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“防止精神病患者的恶化和残疾”。 患有精神疾病的人”。然而，社会保障管理局的残疾率（SSI/DI） 年轻人接受早期精神病治疗的人数仍然很高。关于SSI/DI的现有研究有限 关于FEP人群的信息。参加SSI/DI可以提供福利（包括现金援助， 获得医疗补助/医疗保险和其他社会权利），但也会对精神上的身份，职业 社会保障援助计划是一项长期计划，旨在帮助个人实现抱负、职业发展和就业;个人很少放弃社援津贴而从事全职工作。 在交叉点方面，也发现了种族差异，但仍不清楚 种族、结构性种族主义和长期以来记录在案的少数民族的较差结果之间的关系， 尤其是美国黑人。至关重要的是，要产生有可能为决策提供信息的知识 了解SSI/DI参与的内在好处和权衡，并帮助优化背景下的结果 这一年轻人群体（例如，一般年龄在16-30岁之间）参加社会保险/残疾保险的比例。 本项目的主要目标是调查影响申请SSI/DI的决定的因素， 这些决定的影响，以及SSI/DI和职业发展之间的纵向关系。这 这些信息将用于制定系统的战略，以改善服务，支持客户决策， 创造和优化结果。 NIMH资助的早期精神病干预网络（EPINET），涵盖105个协调专业 在16个州的CSC计划，提供了一个特殊的机会，以更好地了解这些问题。 利用EPINET倡议，这一多阶段、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与职业功能之间的关系，将有助于 制定和评价可采取行动的目标的多级菜单及相关实施 战略，例如，改进方案支助的具体方式和旨在 加强与小系统可持续发展有关的成果（将研究成果转化为实践）。该项目由多层次指导 残疾创造进程框架和综合框架的实施活动 实施研究（CFIR）。拟议的项目将利用EPINET的定量数据 共同数据集（n=5000），补充主要定量（n = 330）和定性（n = 110）数据 在四个不同的国家收集。本研究的目的是：确定SSI/DI的程度和预测因素 申请，SSAD注册和工作/学校功能在CSC方案注册的客户， 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， SSI/DI。种族差异和潜在的差距将在所有三个目标进行审查。