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%患有精神病 疾病，可以合理地假设更多的亚阈值精神病患者- 可能预示风险的谱系症状。有证据表明，多达25%的 患有首发精神病(FEP)的人第一次接触护理是通过罪犯 司法机构。未经治疗的精神病持续时间(DUP)是一个负面的预后因素，已被 在刑事司法系统内的那些人中显示出更长的时间。这表明，年轻人 有精神病症状的人最终在JJS可能得不到适当的心理健康 关心。目前的研究将在罗德岛家庭法院青少年收容所进行 所有青年都接受心理健康筛查的部门(马萨诸塞州青年筛查 仪器-第二版；MAYSI-2)。所有对MAYSI-2想法持积极态度的年轻人 干扰量表，并使用前兆问卷进行第二次门筛查-简要 版本(PQ-B)，将获得协调专科护理(CSC)服务的推荐信息 由JJS工作人员提供。被录取的家庭也将参与研究评估，无论 他们是否寻求CSC转诊，其中包括针对精神病风险的结构化面试 症状[SIPS]和其他彻底评估精神病症状史的措施， 并存的困难，以及精神健康护理的投入。一位年轻人的对比样本 MAYSI-2思维障碍子量表上的屏幕负片也将用 SIPS以确定MAYSI-2/PQ-B筛查在识别精神病风险方面的准确性。 在研究的第一阶段，JJS的职员会按照标准程序把青少年转介至 州CSC。在第二阶段的研究中，将指导JJS进行增强的 转诊/与护理方案的联系，包括直接转诊的“热情移交” 并立即与CSC员工联系。CSC员工还将接受程序方面的培训，以增加 将案件转介给证监会的可能性。三个月随访定性 关于转介途径、瓶颈和差距的面谈和量化评估 将进行护理、青少年精神症状和JJS接触。此设计映射到 PAR 16-264规定的目标包括：1)确定JJS内DUP的基线比率(和 我们还将研究精神病的比率--谱系症状和障碍)；2)地图转介 通向CSC的途径；3)确定造成瓶颈的实施和服务级别因素 以及与CSC的联系方面的差距；4)调查治疗联系和 精神病症状/DUP；以及，5)初步测试减少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.