Impact of peer Support on Health Services and Social Disparities Among Minority Youth with SMI

项目总结/摘要 这项混合方法的研究旨在评估同伴支持是否减少了精神卫生服务的差异 16-24岁的过渡年龄青年（TAY）严重精神疾病（SMI）的利用和社会结果。 患有SMI的TAY在向成年过渡的过程中面临着巨大的挑战，并且表现出较低的 受教育程度和失业率较高，贫穷，意外怀孕，药物使用， 无家可归和司法系统的参与比没有SMI的TAY。这些差距加剧了 少数民族的TAY。因此，非常需要基于证据的、针对文化的干预措施， 有效地将TAY与可以改善其心理健康和社会成果的资源联系起来。2004年的加州 《精神卫生服务法》资助了数百个新的TAY特定项目;而TAY同伴支持服务 现在在心理健康项目中很普遍，关于他们对患有SMI的TAY的有效性的证据是 大部分缺乏。因此，本研究的目的是（1）定量估计是否使用同伴支持， 减少患有重度精神障碍的TAY患者在心理健康服务和社会结果方面的种族/民族差异; (2)定量地确定哪些类型或组合的同伴支持是最有效的，在提高心理 （3）减少TAY中的种族/民族差异; 与向TAY提供同伴支持服务相关的额外心理健康服务成本或成本节约; (4)Qualitative阐明TAY客户和同行提供者对TAY同行支持如何与以下内容相关的看法： 心理健康服务和社会结果的差距;（5）素质的特点障碍， 促进者使用TAY同行支持TAY项目经理和县管理员。满足 为了实现这些目标，我们将调查TAY项目（N=140），分析五年的管理数据以评估成本， 与使用同伴支持服务相关的成本节约（N= 8，800，目标1-3）和进行小组讨论 与TAY同行提供者的访谈（n=30-40），与TAY客户的焦点小组（n=60-80），以及个人 采访TAY项目经理（n=20）和县行政人员（n=6-10）（目标4和5）。这 这项研究利用了加州精神卫生系统的一项重大系统重新设计，旨在严格研究 大规模实施TAY同伴支持服务。调查结果将帮助供应商和政策制定者 关于同伴支持在减少少数TAY生活差异方面的有效性的知情决定 与SMI合作，使我们能够就使用TAY同行支持的潜在最佳实践提出建议。

Project Summary/Abstract This mixed methods study aims to assess whether peer-support reduces disparities in mental health service utilization and social outcomes among transitional age youth (TAY) age 16-24 with severe mental illness (SMI). TAY with SMI face extraordinary challenges in their transition to adulthood and exhibit lower levels of educational attainment, and higher rates of unemployment, poverty, unplanned pregnancy, substance use, homelessness, and justice system involvement than TAY without SMI. These disparities are exacerbated among minority TAY. Therefore, there is a great need for evidence-based, culturally tailored interventions that effectively link TAY to resources that can improve their mental health and social outcomes. The 2004 California Mental Health Services Act funded hundreds of new TAY-specific programs; while TAY peer support services are now pervasive in mental health programs, evidence regarding their effectiveness for TAY with SMI is largely lacking. Therefore, this study aims to (1) Estimate quantitatively whether the use of peer support reduces racial / ethnic disparities in mental health services and social outcomes among TAY living with SMI; (2) Identify quantitatively which types or combinations of peer supports are most effective at improving mental health services and social outcomes and reducing racial / ethnic disparities among TAY; (3) Estimate the additional mental health service costs or cost savings associated with providing peer support services to TAY; (4) Qualitatively elucidate TAY clients’ and peer providers’ perceptions of how TAY peer support relates to mental health services and social outcomes disparities; and (5) Qualitatively characterize barriers and facilitators to the use of TAY peer support by TAY program managers and county administrators. To meet these aims, we will survey TAY programs (N=140), analyze five years of administrative data to assess costs or cost-savings associated with using peer support services (N=8,800, Aims 1-3) and conduct small group interviews with TAY peer providers (n=30-40), focus groups with TAY clients (n=60-80), and individual interviews with as TAY program managers (n=20) and county administrators (n=6-10) (Aims 4 and 5). This study leverages a major system redesign in California’s mental health system and aims to rigorously study a large-scale implementation of TAY peer support services. Findings will help providers and policy-makers make informed decisions about the effectiveness of peer support in reducing disparities among minority TAY living with SMI and enable us to make recommendations on potential best-practices in the use of TAY peer supports.