A Family Peer Navigator Model to Increase Access and Initial Engagement in Coordinated Specialty Care Programs Among Black Families

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ABSTRACT Family members have a key role in facilitating the initiation of mental health services. Yet, Black/African American families often encounter barriers and experience delays accessing coordinated specialty care programs. These delays can be attributed to individual (e.g., knowledge), interpersonal (e.g., connectedness), community (e.g., access), and societal (e.g., discrimination) factors. In other health related areas, peer navigator models improve access to much needed services and promote more positive experiences among individuals and their families. However, there are have been no family peer navigator models developed to address the complexities that impact Black/African American families to improve access to coordinated specialty care programs. Preliminary research suggests approximately 70% of Black/African American family members report no contact with clinicians prior to initial diagnosis and the receipt of services for early psychosis. Among Black/African Americans, family member engagement prior to services and during treatment for first episode psychosis significantly impacts clinical and functional outcomes among youth enrolled in coordinated specialty care programs. Building upon formative research, this mixed methods study will be conducted in three phases to develop, refine, and pilot-test a multi-component Family Peer Navigator model designed to increase access and engagement in coordinated specialty care programs Black families. A community advisory board will provide feedback during each Phase II and III to refine the navigator model. The Family Peer Navigator model will utilize telephone-based strategies and encompass the Cultural Formulation Interview to tailor family psychoeducation and care coordination. Phase I and Phase II utilize an exploratory-sequential mixed methods design to refine the Family Peer Navigator model and implementation strategy. Phase I involves qualitative interviews with coordinated specialty care directors and providers, and agency-level administrators. Phase II is a 4-month open trial that will recruit up to 10 Black families. Phase III will consist of an embedded mixed methods designed randomized pilot trial of the Family Peer Navigator model against a low-intensive care coordination in two coordinated specialty care programs. The acceptability, feasibility, and preliminary impact will be assessed in a sample of 40 Black/African American families with a loved one at risk for psychosis or currently experiencing their first episode of psychosis. Other outcomes include proposed treatment targets (self-efficacy, knowledge, social connectedness), preliminary impact outcomes (time to coordinated specialty care programs, initial family engagement), and implementation outcomes (acceptability, feasibility, appropriateness). This study will establish an innovative culturally informed family peer navigator model and generate preliminary data to support a Type II hybrid effectiveness-implementation R01 application.