Peer-Delivered and Technology-Assisted Integrated Illness Management and Recovery

项目总结 患有严重精神疾病(SMI)的成年人不成比例地受到医学共病的影响，发病较早 与普通人群相比，预期寿命减少了10至25岁。这些高比率 发病率和早期死亡率与管理不善的医疗和精神疾病有关。我们的 系统审查发现了九种有效的自我管理干预措施，分别针对医疗和精神疾病 患有SMI的成年人的疾病。然而，由于这两个原因，这些干预措施的采用有限 供应商和消费者为基础的因素。基于供应商的障碍包括缺乏足够的劳动力 具备为患有SMI的成年人提供有效的自我管理支持的能力、时间和知识 以及慢性健康状况。基于消费者的障碍与有限的自我参与相关 管理计划包括缺乏访问、参与和持续的基于社区的支持 患有SMI的人。同伴支持专家有潜力解决这些障碍，因为它们构成了一个障碍 在增长最快的精神卫生工作人员中，有自我管理的“亲身经历” 实践，并提供获得社区支持的途径。然而，需要解决的挑战是让同行 成为循证干预的有效提供者。例如，对等点经常接受培训以提供 “同伴支持”被描述为“给予和接受建立在尊重、共享的关键原则上的帮助” 责任，以及对什么是有帮助的相互同意“。同行支持与更多的 控制感，做出改变的能力，以及精神症状的减少。尽管有好处，但同行支持 不坚持以证据为基础的精神和医疗自我管理做法，也不遵循 确保保真度和系统监测结果的协议。我们假设移动技术已经 通过提供忠诚度追随者的实时指导来克服同行支持的这些限制的潜力 提供同行提供的、技术辅助的循证自我管理干预(PDTA-IIMR)。 这个K01奖项的目的是建立必要的专业知识，以追求职业发展和测试 同行提供的循证自我管理干预的新方法。培训将包括： 制定同行提供的干预措施；开发和设计由移动保健支持的 干预措施；干预性临床试验研究。同时，我建议完善干预方案 然后，我将通过以用户为中心的设计来增强该协议；以及 最后，我将对PDTA-IIMR的可行性和潜在有效性进行初步的比较研究 为N=6名同伴和N=40名患有SMI和慢性健康问题的成年人提供常规同伴支持。结果 包括可行性、医学和精神科自我管理技能和功能能力。我们将探索 死亡危险因素，并检查自我效能和社会支持作为影响结果的机制。

PROJECT SUMMARY Adults with serious mental illness (SMI) are disproportionately affected by medical comorbidity, earlier onset of disease, and 10 to 25 years reduced life expectancy compared to the general population. These high rates of morbidity and early mortality are associated with inadequately managed medical and psychiatric illnesses. Our systematic review found nine effective self-management interventions that address medical and psychiatric illnesses in adults with SMI. However, there has been limited adoption of these interventions due to both provider and consumer-based factors. Provider-based barriers consist of the lack of an adequate workforce with the capacity, time, and knowledge of effective approaches to self-management support for adults with SMI and chronic health conditions. Consumer-based barriers associated with limited participation in self- management programs include lack of access, engagement, and ongoing community-based support for persons with SMI. Peer support specialists have the potential to address these barriers as they comprise one of the fastest growing sectors of the mental health workforce, have “lived experience” in self-management practices, and offer access to support in the community. However, challenges need to be resolved for peers to be effective providers of evidence-based interventions. For example, peers are frequently trained to provide “peer support” described as “giving and receiving help founded on key principles of respect, shared responsibility, and mutual agreement of what is helpful”. Peer support has been associated with increased sense of control, ability to make changes, and decreased psychiatric symptoms. Despite benefits, peer support does not adhere to evidence-based practices for psychiatric and medical self-management and does not follow protocols that ensure fidelity and systematically monitor outcomes. We hypothesize that mobile technology has the potential to overcome these limitations of peer support by providing real-time guidance in fidelity adherent delivery of a peer-delivered, technology-assisted evidence-based self-management intervention (PDTA-IIMR). The purpose of this K01 award is to build the necessary expertise to pursue a career developing and testing novel approaches to peer-delivered evidence-based self-management interventions. Training will include: development of peer-delivered interventions; development and design of mobile health-supported interventions; and intervention clinical trials research. Concurrently, I propose to refine the intervention protocol with input from peers and consumers; then, I will enhance this protocol through user-centered design; and lastly, I will conduct a pilot study evaluating the feasibility and potential effectiveness of PDTA-IIMR compared to routine peer support for N=6 peers and N=40 adults with SMI and chronic health conditions. Outcomes include feasibility, medical and psychiatric self-management skills, and functional ability. We will explore mortality risk factors and examine self-efficacy and social support as mechanisms on outcomes.