Harlem Strong Mental Health Coalition: A Multi-sector Community-Engaged Collaborative for System Transformation

摘要 解决健康差距，特别是在面对COVID-19的情况下，需要一个综合的多部门公平， 以社区为基础的方法。第一，社区合作网络，以吸引社区参与，加强基于社区的 安全网系统，增加与各种服务的联系，并促进社区范围内的卫生健康意识， 13其次，在网关环境中将任务转移给非卫生保健提供者的卫生保健支持技能被认为是有效的， 解决全球MH短缺问题，但在美国低收入住房开发方面尚未得到充分研究。 第三，流行病方法不仅可以增加健康和心理健康服务的治疗参与度，而且还可以 可为面临多重护理障碍的少数族裔提供更大的效力。 在CBPR流程的指导下，我们的哈莱姆强协作（纽约市立大学公共卫生研究生院，哈莱姆 健康倡议，精神健康创新中心和哈莱姆社区改善大会）将在 扩大到包括健康第一（管理式保健提供者）及其初级保健实践和协调网络 行为保健（行为健康提供者），以建立一个多部门联盟，共同努力，实施扩大的 社区协作模式的循证精神卫生哈莱姆居民通过两个战略 网关（低收入住房开发和初级保健）。我们还将利用纽约市立大学的其他研究所、中心， 和Firefly Innovations，以支持专注于技术创新的黑客团队，以解决障碍和需求 被哈莱姆强势联盟认定 我们的提案审查了哈莱姆强大的社区心理健康和经济赋权的影响 协作，一个社区范围的多部门联盟，其中健康保险公司与社区为基础的 组织和医疗及行为健康提供者（1）解决融资、获取和护理质量问题 障碍，（2）支持社区卫生工作者分担精神卫生任务的能力建设，（3）促进 在心理健康/行为健康、初级保健和社会服务方面进行协调和合作，以及（4）确定 一组用于持续系统质量改进的通用度量和策略。该研究将评估 使用实施效果混合设计评估哈莱姆强的影响和成本效益 在系统和消费者成果方面进行协作。我们还将描述实施成果和关键信息提供者 访谈以探索社区参与、组织变量和供应商因素对模型影响的影响。 我们研究的长期目标是开发一种可持续的任务分担精神卫生保健模式， 嵌入在协调的综合服务网络中。

Abstract Addressing health disparities, especially in the face of COVID-19, requires an integrated multisector equity-focused, community-based approach. First, community-partnered networks to engage communities, strengthen community-based safety net systems, increase linkages to a wide variety of services, and promote community-wide MH awareness are needed.13 Second, task-shifting MH support skills to non-MH providers in gateway settings has been found to effectively address MH shortages worldwide, but has not been well studied in the U.S for low-income housing developments.14-18 Third, a syndemic approach can not only increase treatment engagement in health and mental health services, but also may offer greater effectiveness for ethnic minorities with multiple barriers to care.19 Guided by a CBPR process, our Harlem Strong Collaborative (CUNY Graduate School of Public Health, Harlem Health Initiative, Center for Innovation in Mental Health, and Harlem Congregation for Community Improvement) will be expanded to include Healthfirst (Managed Care Provider), and their network for primary care practices and Coordinated Behavioral Care (Behavioral Health Provider) to create a multisector coalition to work together to implement an expanded model of community collaborative care for evidence-based mental health to Harlem residents through two strategic gateways (low-income housing developments and primary care). We will also leverage other CUNY institutes, centers, and Firefly Innovations to support a hackathon focused on technological innovations to address barriers and needs identified by the Harlem Strong Coalition. Our proposal examines the impact of Harlem Strong Community Mental Health and Economic Empowerment Collaborative, a community-wide multisectoral coalition in which a health insurer works with community-based organizations and medical and behavioral health providers to (1) problem solve financing, access, and quality of care barriers, (2) support capacity building for mental health task-sharing for community health workers, (3) facilitate coordination and collaboration across mental health / behavioral health, primary care, and social services, and (4) identify a set of common metrics and strategies for continuous system quality improvement. The research study will evaluate the impact and cost-effectiveness using a hybrid Implementation-Effectiveness design to assess effects of the Harlem Strong Collaborative on system and consumer outcomes. We will also describe implementation outcomes and key informant interviews to explore impact of community engagement, organization variables, and provider factors on model impact. The long-term goal of our study is to develop a sustainable model for task-sharing mental health care that will be embedded in a coordinated comprehensive network of services.