家人一起进行关于精神健康服务的初步需求和障碍评估， 围绕精神卫生保健进行持续的激励性访谈，提供最多4次心理治疗 (在适当的时候)通过诊所到家庭的视频访问，帮助家人找到并安排适当的心理 社区中的健康提供者，并在精神健康预约或药物补充情况下临时联系 打偏了。主要结果是年轻人开始心理治疗的百分比。次要结果是 至少去过4次心理健康检查的青年所占比例。我们假设干预臂将会有 与对照组相比，心理治疗的使用率更高。我们还将评估精神药物的启动 药物。所有的初步分析都将遵循意向治疗方法。将获得放弃同意，以 在分析中包括提供干预的所有个人的数据，而不考虑干预量 (导航的“剂量”)收到。

ABSTRACT About 55% of children with significant mental health difficulties receive treatment and up to 80% of children with sub-clinical symptoms receive no treatment. Treatments are often not initiated until issues are significantly impacting the child and family. This study aims to conduct a pragmatic randomized trial in two non-academic health care systems to test a mental health family navigator model to promote early access to, engagement in, and coordination of needed mental health services for children. The first task of the study will focus on the implementation of a predictive model to identify symptomatic children with no diagnosed mental health disorder(s) or treatments initiated. The tool identifies patients with documentation of mental health symptoms or complaints in the free text of a progress note from a recent primary care or urgent care visit. Using this predictive algorithm, we will conduct a pragmatic randomized trial comparing intervention and usual care arm patients enrolled from Kaiser Permanente (KP) Washington and KP Northern California. The trial will enroll 200 patients per arm (n=400). Children with (1) a new mental health diagnosis but no treatment initiated; (2) a new mental health medication ordered with no mental health diagnosis; and (3) symptoms identified by the predictive model with no new mental health diagnosis or treatment initiated will be recruited. The study intervention will offer 6 months of support to the family by a mental health navigator (social worker). The navigator will perform an initial needs and barriers assessment with the family around mental health services, conduct ongoing motivational interviewing around mental health care, provide up to 4 psychotherapy sessions (when appropriate) via clinic-to-home video visits, help the family find and schedule with appropriate mental health providers in the community, and reach out ad hoc if mental health appointments or medication refills are missed. The primary outcome is the percentage of youth initiating psychotherapy. The secondary outcome is the percentage of youth with at least 4 mental health visits. We hypothesize that the intervention arm will have higher rates of psychotherapy use compared to the control arm. We will also assess initiation of psychotropic medications. All primary analyses will follow an intent-to-treat approach. A waiver of consent will be obtained to include data for all individuals offered the intervention in the analysis, regardless of the amount of intervention (“dose” of navigation) received.