Pathways through Care: Decision-Making and Treatment Drop-Out in Early Psychosis

减轻精神分裂症和其他精神病患者令人震惊的个人、临床和公共卫生负担 疾病通常在青春期或青年时期发病，是我们国家的优先事项。 在年轻人第一次出现精神病症状后尽早进行干预是很重要的 促进青少年心理健康康复，减少慢性残疾。虽然最先进的技术 像最初的精神分裂症发作后康复(RAISE)这样的干预措施为年轻人提供护理 虽然提高了他们康复的机会，但他们并不能帮助~1/2辍学的年轻人。 初步证据表明，至少有一半的年轻人最初因精神病而住院 失调症患者没有参加他们的第一次门诊随访，在最初的时候变成了“失访” 在他们住院几个月后。关于这一群体的研究存在差距--我们对此一无所知 他们。了解哪些个人和背景因素会影响年轻人是否辍学的决定 在最初因精神病住院到参与治疗之间的关键时间段内放弃护理 门诊服务是极其重要的。我们可以利用这一知识来概念化干预 吸引他们，并激励他们从事护理工作。这份R03建议书将产生我们的知识 需要针对这一关键和未经研究的治疗时刻制定以人为中心的干预措施 24名早期精神病青少年(18-30岁)和24名自闭症患者的生活决策 确定关键支持者(例如，家庭成员、恋人)。以服务不足的人为目标 如果人口比例过高，研究样本中将有50%是非裔美国人。在这个自给自足、 前瞻性、人种学研究，我们将在他们首次住院期间进行访谈，询问 参与者确定一个关键的支持者，然后跟随他们进入社区，进行1小时的访谈和2- 在第2、4、8、12和16周进行3小时的人种学家访(目标1)。我们还将采访主要支持者，网址为 其中三个时间点。目标1将使我们能够收集从未研究过的人口的数据。我们 根据我们的初步工作，预计~1/2的样本将退出临床服务，这将提供 美国有两个对照组--最初退出治疗的人和没有接受治疗的人。比较 这些关于在这一关键时期内的治疗决策的定性数据 而那些不这样做的人，以及他们的主要支持者，我们将能够形成一种扎根的理论 目前对年轻人及其主要支持者有意义的个人和背景因素，以及 这些因素如何影响治疗决策(目标2)。这一理论将提供我们需要的知识 概念化适合年龄的、以人为中心的干预措施，减少治疗脱落，促进 参与，并激励年轻人设想一条对他们有意义的“关怀之路” (目标3)，从而帮助他们在这一关键的早期阶段获得持续的护理。

Reducing the staggering personal, clinical, and public health burden of schizophrenia and other psychotic disorders, which typically have their onset in adolescence or young adulthood, is a priority for our nation. Intervening early, as soon as possible after a young adult first experiences psychotic symptoms, is important for promoting young people's mental health recovery and reducing chronic disability. While state-of-the-art interventions like Recovery After an Initial Schizophrenia Episode (RAISE) provide care for young people that improves their chance of recovery, they do not help the ~1/2 of the young people who drop-out of care. Preliminary evidence suggests that at least half of the young people initially hospitalized for a psychotic disorder do not attend their first outpatient follow-up appointment, and become "lost to follow-up" in the initial months after their hospitalization. There is a gap in the research regarding this group-we know nothing about them. Understanding what personal and contextual factors shape young people's decisions to drop-out or not drop-out of care during the critical time between an initial hospitalization for psychosis and engagement with outpatient services is immensely important. We can use this knowledge to conceptualize an intervention that appeals to them and motivates them to engage in care. This R03 proposal will generate the knowledge we need to develop a person-centered intervention targeting this crucial and unstudied moment of treatment decision-making in the lives of 24 young people with early psychosis (ages 18-30) and 24 of their self- identified key supporters (e.g., family members, romantic partners). To target an underserved and overrepresented population, 50% of the study sample will be African American. In this self-contained, prospective, ethnographic study, we will conduct an interview during their initial inpatient hospitalization, ask participants to identify a key supporter, and then follow them into the community with 1-hour interviews and 2- 3 hour ethnographic home visits at weeks 2, 4, 8, 12, and 16 (Aim 1). We will also interview key supporters at three of those timepoints. Aim 1 will enable us to collect data on a population that has never been studied. We expect ~1/2 of our sample to disengage from clinical services based on our preliminary work, which will provide us with 2 comparison groups-people who drop-out of treatment initially and people who do not. Comparing these qualitative data about treatment decision-making during this critical period between those who drop-out and those who do not, as well as their key supporters, we will be able to form a grounded theory of the personal and contextual factors that are meaningful to young people and their key supporters at this time, and how those factors shape treatment decision-making (Aim 2). This theory will provide the knowledge we need to conceptualize an age-appropriate, person-centered intervention that reduces treatment drop-out, promotes engagement, and motivates young people to envision a "pathway through care" that is meaningful for them (Aim 3), thereby helping them experience a continuity of care during this critical, early period.