StepWell: Stepped Care Mental Health and Substance Use Telehealth Services for COVID-19 Affected Patients

社会孤立、经济不安全以及新冠肺炎病例和死亡人数的迅速增加是 导致了令人震惊的精神健康和物质使用障碍。 此外，现有的社会、健康、 和少数族裔之间的精神健康(MH)差距加剧 。卫生保健系统和 将MH整合到初级保健环境中的协作保健系统一直很难提供 大流行引起的MH和物质使用障碍(MHSUD)新患者的精神科护理 -包括从新冠肺炎康复/康复的患者(“新冠肺炎幸存者”)及其家人。必然性 使用远程医疗策略来保护患者和提供者，给MH/SU护理带来了额外的挑战 系统。尽管远程医疗可能会增加患者的参与度，但还没有研究确定最佳的资源- 在MHSUD筛查和护理提供中使用它的有效策略。因此，一种新的方法既满足了 需要新冠肺炎时代的需求和安全挑战来应对蓬勃发展的COVID相关问题 MHSUD的护理需求。将分级护理策略与自动分诊、心理教育和共享相结合 决策不仅可以解决能力和系统层面的障碍，而且还可以加强治疗效果 并解决患者/提供者层面的参与障碍。为了应对MH带来的关键挑战， 在新冠肺炎大流行期间，建议的补充研究将适应和应用一项在 Parent Grant，电子精神健康工具(EmwT)，指导提供者对患者进行筛查 MHSUDS使用3个高灵敏度的验证项目，然后使用另外9个验证项目，对患者进行分诊 根据诊断类别进行具体循证治疗，具有较好的特异性。最初的3个项目 还可以通过代理和高灵敏度检测亲属中的任何MHSUD。我们将把这项工作扩大到 开发和实施StepWell，一种针对MHSUD治疗的远程医疗分级护理方法，它集成了 EmwT拥有面向患者的电子抑郁症和焦虑症护理共享决策工具在New 约克长老会医院(NYPH)。在对1000名新近出院的COVID患者进行跟踪调查的新队列中 通过为期一年的NYPH，我们将测试使用STEPWELL在COVID中识别MHSUD问题的可行性 幸存者及其家人，并满足他们的MHSUD治疗需求，同时监测MH结果1 年。我们将使用以人为中心的设计原则来整合ESDM(患者偏好)和EmwT (评估和治疗)技术，以逐步发展。在混合方法的试点测试中，我们将检查 实施分步实施的可行性、可接受性和影响因素 实施科学R01提案。该项目解决了监测和解决MH影响的呼吁 新冠肺炎感染和受影响患者，同时扩大卫生系统解决现有问题的能力 治疗缺口，以提供超越新冠肺炎危机的可持续、可推广的MH服务解决方案。

Social isolation, economic insecurity, and rapid increases in numbers of COVID-19 cases and deaths are resulting in alarming rates of mental health and substance use disorders. Furthermore, existing social, health, and mental health (MH) disparities among racial/ethnic minorities have exacerbated . MH care systems and collaborative care systems, which integrate MH into primary care settings, have been hard pressed to provide psychiatric care to new patients with MH and substance use (SU) disorders (MHSUDs) arising from the pandemic – including patients recovered/ recovering from COVID-19 (“COVID survivors”) and their families. The necessity of using telehealth strategies to protect patients and providers has posed additional challenges for MH/SU care systems. Although telehealth may increase patient engagement, no research has identified optimal, resource- efficient strategies for its use in MHSUD screening and care delivery. Thus, a novel approach that meets both the demand and the safety challenges of the COVID-19 era is required to address the burgeoning COVID-related MHSUD care needs. Coupling a stepped-care strategy with automated triage, psychoeducation, and shared decision-making can not only address capacity and system-level barriers, but also potentiate treatment effects and address patient/provider-level barriers to engagement. To meet the critical MH challenges presented by the COVID-19 pandemic, the proposed supplement research will adapt and apply a technology developed in the parent grant, the Electronic Mental Wellness Tool (EmwT), that guides providers in screening patients for any MHSUDs using 3 validated items with high sensitivity and then, using another 9 validated items, triages patients to specific evidence-based treatments according to diagnostic categories with good specificity. The initial 3 items also can detect, by proxy and with high sensitivity, any MHSUDs among relatives. We will extend this work to develop and implement StepWell, a telehealth stepped-care approach to MHSUD treatment that integrates the EmwT with an electronic patient-facing depression and anxiety care shared decision-making tool in use at New York Presbyterian Hospital (NYPH). In a new cohort of 1,000 recently discharged COVID patients being followed by NYPH for one year, we will test the feasibility of using StepWell to identify MHSUD problems among COVID survivors and their families and address their MHSUD treatment needs while monitoring MH outcomes for 1 year. We will use human-centered design principles to integrate the eSDM (patient preference) and EmwT (assessment and treatment) technologies to develop StepWell. In a mixed-methods pilot test, we will examine feasibility, acceptability, and factors influencing StepWell implementation in preparation for a larger implementation science R01 proposal. This project addresses calls to monitor and address the MH impact of COVID-19 infected and affected patients, while expanding the ability of the health systems to address the existing treatment gap to provide a sustainable, generalizable MH services solution beyond the COVID-19 crisis.