The STIRR Intervention for Dually Diagnosed Clients

针对双重诊断客户的 STIRR 干预

• 批准号: 6892531
• 负责人: STANLEY D ROSENBERG
• 金额: $ 60.13万
• 依托单位: DARTMOUTH COLLEGE
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-04-01 至 2008-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6892531
• 关键词: AIDS education /prevention; HIV infections; behavioral /social science research tag; clinical research; clinical trials; communicable disease control; community mental health services; comorbidity; health care cost /financing; health care service evaluation; health disparity; health services research tag; hepatitis B; hepatitis B virus group; hepatitis C; hepatitis C virus; high risk behavior /lifestyle; human immunodeficiency virus; human subject; longitudinal human study; medically underserved population; mental disorders; patient oriented research; substance abuse related disorder; urban poverty area

DESCRIPTION (provided by applicant): People with severe mental illness and co-occurring substance abuse disorder are at extremely high risk for HIV, hepatitis B, and hepatitis C. An estimated 1/2 of these dually diagnosed clients test positive for at least one infection, and co-infection, which complicates course and treatment of infection, is also high. Approximately 2/3rds of dually diagnosed clients with HIV are likely to be infected with HCV. Best-practice interventions for blood-borne infections, including screening, testing, immunizing, counseling, and referring to medical specialists could be life-saving for these clients, but they generally do not receive these services. We have developed and pilot tested a brief intervention (STIRR) to provide common basic preventive measures for blood-borne infections to patients with severe mental illness and substance use disorders. Community mental health systems, where clients are most reliably engaged, are not adequately providing these recommended services. The STIRR intervention is based on integrating mental health and other medical care through a public health approach, delivered by nursing and medical specialists, at the site of mental health care. We propose a randomized clinical trial to test STIRR against the usual service model, in which mental health practitioners refer patients directly to other medical providers off site. The proposed RCT will be conducted with an ethnically diverse, inner city sample of low-income clients receiving community based mental health care at two sites in Baltimore, MD, an area of high infection prevalence. Pilot data support the hypothesis that the intervention will prove feasible in typical community mental health settings serving high-risk clients. We hypothesize that clients who receive STIRR, compared to clients receiving treatment as usual, will be more likely to receive screening, testing, immunization, counseling for risk reduction, and appropriate medical care.

描述（由申请人提供）：患有严重的精神疾病和同时发生的药物滥用障碍的人患HIV，乙型肝炎和乙型肝炎的风险极高。估计有1/2的双重诊断患者对至少一种感染进行了阳性，并共同感染，这使感染的过程和治疗复杂化，这也很高。大约2/3诊断为艾滋病毒的患者可能会感染HCV。血液传播感染的最佳练习干预措施，包括筛查，测试，免疫，咨询和参考医学专家可能会为这些客户挽救生命，但通常不会获得这些服务。我们已经开发并试点测试了简短的干预措施（Stirr），为严重精神疾病和药物使用障碍患者提供了常见的基本预防措施。社区心理卫生系统，客户最可靠地参与其中，并未充分提供这些推荐的服务。 Strir干预基于护理和医疗专家在心理保健现场提供的公共卫生方法，通过公共卫生方法整合心理健康和其他医疗服务。我们提出了一项随机临床试验，以针对通常的服务模型进行测试，其中心理健康从业人员将患者直接推荐给现场其他医疗提供者。拟议的RCT将由低收入客户的种族多样化的内城样本进行，该样本在马里兰州巴尔的摩的两个地点接受社区心理保健，这是一个高感染率的领域。试点数据支持以下假设：干预措施在为高危客户的典型社区心理健康环境中被证明是可行的。我们假设，与像往常一样接受治疗的客户相比，接受Strir的客户更有可能接受筛查，测试，免疫，降低风险和适当的医疗服务。