Reducing the Duration of Untreated Illness Among Youth in the Juvenile Justice System with Psychosis-Spectrum Disorders

项目摘要 在少年司法系统（JJS）的青少年中，估计有3%的人患有精神病。 疾病，可以合理地假设，更多的经验亚阈值精神病- 这些症状可能是危险的征兆。有证据表明，多达25%的 那些首次发作精神病（FEP）的人通过犯罪行为首次接触护理 司法机构。未治疗精神病（DUP）的持续时间是一个负面的预后因素， 在刑事司法系统内的时间更长。这表明，年轻人 最终被送往JJS的患有精神病症状的人可能无法获得适当的心理健康 在乎目前的研究将在罗得岛家庭法院少年收容所进行 所有青少年接受心理健康筛查的部门（马萨诸塞州青少年筛查 仪器-第2版艾德; MAYSI-2）。所有在MAYSI-2思想上表现积极的青少年 干扰量表和使用前驱期问卷进行的第二次筛选-简要 版本（PQ-B），将获得协调专科护理（CSC）服务的转诊信息 JJS员工入选的家庭也将参与研究评估，无论 他们是否寻求CSC转介，其中涉及精神病风险结构化面谈 Syndrome [SIPS]和其他彻底评估精神病症状史的措施， 共病困难和精神卫生保健参与。一个年轻人的比较样本， MAYSI-2思维障碍子量表的筛查阴性也将使用 SIPS确定MAYSI-2/PQ-B筛查在精神病风险识别中的准确性。 在研究的第一阶段，JJS工作人员将遵循标准程序将年轻人转介到 国家CSC。在研究的第二阶段，JJS将接受强化的 转诊/与护理挂钩协议，包括“热情交接”，将转诊直接交给 并立即与CSC工作人员联系。CSC工作人员还将接受程序培训， 有可能跟进转介到CSC。3个月随访定性 关于转诊途径、瓶颈和差距的访谈和定量评估， 将进行护理、青年精神病症状和JJS接触。这种设计映射到 PAR 16- 264的既定目标包括：1）确定JJS内DUP的基线率（以及 我们还将研究精神病谱系症状和障碍的发生率）; 2）地图转诊 实现CSC的途径; 3）确定造成瓶颈的实施和服务级别因素 和与CSC联系的差距; 4）调查治疗联系与 精神病性症状/DUP;和，5）试点测试减少DUP的可行策略。

Project Summary Among adolescents in the Juvenile Justice System (JJS), an estimated 3% have a psychotic illness, and it can be reasonably assumed that many more experience subthreshold psychotic- spectrum symptoms that may be indicative of risk. Evidence suggests that as many as 25% of those with first episode psychosis (FEP) have their first contact with care through criminal justice agencies. Duration of untreated psychosis (DUP), a negative prognostic factor, has been shown to be longer among those within the criminal justice system. This suggests that youth with psychotic symptoms who end up in the JJS may not receive appropriate mental health care. The current study will be conducted in the Rhode Island Family Court Juvenile Intake Department where all youth receive a mental health screen (Massachusetts Youth Screening Instrument – 2nd Ed; MAYSI -2). All youth who screen positive on the MAYSI-2 Thought Disturbance scale, and a second gate screening with the Prodromal Questionnaire – Brief Version (PQ-B), will be given referral information for Coordinated Specialty Care (CSC) services by JJS staff. Enrolled families will also participate in the research assessment, regardless of whether they pursue the CSC referral, which involves the Structured Interview for Psychosis-risk Syndromes [SIPS] and other measures to thoroughly assess history of psychotic symptoms, comorbid difficulties, and mental health care engagement. A comparison sample of youth who screen negative on the MAYSI-2 Thought Disturbance subscale will also be assessed with the SIPS to determine accuracy of the MAYSI-2/PQ-B screen in the identification of psychosis-risk. During the first phase of the study, JJS staff will follow standard procedures in referring youth to the state CSC. In the second phase of the study, JJS will be instructed in an enhanced referral/linkage to care protocol, including a “warm hand-off” where referrals will be put in direct and immediate contact with CSC staff. CSC staff will also be trained in procedures to increase the likelihood of follow through with the referral to the CSC. Three month follow-up qualitative interviews and quantitative assessments regarding referral pathways, bottlenecks and gaps in care, youth psychiatric symptoms, and JJS contacts will be conducted. This design maps onto the stated goals of PAR 16- 264 including: 1) Identify baseline rates of DUP within the JJS (and we will also look at rates of psychosis-spectrum symptoms and disorders); 2) Map referral pathways to CSC; 3) Identify implementation and service level factors that create bottlenecks and gaps in linkage to the CSC; 4) Investigate the relationship between treatment linkage and psychotic symptoms/DUP; and, 5) Pilot test feasible strategies for reducing DUP.