Optimizing Engagement in Services for First-Episode Psychosis (FEP) in the Community Mental Health Setting

优化社区心理健康环境中首发精神病 (FEP) 服务的参与度

• 批准号: 9977721
• 负责人: Maria M Santos
• 金额: $ 13.43万
• 依托单位: CALIFORNIA STATE UNIV SAN BERNARDINO
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-09 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/9977721
• 关键词: Acculturation; Address; Affect; Appointment; Attention; Attenuated; Behavioral; California; Caring; Characteristics; Client; Clinic; Clinical; Communication; Communities; Community Mental Health Services; Country; Development; Dimensions; Disease; Disease remission; Doctor of Medicine; Doctor of Philosophy; Early Intervention; Empathy; Ethnic Origin; Evidence based intervention; Family; Family Caregiver; Family member; Future; Goals; Healthcare; Immigrant; Immigration; Individual; Institution; Intervention; Intervention Studies; Investigation; Latino; Lead; Life; Literature; Mediator of activation protein; Medication Management; Mental Depression; Mental Health; Mental Health Services; Mentors; Methods; Minority Groups; Modeling; National Institute of Mental Health; Nature; Outcome; Participant; Patients; Pattern; Persons; Phase; Population; Positive Reinforcements; Process; Psychosocial Assessment and Care; Psychotic Disorders; Public Health; Qualitative Methods; Quality of life; Randomized Controlled Trials; Recovery; Research; Research Methodology; Research Project Grants; Resources; Rewards; Risk; Role; Sampling; Services; Site; Support Groups; Symptoms; Therapeutic; Time; Training; Training Support; Universities; base; behavioral outcome; community based service; effective intervention; experience; family support; first episode psychosis; flexibility; follow-up; functional disability; functional outcomes; health goals; high risk; improved; interest; medication compliance; meetings; person centered; premature; prevent; psychotic symptoms; racial and ethnic; service engagement; service intervention; theories; therapy design; treatment as usual; treatment services

Disengagement from services is a major public health problem for individuals with first-episode psychosis (FEP) as up to 40% of individuals prematurely terminate early care. Individuals with FEP are consequently at increased risk of persistent symptomatic and functional impairment and poor long-term outcomes. Engagement can be improved by (1) identifying pragmatic and effective evidence-based interventions, (2) pinpointing the mechanisms through which change in engagement is achieved, and (3) enhancing the literature on engagement, such as by developing a nuanced and dynamic conceptualization of engagement to guide future research. In the U.S., effective interventions for engagement are particularly needed for community mental health services, which deliver most mental health care and encounter major engagement issues, and for hard- to-reach communities, such as those comprised by Latinos. Research conducted with individuals with psychosis has shown that Behavioral Activation (BA), designed for the treatment of depression, may effectively target engagement and also symptomatic and functional outcomes. This study will develop 12-session BA for FEP and compare it to treatment-as-usual over six months with a sample of 58 (29 per condition) Latinos and their family caregivers in a longitudinal randomized controlled trial. Dyads will also participate in comparable family support groups delivered separately by condition. To examine mechanisms of change, the association between intervention mediators and engagement will be examined to determine whether changes in mediators precede changes in engagement over time. Using mixed-methods, the relationship between local/cultural factors and engagement will be explored. Qualitative methods will be used to explore how local/cultural factors impact engagement for future quantitative analysis, how specific characteristics of robust predictors (e.g., family support) influence engagement, discover other critical influences, consider BA specific factors, and generate a model of engagement in FEP care with attention to stages of development, illness, and treatment. The project provides training in service engagement and intervention for FEP, developing and applying BA for FEP, addressing engagement during FEP in hard-to-reach communities with cultural responsivity, and relevant research methods with primary mentor, Alex Kopelowicz, M.D, co-mentors Steven R. Lopez, Ph.D., Lisa B. Dixon, M.D., M.P.H., and Sona Dimidjian, Ph.D., and consultants Hilary Mairs, Ph.D., Anahi Collado, Ph.D., Mark Lai, Ph.D., Jodie Ullman, Ph.D., Lawrence Palinkas, Ph.D., and Ethel Nicdao, Ph.D. Activities will be sustained through regular communication with and between trainers and resources at California State University San Bernardino, University of Southern California, and relevant institutions/sites. Training supports Dr. Santos’s long-term goal of advancing the field of service engagement for persons with FEP from hard-to- reach communities. The project will enhance the FEP engagement and intervention field and supports the NIMH’s goals of improving engagement and maximizing recovery for persons with early psychotic illness.

对于首发精神病患者来说，脱离服务是一个主要的公共卫生问题 (FEP) 高达 40% 的人提前终止早期护理。因此，患有 FEP 的人处于 持续症状和功能障碍以及长期预后不良的风险增加。订婚 可以通过以下方式改进：(1) 确定务实且有效的循证干预措施；(2) 查明 实现参与变革的机制，以及 (3) 加强有关方面的文献 参与，例如通过制定细致入微且动态的参与概念来指导未来 研究。在美国，社区心理特别需要有效的参与干预措施 卫生服务，提供大部分精神卫生保健并遇到重大参与问题，并为困难 覆盖社区，例如由拉丁裔组成的社区。对患有以下疾病的个体进行的研究 精神病表明，专为治疗抑郁症而设计的行为激活（BA）可以有效地 目标参与度以及症状和功能结果。本研究将开发 12 个学期的文学学士课程 FEP 并将其与六个月内的常规治疗进行比较，样本为 58 名（每种情况 29 名）拉丁裔和 他们的家庭照顾者在一项纵向随机对照试验中。 Dyads也将参加类似的活动 家庭支持小组根据病情单独提供。为了检查变革机制，协会 将检查干预调解员和参与之间的关系，以确定调解员是否发生变化 随着时间的推移，参与度发生变化。使用混合方法，当地/文化之间的关系 将探讨因素和参与度。将使用定性方法来探索当地/文化因素如何 影响未来定量分析的参与度，稳健预测变量的具体特征（例如， 家庭支持）影响参与度，发现其他关键影响，考虑 BA 特定因素，以及 建立参与 FEP 护理的模型，关注发育阶段、疾病和治疗。 该项目为 FEP 提供服务参与和干预方面的培训，开发和应用 BA FEP，解决 FEP 期间对具有文化责任感的难以到达的社区的参与，以及相关 与主要导师 Alex Kopelowicz 医学博士、联合导师 Steven R. Lopez 博士、Lisa B. Dixon, M.D., M.P.H. 和 Sona Dimidjian, Ph.D.，以及顾问 Hilary Mairs, Ph.D., Anahi Collado, Ph.D., Mark Lai 博士、Jodie Ullman 博士、Lawrence Palinkas 博士和 Ethel Nicdao 博士活动将是 通过与加利福尼亚州培训师和资源之间的定期沟通来维持 圣贝纳迪诺大学、南加州大学以及相关机构/网站。培训支持 Santos 博士的长期目标是推动 FEP 患者的服务参与领域从困难到 到达社区。该项目将加强 FEP 的参与和干预领域，并支持 NIMH 的目标是提高早期精神病患者的参与度并最大限度地使其康复。