Reducing Duration of Untreated Psychosis through Early Detection in a Large Jail System

未经治疗的精神病（DUP）持续时间较长与首次发作精神病的预后较差有关 （FEP）。以纽约州OnTrackNY项目为例的协调专科护理（CSC）改善了 通过早期、多组分护理，DUP的治疗效果显著;然而，DUP的持续时间仍然长得令人无法接受。有证据 年轻的成年人与FEP谁是参与刑事司法（CJ）系统（在那里可能有很多 未被发现、未经治疗的精神病的患病率高于一般人群）， DUP。因此，虽然初级保健环境（例如，诊所）和教育机构（例如，大学）可能是 早期检测的重要场所，有必要在CJ系统内建立早期检测服务 (and特别是城市监狱），并创造从CJ参与到CSC注册的途径。 依靠先前的研究，相关理论，以及我们对DUP，护理途径，CSC和CJ的研究结果 系统，我们提出了4个干预发展目标。首先，我们会推行“公众宣传运动” (PIC)在纽约市里克斯岛的两个监狱里，这将更早地检测到FEP，减少我们的DUP-1（精神病 从发病到开始服药），并导致将被拘留者转介给早期发现小组。事先知情同意 将通过三个可衡量的目标/媒介（分发的印刷材料的累计数量）来实现这一目标 在监狱方面，惩教主任和惩教保健处人员在 精神病和如何参考EDT，以及3个社会认知理论结构的分数变化[研究1]）。 其次，我们将在这两个监狱实施EDT，这将增加转介被拘留者的可能性。 发现FEP与CSC接合（例如，在被拘留者的居住区的OnTrackNY程序） 释放后，并减少我们的DUP-2（精神病发作到CSC登记）。EDT将实现这些目标 通过关键目标/调解人实现目标（在监狱中与被拘留者面对面接触的分钟数和电话 释放后联系）。研究2将包括对提交给EDT的被拘留者的临床访谈。第三、 我们将彻底研究监狱PIC和EDT的可接受性和可行性，这将使我们 更大规模、多中心、确定有效性试验之前所需的信息。关于可接受性，我们 将与新干预措施的所有相关最终用户进行利益相关者访谈和焦点小组讨论 (PIC+EDT）[研究3]。就更大规模试验的可行性而言，将收集有关多个指标的数据。 第四，我们将编写一份干预手册，供不同监狱更广泛使用，并进一步开展正式研究。 总之，城市和县监狱可能有相对较多的未被发现的年轻人， 未经治疗的FEP，源于精神疾病的刑事化，CJ和精神病之间的分裂 卫生部门，以及迄今为止在这种情况下缺乏早期发现举措。一旦PIC和EDT 成功地在这个理想的网站进行试点测试，一旦可接受性和可行性， 如果建立了这一机制，DUP可能会减少，并加强与CSC的接触，以帮助这一特别脆弱的群体。

Longer duration of untreated psychosis (DUP) is linked to poorer outcomes in first-episode psychosis (FEP). Coordinated Specialty Care (CSC), exemplified by New York State’s OnTrackNY programs, improves outcomes through early, multi-component care; however, DUP remains unacceptably long. There is evidence that young adults with FEP who are involved in the criminal justice (CJ) system (where there is likely a much greater prevalence of undetected, untreated psychosis than in the general population) have an alarmingly long DUP. Thus, although primary care settings (e.g., clinics) and educational institutions (e.g., colleges) may be important sites for early detection, there is a need to establish early detection services within the CJ system (and in particular, urban jails) and to create pathways from CJ involvement to CSC enrollment. Relying on prior research, relevant theory, and our findings on DUP, pathways to care, CSC, and the CJ system, we propose 4 intervention development aims. First, we will implement a “Public Information Campaign” (PIC) in 2 jails at New York City’s Rikers Island, which will detect FEP earlier, reduce our DUP-1 (psychosis onset to medication initiation) and lead to referrals of detainees to the Early Detection Team (EDT). The PIC will accomplish this via three measurable targets/mediators (cumulative number of print materials disseminated in the jail, cumulative number of Corrections Officers and Correctional Health Services staff trained in early psychosis and how to refer to EDT, and change in scores on 3 Social Cognitive Theory constructs [Study 1]). Second, we will implement an EDT in the same 2 jails, which will increase the likelihood of referred detainees found to have FEP engaging with CSC (e.g., an OnTrackNY program in the detainee’s borough of residence) upon release, and reduce our DUP-2 (psychosis onset to CSC enrollment). The EDT will accomplish these goals via a key target/mediator (minutes of face-to-face contact with the detainee while in jail and telephone contact following release). Clinical interviews with detainees referred to the EDT will comprise Study 2. Third, we will thoroughly study acceptability and feasibility of the jail-based PIC and EDT, which will give us information needed in advance of a larger, multi-site, definitive effectiveness trial. Regarding acceptability, we will conduct stakeholder interviews and focus groups with all relevant end-users of the new intervention (PIC+EDT) [Study 3]. In terms of feasibility for a larger trial, data on a number of metrics will be collected. Fourth, we will prepare an Intervention Manual for broader use in diverse jails and further formal research. In summary, city and county jails likely have a relatively high number of young people with undetected and untreated FEP, stemming from the criminalization of mental illnesses, fragmentation between CJ and mental health sectors, and a lack of early detection initiatives in such settings to date. Once the PIC and EDT are successfully implemented in this ideal site for pilot testing, and once acceptability and feasibility are established, DUP may be reduced, and engagement with CSC enhanced, for this especially vulnerable group.