A Trial of "Opening Doors to Recovery" for Persons with Serious Mental Illnesses

描述(由申请人提供)：许多有严重精神疾病(SMI)和精神科住院史的人正在与机构累犯(反复住院、监禁和无家可归)和缺乏个人康复作斗争。造成这些问题的部分原因是：社区服务支离破碎，难以获得；当地利益攸关方没有参与，住院后可能成为社区支助的合作伙伴；与警察频繁接触，心理健康和警察之间的沟通不畅；以及恢复支助有限。对许多人来说，对复苏进行现代概念化的承诺仍然是一个未实现的承诺。为帮助这类人减少机构累犯和从事恢复工作，制定了恢复门户开放模式。它通过向参与者提供由三个社区导航专家(CNS)组成的团队的社区支持来实现这一点：一名有执照的社会工作者(“专业CNS”)，一名有生活经验的朋辈专家(“Peer CNS”)，以及一名患有SMI的家庭成员，该家庭成员有SMI对家庭成员施加的压力和复杂、支离破碎的精神健康系统(“家庭CNS”)的经验。该团队提供社区导航(绘制所有可用社区资源的地图)，并嵌入当地社区。他们还提供持续的恢复支持，侧重于：(1)确保适当的治疗，(2)维护安全住房，(3)制定有意义的一天，以及(4)利用技术支持恢复。网上解决至少还有两个特点使其有别于其他以社区为基础的服务：一组合作的当地合作伙伴致力于支持网上解决和国家安全机构的工作，与警察的新型联系制度使国家法律服务机构能够在其客户之一遇到当地执法部门时立即作出反应。网上解决的所有这些组成部分共同努力，减少机构累犯，促进复苏。通过一个有100名参与者参与的大型试点/示范项目，我们已经证明了所有方面的可行性，彻底建立了不同利益攸关方的接受度，并在减少住院时间和促进恢复方面显示出良好的效果。网上解决现在已经准备好进行更明确的随机对照试验，研究小组非常适合进行这种试验，而且经验丰富。我们将240名患有SMI并在过去6个月内有&gt；2住院史的患者随机分成ODR组(n=120，随访12个月，最大CNS工作量为40例)与现有的社区支持小组(CST)模式(n=120)。评估将在基线(出院时)以及4、8、12和18个月进行。我们的假设集中在网上解决参与者住院天数更少、被捕人数更少、住房结果更好、恢复更快，后者通过一套不同的恢复措施(例如，社区调整、心理健康恢复、社区导航能力、有意义的日常活动、希望和赋权)来衡量。如果我们的假设得到证实，我们将有必要的证据来推进这一新服务模式的传播活动。

DESCRIPTION (provided by applicant): Many persons with serious mental illnesses (SMI) and a history of psychiatric hospitalizations are struggling with a cycle of institutional recidivim (repeated hospitalizations, incarcerations, and homelessness) and a lack of personal recovery. These problems are in part driven by fragmented, inaccessible community services; unengaged local stakeholders who could be partners in community support after hospitalization; frequent police contacts and poor communication between mental health and the police; and limited recovery support. For many, the promise of modern conceptualizations of recovery remains an unrealized promise. The Opening Doors to Recovery (ODR) model was developed to help such persons reduce institutional recidivism and engage in recovery. It does this by providing the participant with community support from a team of three Community Navigation Specialists (CNSs): a licensed social worker (the "Professional CNS"), a peer specialist with lived experience (the "Peer CNS"), and a family member of someone with SMI who has experience with the stress imposed on family members by the SMI and a complex, fragmented mental health system (the "Family CNS"). This team provides community navigation (mapping of all available community resources) and is embedded within the local community. They also provide ongoing recovery support by focusing on: (1) ensuring adequate treatment, (2) maintaining safe housing, (3) developing a meaningful day, and (4) using technology to support recovery. At least two other features of ODR distinguish it from other community-based services: a group of collaborative local partners is committed to supporting ODR and the work of the CNSs, and a novel linkage system with the police allows CNSs to respond immediately when one of their clients has an encounter with local law enforcement. All of these components of ODR work together to reduce institutional recidivism and promote recovery. Through a large-scale pilot/demonstration project involving 100 participants, we have demonstrated all aspects of feasibility, thoroughly established acceptability from diverse stakeholders, and shown promising effects in terms of reduced hospital stays and enhanced recovery. ODR is now ready for a more definitive randomized, controlled trial, and the research team is ideally suited and highly experienced to carry out such a trial. We will randomize 240 persons with SMI and a history of >2 inpatient stays in the past 6 months to ODR (n=120, followed for 12 months, with a maximum CNS caseload of 40) versus the existing Community Support Team (CST) model (n=120). Assessments will be conducted at baseline (at hospital discharge), and at 4, 8, 12, and 18 months. Our hypotheses center on ODR participants having fewer days of hospitalization, fewer arrests, better housing outcomes, and greater recovery, the latter measured with a diverse set of recovery measures (e.g., community adjustment, mental health recovery, community navigation competencies, meaningful day activities, hope, and empowerment). If our hypotheses are proven, we will have the needed evidence to move forward with dissemination activities for this new service model.