Peer-Delivered and Technology-Assisted Integrated Illness Management and Recovery

项目摘要 患有严重精神疾病（SMI）的成年人不成比例地受到医学合并症的影响， 与一般人口相比，预期寿命缩短了10至25年。这些高比率的 发病率和早期死亡率与医疗和精神疾病管理不当有关。我们 系统回顾发现了9种有效的自我管理干预措施， 成人SMI患者的疾病。然而，由于这两个原因，这些干预措施的采用有限。 供应商和消费者因素。供应商方面的障碍包括缺乏足够的劳动力 有能力，时间和知识的有效方法，以自我管理支持的成年人与SMI 和慢性健康问题。消费者对自我保护的参与有限， 管理计划包括缺乏访问，参与和持续的社区支持， 患有SMI的人。同伴支持专家有可能解决这些障碍，因为它们是一个 在心理健康劳动力中增长最快的部门中，有自我管理的“生活经验”。 实践，并提供获得社区支持的机会。然而，需要解决同行面临的挑战， 有效提供循证干预措施。例如，同行经常接受培训， “同伴支持”被描述为“基于尊重、分享和尊重的关键原则给予和接受帮助”。 责任，并相互同意什么是有益的”。同伴支持与增加 控制感，做出改变的能力，以及减少精神症状。尽管有好处， 不坚持精神病和医疗自我管理的循证实践，不遵循 确保忠实性和系统监测结果的协议。我们假设移动的技术 通过提供忠实追随者的实时指导来克服同伴支持的这些限制的潜力 提供同行提供的技术辅助循证自我管理干预（PDTA-IIMR）。 这个K 01奖项的目的是建立必要的专业知识，以追求职业发展和测试 新的方法，以同行交付的循证自我管理干预措施。培训将包括： 制定同行提供的干预措施;开发和设计移动的保健支助 干预;干预临床试验研究。与此同时，我建议修改干预协议， 然后，我将通过以用户为中心的设计来增强这个协议; 最后，我将进行一项试点研究，评估PDTA-IIMR的可行性和潜在有效性， 常规同伴支持N=6同龄人和N=40成人与SMI和慢性健康状况。成果 包括可行性、医疗和精神自我管理技能以及功能能力。我们将探讨 死亡率的危险因素，并检查自我效能和社会支持的结果的机制。

PROJECT SUMMARY Adults with serious mental illness (SMI) are disproportionately affected by medical comorbidity, earlier onset of disease, and 10 to 25 years reduced life expectancy compared to the general population. These high rates of morbidity and early mortality are associated with inadequately managed medical and psychiatric illnesses. Our systematic review found nine effective self-management interventions that address medical and psychiatric illnesses in adults with SMI. However, there has been limited adoption of these interventions due to both provider and consumer-based factors. Provider-based barriers consist of the lack of an adequate workforce with the capacity, time, and knowledge of effective approaches to self-management support for adults with SMI and chronic health conditions. Consumer-based barriers associated with limited participation in self- management programs include lack of access, engagement, and ongoing community-based support for persons with SMI. Peer support specialists have the potential to address these barriers as they comprise one of the fastest growing sectors of the mental health workforce, have “lived experience” in self-management practices, and offer access to support in the community. However, challenges need to be resolved for peers to be effective providers of evidence-based interventions. For example, peers are frequently trained to provide “peer support” described as “giving and receiving help founded on key principles of respect, shared responsibility, and mutual agreement of what is helpful”. Peer support has been associated with increased sense of control, ability to make changes, and decreased psychiatric symptoms. Despite benefits, peer support does not adhere to evidence-based practices for psychiatric and medical self-management and does not follow protocols that ensure fidelity and systematically monitor outcomes. We hypothesize that mobile technology has the potential to overcome these limitations of peer support by providing real-time guidance in fidelity adherent delivery of a peer-delivered, technology-assisted evidence-based self-management intervention (PDTA-IIMR). The purpose of this K01 award is to build the necessary expertise to pursue a career developing and testing novel approaches to peer-delivered evidence-based self-management interventions. Training will include: development of peer-delivered interventions; development and design of mobile health-supported interventions; and intervention clinical trials research. Concurrently, I propose to refine the intervention protocol with input from peers and consumers; then, I will enhance this protocol through user-centered design; and lastly, I will conduct a pilot study evaluating the feasibility and potential effectiveness of PDTA-IIMR compared to routine peer support for N=6 peers and N=40 adults with SMI and chronic health conditions. Outcomes include feasibility, medical and psychiatric self-management skills, and functional ability. We will explore mortality risk factors and examine self-efficacy and social support as mechanisms on outcomes.