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

摘要 家庭成员在促进启动心理健康服务方面发挥着关键作用。然而，黑人/非洲人 美国家庭经常遇到障碍，并在获得协调的专业护理方面遇到延误 程序.这些延迟可以归因于个人（例如，知识），人际（例如， 连通性），社区（例如，访问），和社会（例如，歧视）因素。其他健康相关 在这些领域，同行导航模式改善了获得急需服务的机会，并促进了更积极的 个人及其家庭的经历。但是，一直没有家庭同行领航员 为解决影响黑人/非裔美国人家庭的复杂性而开发的模型，以改善获得 协调的专业护理计划。初步研究表明，大约70%的黑人/非洲人 美国家庭成员报告在初步诊断和接受服务之前没有与临床医生接触 治疗早期精神病在黑人/非裔美国人中，家庭成员在服务之前和服务期间 治疗首次发作的精神病显着影响青年的临床和功能结果 参加了协调的专业护理计划。在形成性研究的基础上，这种混合方法研究 将分三个阶段进行，以开发、完善和试点测试多组件的家庭同伴导航器 旨在增加黑人家庭获得和参与协调专业护理计划的模式。 社区咨询委员会将在每个阶段II和III提供反馈，以完善导航模型。 家庭同伴导航模式将利用基于电话的战略， 制定面谈，以调整家庭心理教育和护理协调。第一阶段和第二阶段利用 探索-顺序混合方法设计，以完善家庭同伴导航模型和实施 战略第一阶段涉及与协调的专科护理主任和提供者进行定性访谈， 机构一级的管理人员。第二阶段是为期4个月的公开试验，将招募多达10个黑人家庭。相 III将包括一个嵌入式混合方法设计的随机试点试验的家庭同伴导航 在两个协调的专科护理计划中，对低重症监护协调模式进行了研究。的 可接受性、可行性和初步影响将在40名黑人/非裔美国人的样本中进行评估 有亲人有精神病风险或目前正在经历首次精神病发作的家庭。其他 结果包括拟议的治疗目标（自我效能，知识，社会联系），初步 影响结果（协调专科护理计划的时间，最初的家庭参与），以及 实施结果（可接受性、可行性、适当性）。这项研究将建立一个创新的 文化知情的家庭同伴导航模型，并生成初步数据，以支持II型混合 R 01应用程序的有效性。

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.