Optimizing Disability Benefit Decisions and Outcomes in First Episode Psychosis

优化首发精神病中的残疾福利决策和结果

• 批准号: 10521916
• 负责人: LISA B. DIXON
• 金额: $ 78.76万
• 依托单位: NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-09 至 2028-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10521916
• 关键词: Affect; Age; Attention; Award; Black American; COVID-19 pandemic; California; Characteristics; Client; Clinical; Communities; Complex; Consolidated Framework for Implementation Research; Coordinated Specialty Care; Data; Data Collection; Data Set; Decision Making; Deterioration; Development; Disincentive; Economics; Employment; Enrollment; Evaluation; Evidence based practice; Feedback; Funding; Generations; Goals; Impairment; Independent Living; Individual; Interruption; Intervention; Interview; Knowledge; Learning; Link; Medicaid; Medicare/Medicaid; Mental Health Services; Methods; Minority; Modeling; Motivation; National Institute of Mental Health; New York; Outcome; Partnership Practice; Pennsylvania; Persons; Play; Policies; Population; Poverty; Process; Psychoses; Psychotic Disorders; Race; Recovery; Research; Research Personnel; Role; Schizophrenia; Schools; Service delivery model; Services; Shock; Site; Social Security; Structural Racism; Surveys; Texas; Time; Translational Research; United States; United States Social Security Administration; Work; Youth; aged; care recipients; care systems; career development; design; disability; disability impact; early psychosis; evidence base; experience; first episode psychosis; implementation strategy; improved; improved outcome; innovation; minority children; prevent; programs; racial difference; racial discrimination; racial disparity; racial identity; research to practice; social; social determinants; social influence; sociodemographics; young adult

A major NIMH goal for early psychosis treatment is to “prevent deterioration and disability among individuals suffering from psychotic illness”. However, rates of Social Security Administration disability (SSI/DI) enrollment remain high for young people in early psychosis treatment. Existing studies on SSI/DI have limited information on the FEP population. Enrollment in SSI/DI may provide benefits (including cash assistance, access to Medicaid/Medicare, and other social entitlements), but also detrimentally impact identity, vocational aspirations, career development and employment; individuals rarely leave SSAD benefits for full-time work. Racial disparities have also been identified, but remain poorly understood, with respect to the intersections between race, structural racism and the poorer outcomes long-documented among ethnoracialized minorities, particularly Black Americans. It is crucial to generate knowledge with the potential to inform decision-making about the benefits and trade-offs inherent in SSI/DI participation and help optimize outcomes within the context of SSI/DI participation among this population of young people (e.g. generally aged 16-30). The primary goal of this project is to investigate factors influencing decisions to apply for SSI/DI, the impact of these decisions, and the longitudinal relationships between SSI/DI and career development. This information will then be used to develop systematic strategies for improving services, supporting client decision making and optimizing outcomes. The NIMH-funded Early Psychosis Intervention Network (EPINET), spanning 105 coordinated specialty care (CSC) programs across 16 states, affords an exceptional opportunity to better understand these issues. Leveraging the EPINET initiative, this multi-phase, mixed methods study will provide important new knowledge regarding predictors of application and the relationship between SSI/DI and vocational functioning, will facilitate development and evaluation of a multi-level menu of actionable targets and associatedimplementation strategies, for example, specific ways of improving programmatic supports and policy changes designed to strengthen SSAD-related outcomes (translation of research to practice). The project is guided by the multi-level Disability Creation Process (DCP2) framework, and implementation activities by the Consolidated Framework for Implementation Research (CFIR). The proposed project will utilize quantitative data from the EPINET common dataset (n=5000), supplemented with primary quantitative (n = 330) and qualitative (n = 110) data collection in four distinct states. The study aims are to: determine the extent and predictors of SSI/DI application, SSAD enrollment and work/school functioning among clients enrolled in CSC programs, systematically investigate the client experience of SSI/DI decision making (through quantitative and qualitative data) and using implementation mapping to develop strategies to optimize CSC services as they impact SSI/DI. Racial differences and potential disparities will be examined across all three Aims.

NIMH 早期精神病治疗的一个主要目标是“防止患者病情恶化和残疾” 患有精神疾病的个人”。但是，社会保障局残疾率 (SSI/DI) 年轻人早期精神病治疗的入学率仍然很高。现有关于 SSI/DI 的研究有限 FEP 人群的信息。加入 SSI/DI 可能会带来好处（包括现金援助、 获得医疗补助/医疗保险和其他社会权利），而且还会对身份、职业产生不利影响 愿望、职业发展和就业；人们很少放弃 SSAD 福利去从事全职工作。 种族差异也已得到确认，但在交叉点方面仍然知之甚少 种族、结构性种族主义和种族化少数群体中长期记录的较差结果之间， 特别是美国黑人。生成能够为决策提供信息的知识至关重要 了解参与 SSI/DI 所固有的利益和权衡，并帮助在背景下优化结果 该年轻人口（例如通常年龄在 16-30 岁）中参与 SSI/DI 的情况。 该项目的主要目标是调查影响申请 SSI/DI 决策的因素， 这些决策的影响，以及 SSI/DI 和职业发展之间的纵向关系。这 然后，信息将用于制定系统策略，以改善服务，支持客户决策 制定和优化结果。 NIMH 资助的早期精神病干预网络 (EPINET)，涵盖 105 个协调专业 遍布 16 个州的护理 (CSC) 计划为更好地了解这些问题提供了绝佳的机会。 利用 EPINET 计划，这项多阶段、混合方法的研究将提供重要的新知识 关于应用的预测因素以及 SSI/DI 和职业功能之间的关系，将有助于 制定和评估可操作目标的多级菜单及相关实施 战略，例如，改进方案支持的具体方法以及旨在 加强 SSAD 相关成果（将研究转化为实践）。该项目以多层次引导 残疾创建流程 (DCP2) 框架以及综合框架的实施活动 实施研究（CFIR）。拟议项目将利用 EPINET 的定量数据 通用数据集 (n = 5000)，辅以主要定量 (n = 330) 和定性 (n = 110) 数据 四个不同州的收集。该研究的目的是： 确定 SSI/DI 的程度和预测因素 申请、SSAD 注册以及参加 CSC 计划的客户的工作/学校功能， 系统地调查 SSI/DI 决策的客户体验（通过定量和定性 数据）并使用实施映射来制定策略，以优化 CSC 服务的影响 SSI/DI。所有三个目标都将审查种族差异和潜在差异。