A Trial of "Opening Doors to Recovery" for Persons with Serious Mental Illnesses

描述（由申请人提供）：许多患有严重精神疾病（SMI）和精神病院住院史的人正在与机构再犯的循环（反复住院，监禁和无家可归）和缺乏个人康复作斗争。这些问题部分是由支离破碎、难以获得的社区服务造成的；可在住院后成为社区支持伙伴的未参与的当地利益攸关方；与警方频繁接触，精神卫生部门与警方沟通不畅；以及有限的恢复支持。对许多人来说，现代康复概念的承诺仍然是一个未实现的承诺。开发“打开康复之门”模式是为了帮助这些人减少机构再犯并参与康复。它通过为参与者提供由三名社区导航专家（CNSs）组成的团队的社区支持来实现这一目标：一名有执照的社会工作者（“专业CNS”），一名有生活经验的同伴专家（“同伴CNS”），以及一名重度精神障碍患者的家庭成员，该家庭成员曾经历过重度精神障碍给家庭成员带来的压力，以及一个复杂、分散的精神卫生系统（“家庭CNS”）。该团队提供社区导航（所有可用社区资源的映射），并嵌入到本地社区中。他们还提供持续的康复支持，重点是：(1)确保充分的治疗，(2)维护安全的住房，(3)制定有意义的一天，(4)利用技术支持康复。ODR的至少另外两个特点使其有别于其他社区服务：一组协作的地方伙伴致力于支持ODR和中央服务中心的工作，以及一个与警方的新型联系系统，使中央服务中心能够在其客户遇到当地执法部门时立即作出反应。ODR的所有这些组成部分共同努力，减少机构再犯并促进康复。通过一项涉及100名参与者的大型试点/示范项目，我们已经证明了各方面的可行性，彻底建立了不同利益相关者的可接受性，并在减少住院时间和促进康复方面显示出令人鼓舞的效果。ODR现在已经准备好进行更明确的随机对照试验，研究小组非常适合并经验丰富地进行这样的试验。我们将240名重度精神障碍患者和过去6个月内住院史为150次的患者随机分配到ODR （n=120，随访12个月，最多40例CNS病例）和现有社区支持团队（CST）模型（n=120）。评估将在基线（出院时）以及4、8、12和18个月时进行。我们的假设集中在ODR参与者有更少的住院天数，更少的逮捕，更好的住房结果和更大的恢复，后者用一系列不同的恢复措施来衡量（例如，社区适应，心理健康恢复，社区导航能力，有意义的日常活动，希望和赋权）。如果我们的假设得到证实，我们将有必要的证据来推进这种新服务模式的传播活动。

DESCRIPTION (provided by applicant): Many persons with serious mental illnesses (SMI) and a history of psychiatric hospitalizations are struggling with a cycle of institutional recidivim (repeated hospitalizations, incarcerations, and homelessness) and a lack of personal recovery. These problems are in part driven by fragmented, inaccessible community services; unengaged local stakeholders who could be partners in community support after hospitalization; frequent police contacts and poor communication between mental health and the police; and limited recovery support. For many, the promise of modern conceptualizations of recovery remains an unrealized promise. The Opening Doors to Recovery (ODR) model was developed to help such persons reduce institutional recidivism and engage in recovery. It does this by providing the participant with community support from a team of three Community Navigation Specialists (CNSs): a licensed social worker (the "Professional CNS"), a peer specialist with lived experience (the "Peer CNS"), and a family member of someone with SMI who has experience with the stress imposed on family members by the SMI and a complex, fragmented mental health system (the "Family CNS"). This team provides community navigation (mapping of all available community resources) and is embedded within the local community. They also provide ongoing recovery support by focusing on: (1) ensuring adequate treatment, (2) maintaining safe housing, (3) developing a meaningful day, and (4) using technology to support recovery. At least two other features of ODR distinguish it from other community-based services: a group of collaborative local partners is committed to supporting ODR and the work of the CNSs, and a novel linkage system with the police allows CNSs to respond immediately when one of their clients has an encounter with local law enforcement. All of these components of ODR work together to reduce institutional recidivism and promote recovery. Through a large-scale pilot/demonstration project involving 100 participants, we have demonstrated all aspects of feasibility, thoroughly established acceptability from diverse stakeholders, and shown promising effects in terms of reduced hospital stays and enhanced recovery. ODR is now ready for a more definitive randomized, controlled trial, and the research team is ideally suited and highly experienced to carry out such a trial. We will randomize 240 persons with SMI and a history of >2 inpatient stays in the past 6 months to ODR (n=120, followed for 12 months, with a maximum CNS caseload of 40) versus the existing Community Support Team (CST) model (n=120). Assessments will be conducted at baseline (at hospital discharge), and at 4, 8, 12, and 18 months. Our hypotheses center on ODR participants having fewer days of hospitalization, fewer arrests, better housing outcomes, and greater recovery, the latter measured with a diverse set of recovery measures (e.g., community adjustment, mental health recovery, community navigation competencies, meaningful day activities, hope, and empowerment). If our hypotheses are proven, we will have the needed evidence to move forward with dissemination activities for this new service model.