Engaging Young Adults in Their Mental Health Care Through a Brief Empirically-Based Meta-Intervention

项目摘要 作为对RFA-MH-16-410的响应，R34解决了NIMH的关键优先事项，1)关注健康 差距；2)创新服务干预措施的开发和初步测试。我们 建议在年轻人开始治疗时对他们进行短暂的Meta干预并测试其有效性 在成人心理健康诊所(因此，治疗和元干预同时进行)。元干预 旨在通过以下方式减少治疗辍学，这是一个有记录在案的重大公共卫生问题 帮助年轻人正确看待治疗，更好地理解护理的基本原理和目标，以及 解决继续治疗的障碍，因为他们建立了出诊程序和与提供者的关系。 到目前为止，研究的重点是“过渡干预”，即儿童系统内的方案 服务于将青年过渡到青年，其中一些已经将服务延长到早期 二十多岁。这些方案为仍在儿童之家的青少年提供临时的额外支持 系统。我们的研究提出了一种补充策略，该策略延伸到那些已经形成 试探性和初步参与成人系统的服务，但由于以下原因而有很高的脱离风险 服务未能考虑到年轻人独特的发展需要和取向。 我们的团队开发了一个中层理论来理解脱离的潜在机制。 该理论将服务使用理论与决策理论相结合，并提出了一系列因素 (个人和背景)对患有严重精神疾病的年轻人的脱离影响。我们的 干预使用新颖的沟通策略来保持年轻人的注意力，并影响这些 因素，因此，总体参与度。我们使用叙述性交流(例如，战略性讲故事作为一种手段 传递健康信息)，使年轻人与护理保持联系，进而改善功能。我们 使用一个康复榜样，他是一个经历了与年轻人第一次类似的困难的人 让成人心理健康系统参与进来。S/他领导活动，是关键资源。尽管恢复角色 模式与同伴支持的方式有关，它区别于不同的机制，并诉诸于不同的机制。 195名年轻人(3组，每组65人)将被随机分配到 干预组、积极控制组(安全人际关系课程)或常规对照治疗 当他们第一次注册服务时，他们会被视为一个群体。评估是在基线、2周后测、4周随访时进行的 并进行三个月的随访。本研究的目的是(1)开发和初步测试一种 新颖的两节课参与度元干预，旨在实现参与度和功能成果 被边缘化的患有严重精神疾病的年轻人，以及(2)初步确定潜在的 精神卫生保健中脱离接触的变化机制，即 干预效果。我们将推进理论，同时加强拟议的干预。

Project Summary In response to RFA-MH-16-410, this R34 addresses key NIMH priorities, 1) focusing on health disparities, and 2) development and preliminary testing of an innovative services intervention. We propose to refine and test the efficacy of a brief meta-intervention for young adults when they begin treatment at adult mental health clinics (hence, treatment and meta-intervention run concurrently). The meta-intervention is designed to reduce treatment dropout, a documented problem of significant public health concern, by helping young adults put treatment into perspective, better understand the rationale and goals of care, and address barriers to continued treatment as they build attendance routines and relationships with providers. To date, research has focused on `transition interventions,' namely programs within children's systems that serve transitioning youth into young adulthood, some of which have extended services into the early twenties. These programs create temporary additional support for youth while they are still in the children's systems. Our research suggests a complementary strategy that outreaches to youth who have formed tentative and initial engagement in services in the adult system, but who are at high risk of disengaging due to the failure of services to take into account the unique developmental needs and orientations of young adults. Our team developed a mid-level theory to understand the underlying mechanisms of disengagement. The theory integrates theories of service use with theories of decision-making, and suggests a set of factors (individual and contextual) impact disengagement among young adults with serious mental illness. Our intervention uses novel communication strategies to maintain the attention of young adults and impact these factors and thus, overall engagement. We use narrative communication (e.g., strategic storytelling as a means of conveying health information) to keep young adults connected to care and, in turn, improve functioning. We use a recovery role model who is a person who has had similar difficulties that young adults have as they first engage the adult mental health system. S/he leads activities and is a key resource. Although the recovery role model is related to approaches of peer support, it is distinct from and appeals to different mechanisms. One hundred ninety five young adults (3 groups, 65 per group) will be randomly assigned to either the intervention group, an active control group (curriculum on safe relationships), or the treatment as usual control group when they first enroll in services. Assessments are taken at baseline, 2-week posttest, 4-week follow-up and at a three month follow-up. The study aims are (1) to develop and preliminarily test the efficacy of a novel, 2-session engagement meta-intervention aimed at engagement and functioning outcomes for marginalized young adults with serious mental illness, and (2) to preliminarily identify the underlying mechanisms of change for disengagement in mental health care, i.e., mediators and moderators of intervention effectiveness. We will advance theory as well as strengthen the proposed intervention.