Project 2: Managed care updates of subscriber justice system involvement for suicide prevention

项目 2：订户司法系统参与预防自杀的管理式护理更新

• 批准号: 10688249
• 负责人: Sarah A Arias
• 金额: $ 25.45万
• 依托单位: MICHIGAN STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-22 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10688249
• 关键词: Address; Admission activity; Adult; Algorithms; Appointment; Books; Budgets; Caring; Client; Community Healthcare; County; Data; Direct Costs; Drops; Effectiveness; Ensure; Ethics; Feeling suicidal; Funding; Future; General Population; Goals; Health; Health Care Visit; Health Services; Healthcare; Healthcare Systems; Hybrids; Individual; Information Systems; Injury; Inpatients; Instruction; Intervention; Investments; Jail; Justice; Lead; Legal; Letters; Life; Link; Managed Care; Mediator; Medicaid; Medical; Mental Health; Mental Health Services; Morbidity - disease rate; National Institute of Mental Health; Notification; Ohio; Outcome; Outcome Study; Outpatients; Persons; Poisoning; Population; Practice based research; Pregnant Women; Prevention Research; Prisons; Provider; Publishing; Randomized; Reporting; Research; Risk Assessment; Role; Running; Safety; Services; Suicide; Suicide attempt; Suicide prevention; Symptoms; System; Testing; Time; Training; Update; Vendor; behavioral health; care coordination; care fragmentation; clinical care; cost; cost effectiveness; design; evidence base; experience; implementation outcomes; implementation process; implementation strategy; implementation trial; improved; innovation; intervention effect; mortality; prevention practice; program costs; reducing suicide; research to practice; scale up; service member; service utilization; stressor; suicidal behavior; suicidal risk; suicide rate; treatment as usual

Abstract (PROJECT 2: Managed Care Updates) More than 10 million people pass through US jails each year. Suicide risk is especially high at jail release. Individuals are often arrested when they are out of care and experiencing worsening symptoms. Jail detention may disrupt existing care and provide additional stressors. However, high jail admission and discharge volumes (>10,000,000 per year), jail stays that only last a few days, and understaffing mean that most of the U.S.’s ~3,100 county and local jails do not have the capacity to coordinate care. Outside jail, many justice-involved individuals are supported by professionals in publicly funded systems, who are typically unaware that their client was in jail and may drop the client for missing appointments. The resulting lack of care or fragmented care leads to unnecessary cycling in and out of jail and suicide-related morbidity and mortality. Better coordination of care between county jails and healthcare systems is widely acknowledged as crucial but difficult to achieve at scale. To address this problem, a large Medicaid managed care organization (MCO; CareSource) and a justice data vendor partnered to track county jail booking and release data for Ohio CareSource through an algorithm using publicly available data, generalizable to other healthcare/MCOs. The goal was to help CareSource ensure that subscribers were connected to needed community care following jail release and to minimize disruptions of any existing care due to jail detention. MCOs like CareSource are ideal organizations to help address system fragmentation because they span multiple behavioral health (BH) care systems (400 in Ohio alone) and multiple county jails (~88 in Ohio alone). In 2019, 43,000 (5.4%) of CareSource’s 800,000 total adult subscribers in Ohio, including 2,306 pregnant women, spent time in jail. CareSource is exploring ways to ensure that these subscribers receive needed care. This proposal involves two studies of evidence-based suicide prevention practices triggered by CareSource justice notifications, in a 2x2 factorial design. The first study will randomize CareSource’s ~43,000 Ohio subscribers who pass through jails over 12 months to receive Caring Contact letters sent by CareSource or to Care as Usual. The second study (running simultaneously) will involve a subset of ~6,000 of the 43,000 subscribers passing through jail who were seen in one of 12 large BH agencies in the 6 months prior to jail detention. Using a stepped wedge design, the 12 agencies will be brought online over time, receiving (a) notifications of jail detentions/releases with instructions for re-engaging clients in services; and (b) training in the Safety Planning Intervention plus notification to use it when a subscriber with past medically treated suicide attempts (identified by CareSource through claims data) is released from jail. Outcomes include medically treated suicide attempts, all-cause injury and poisoning, service utilization, cost-effectiveness, and implementation data. This Hybrid Type I 2-year “Exploratory” Center project is fully powered, yielding definitive effectiveness results that can be scaled immediately to improve suicide prevention nationally.

摘要（项目2：管理式护理更新） 每年有超过1000万人通过美国监狱。监狱里的自杀风险特别高 release.个人往往在得不到照顾和症状恶化时被捕。监狱 拘留可能会扰乱现有的照料，并造成额外的压力。然而，高额的监狱收入和 释放量（每年超过10，000，000），监狱停留时间仅持续几天，人员不足意味着， 美国大部分地区“约3 100个郡和地方监狱没有协调照料的能力。在监狱外，许多 参与司法的个人得到公共资助系统中的专业人员的支持，这些专业人员通常是 不知道他们的客户在监狱里，可能会因为错过约会而放弃客户。由此造成的缺乏照顾 或分散的护理导致不必要的循环进出监狱和与自杀有关的发病率和死亡率。 县监狱和医疗保健系统之间更好的护理协调被广泛认为是 关键但难以大规模实现。为了解决这个问题，一个大型医疗补助管理医疗组织 (MCO CareSource）和一家司法数据供应商合作，跟踪县监狱的预订情况，并发布俄亥俄州的数据 CareSource通过使用公开可用数据的算法，可推广到其他医疗保健/MCO。的 目标是帮助CareSource确保用户在入狱后能够获得所需的社区护理 这将有助于释放囚犯，并尽量减少因监狱拘留而对现有护理的干扰。像CareSource这样的MCO是理想的 组织，以帮助解决系统碎片，因为他们跨越多个行为健康（BH）护理 系统（仅俄亥俄州就有400个）和多个县监狱（仅俄亥俄州就有88个）。2019年，43，000（5.4%） CareSource在俄亥俄州的80万成年用户，包括2,306名孕妇，都在监狱里度过了一段时间。 CareSource正在探索确保这些订户获得所需护理的方法。 这项建议涉及两项基于证据的自杀预防实践研究， CareSource正义通知，采用2x2析因设计。第一项研究将随机选择CareSource的 约43，000名俄亥俄州的订户在12个月内通过监狱接收由 CareSource或以护理为基础。第二项研究（同时运行）将涉及约6，000个子集 在过去的6个月里，在波黑12家大型机构中的一家， 在被拘留之前。使用阶梯式楔形设计，随着时间的推移，12个机构将被带到网上， 接收（a）监狱拘留/释放通知，并指示重新聘用客户提供服务;以及（B） 安全计划干预培训，以及在订阅者有既往医疗史时使用安全计划干预的通知 治疗自杀企图（由CareSource通过索赔数据确定）从监狱释放。成果包括 医学治疗的自杀企图，全因伤害和中毒，服务利用，成本效益，和 实施数据。这个混合I型2年“探索”中心项目是完全动力， 明确的有效性结果，可以立即扩大规模，以改善全国自杀预防。