Pathways through Care: Decision-Making and Treatment Drop-Out in Early Psychosis

护理途径:早期精神病的决策和治疗退出

基本信息

  • 批准号:
    8618689
  • 负责人:
  • 金额:
    $ 1.4万
  • 依托单位:
  • 依托单位国家:
    美国
  • 项目类别:
  • 财政年份:
    2014
  • 资助国家:
    美国
  • 起止时间:
    2014-02-15 至 2014-06-30
  • 项目状态:
    已结题

项目摘要

Reducing the staggering personal, clinical, and public health burden of schizophrenia and other psychotic disorders, which typically have their onset in adolescence or young adulthood, is a priority for our nation. Intervening early, as soon as possible after a young adult first experiences psychotic symptoms, is important for promoting young people's mental health recovery and reducing chronic disability. While state-of-the-art interventions like Recovery After an Initial Schizophrenia Episode (RAISE) provide care for young people that improves their chance of recovery, they do not help the ~1/2 of the young people who drop-out of care. Preliminary evidence suggests that at least half of the young people initially hospitalized for a psychotic disorder do not attend their first outpatient follow-up appointment, and become "lost to follow-up" in the initial months after their hospitalization. There is a gap in the research regarding this group-we know nothing about them. Understanding what personal and contextual factors shape young people's decisions to drop-out or not drop-out of care during the critical time between an initial hospitalization for psychosis and engagement with outpatient services is immensely important. We can use this knowledge to conceptualize an intervention that appeals to them and motivates them to engage in care. This R03 proposal will generate the knowledge we need to develop a person-centered intervention targeting this crucial and unstudied moment of treatment decision-making in the lives of 24 young people with early psychosis (ages 18-30) and 24 of their self- identified key supporters (e.g., family members, romantic partners). To target an underserved and overrepresented population, 50% of the study sample will be African American. In this self-contained, prospective, ethnographic study, we will conduct an interview during their initial inpatient hospitalization, ask participants to identify a key supporter, and then follow them into the community with 1-hour interviews and 2- 3 hour ethnographic home visits at weeks 2, 4, 8, 12, and 16 (Aim 1). We will also interview key supporters at three of those timepoints. Aim 1 will enable us to collect data on a population that has never been studied. We expect ~1/2 of our sample to disengage from clinical services based on our preliminary work, which will provide us with 2 comparison groups-people who drop-out of treatment initially and people who do not. Comparing these qualitative data about treatment decision-making during this critical period between those who drop-out and those who do not, as well as their key supporters, we will be able to form a grounded theory of the personal and contextual factors that are meaningful to young people and their key supporters at this time, and how those factors shape treatment decision-making (Aim 2). This theory will provide the knowledge we need to conceptualize an age-appropriate, person-centered intervention that reduces treatment drop-out, promotes engagement, and motivates young people to envision a "pathway through care" that is meaningful for them (Aim 3), thereby helping them experience a continuity of care during this critical, early period.
减少精神分裂症和其他精神病患者惊人的个人、临床和公共卫生负担 通常在青春期或青年期发病的疾病是我国的一个优先事项。 在年轻人第一次出现精神病症状后,尽早进行干预是很重要的 促进青少年的精神健康康复及减少慢性残疾。虽然是最先进的 干预措施,如恢复后,最初的精神分裂症发作(RAISE)提供照顾的年轻人, 提高他们的康复机会,他们没有帮助的〜 1/2的年轻人谁辍学的照顾。 初步证据表明,至少有一半的年轻人最初住院的精神病 疾病不参加他们的第一次门诊随访预约,并成为“失去后续行动”,在最初的 在他们住院几个月后。关于这个群体的研究存在空白-我们对这个群体一无所知。 他们了解哪些个人和背景因素影响年轻人辍学或不辍学的决定 在最初因精神病住院治疗和参与精神病治疗之间的关键时期, 门诊服务非常重要。我们可以利用这些知识来概念化干预, 吸引他们并激励他们参与护理。此R 03提案将产生我们 需要针对这一关键且未经研究的治疗时刻,制定以人为本的干预措施 在24名患有早期精神病的年轻人(18-30岁)和24名自己的生活中, 确定了关键支持者(例如,家庭成员,浪漫的伴侣)。针对一个得不到充分服务的 如果研究样本中有50%是非裔美国人,在这个自给自足的, 前瞻性人种学研究,我们将在他们最初住院期间进行访谈,询问 参与者确定一个关键的支持者,然后跟随他们进入社区,进行1小时的访谈和2小时的访谈。 在第2、4、8、12和16周进行3小时人种学家访(目标1)。我们还将采访主要支持者, 其中三个时间点。目标1将使我们能够收集从未被研究过的人口数据。我们 根据我们的初步工作,预计约1/2的样本将脱离临床服务,这将提供 我们有2个对照组-人谁辍学的治疗最初和人谁不。比较 这些关于治疗决策的定性数据,在这一关键时期, 而那些不这样做的人,以及他们的主要支持者,我们将能够形成一个基础理论, 目前对年轻人及其主要支持者有意义的个人和背景因素, 这些因素如何影响治疗决策(目标2)。这个理论将提供我们需要的知识, 概念化一种适合年龄的、以人为本的干预措施,以减少治疗脱落,促进 参与,并激励年轻人设想一个对他们有意义的“通过护理的途径” (Aim 3),从而帮助他们在这一关键的早期阶段获得持续的护理。

项目成果

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{{ truncateString('NEELY A MYERS', 18)}}的其他基金

Pathways through Care: Decision-Making and Treatment Drop-Out in Early Psychosis
护理途径:早期精神病的决策和治疗退出
  • 批准号:
    8956759
  • 财政年份:
    2014
  • 资助金额:
    $ 1.4万
  • 项目类别:
Pathways through Care: Decision-Making and Treatment Drop-Out in Early Psychosis
护理途径:早期精神病的决策和治疗退出
  • 批准号:
    8804288
  • 财政年份:
    2014
  • 资助金额:
    $ 1.4万
  • 项目类别:
First-Episode Psychosis and Pre-Onset Cannabis Use
首发精神病和发作前吸食大麻
  • 批准号:
    8322750
  • 财政年份:
    2008
  • 资助金额:
    $ 1.4万
  • 项目类别:

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