Project 2: Managed care updates of subscriber justice system involvement for suicide prevention

摘要(项目2：托管服务更新) 每年有超过1000万人通过美国监狱。在监狱里自杀的风险特别高 放手。当个人失去照顾并经历症状恶化时，他们往往会被逮捕。监狱 拘留可能会扰乱现有的护理，并提供额外的压力来源。然而，高额的入狱人数和 排泄量(每年1000万英镑)，监狱停留时间只有几天，人员不足意味着 美国S监狱的大部分3,100个县和地方监狱没有能力协调看护。在监狱外，许多人 参与司法的个人得到公共资助系统中的专业人员的支持，他们通常是 没有意识到他们的客户正在坐牢，可能会因为错过约会而放弃客户。由此导致的缺乏照顾 或者零散的护理导致不必要的自行车进出监狱，以及与自杀有关的发病率和死亡率。 更好地协调县监狱和医疗系统之间的护理被广泛认为是 这一点至关重要，但很难大规模实现。为了解决这个问题，一家大型的医疗补助管理保健组织 (MCO；CareSource)和一家司法数据供应商合作跟踪县监狱预订并发布俄亥俄州的数据 CareSource通过使用公开可用的数据的算法实现，可推广到其他医疗保健/MCO。这个 目标是帮助CareSource确保订阅者在入狱后获得所需的社区护理 释放，并最大限度地减少因监狱拘留而对现有护理造成的干扰。像CareSource这样的MCoS是理想的 帮助解决系统碎片化问题的组织，因为它们跨越多个行为健康(BH)护理 系统(仅在俄亥俄州就有400个)和多个县监狱(仅在俄亥俄州就有88个)。2019年，43,000人(5.4%) CareSource在俄亥俄州总共有80万成人订户，其中包括2306名孕妇，他们在监狱里度过了一段时间。 CareSource正在探索确保这些订户获得所需护理的方法。 这项提案涉及两项关于循证自杀预防实践的研究，这些实践由 CareSource正义通知，采用2x2析因设计。第一项研究将随机选择CareSource的 ~43,000名俄亥俄州订户在12个月内通过监狱收到由 CareSource或照常护理。第二项研究(同时进行)将涉及约6,000人的子集 在过去的6个月里，在12家大型BH机构中的一家看到了43,000名通过监狱的订阅者 在监狱拘留之前。使用阶梯式楔形设计，随着时间的推移，这12家机构将上线， 接收(A)关于监狱拘留/释放的通知，以及重新让客户参与服务的指示；和(B) 安全计划干预的培训，以及当订阅者有既往医疗记录时使用它的通知 经过治疗的自杀未遂(由CareSource通过索赔数据确认)从监狱获释。结果包括 医疗自杀未遂、各种原因的伤害和中毒、服务利用率、成本效益和 实施数据。这个为期两年的混合动力I型“探索性”中心项目正在全力推进，并取得了成效 最终的有效性结果，可以立即进行扩展，以改善全国的自杀预防。

Abstract (PROJECT 2: Managed Care Updates) More than 10 million people pass through US jails each year. Suicide risk is especially high at jail release. Individuals are often arrested when they are out of care and experiencing worsening symptoms. Jail detention may disrupt existing care and provide additional stressors. However, high jail admission and discharge volumes (>10,000,000 per year), jail stays that only last a few days, and understaffing mean that most of the U.S.’s ~3,100 county and local jails do not have the capacity to coordinate care. Outside jail, many justice-involved individuals are supported by professionals in publicly funded systems, who are typically unaware that their client was in jail and may drop the client for missing appointments. The resulting lack of care or fragmented care leads to unnecessary cycling in and out of jail and suicide-related morbidity and mortality. Better coordination of care between county jails and healthcare systems is widely acknowledged as crucial but difficult to achieve at scale. To address this problem, a large Medicaid managed care organization (MCO; CareSource) and a justice data vendor partnered to track county jail booking and release data for Ohio CareSource through an algorithm using publicly available data, generalizable to other healthcare/MCOs. The goal was to help CareSource ensure that subscribers were connected to needed community care following jail release and to minimize disruptions of any existing care due to jail detention. MCOs like CareSource are ideal organizations to help address system fragmentation because they span multiple behavioral health (BH) care systems (400 in Ohio alone) and multiple county jails (~88 in Ohio alone). In 2019, 43,000 (5.4%) of CareSource’s 800,000 total adult subscribers in Ohio, including 2,306 pregnant women, spent time in jail. CareSource is exploring ways to ensure that these subscribers receive needed care. This proposal involves two studies of evidence-based suicide prevention practices triggered by CareSource justice notifications, in a 2x2 factorial design. The first study will randomize CareSource’s ~43,000 Ohio subscribers who pass through jails over 12 months to receive Caring Contact letters sent by CareSource or to Care as Usual. The second study (running simultaneously) will involve a subset of ~6,000 of the 43,000 subscribers passing through jail who were seen in one of 12 large BH agencies in the 6 months prior to jail detention. Using a stepped wedge design, the 12 agencies will be brought online over time, receiving (a) notifications of jail detentions/releases with instructions for re-engaging clients in services; and (b) training in the Safety Planning Intervention plus notification to use it when a subscriber with past medically treated suicide attempts (identified by CareSource through claims data) is released from jail. Outcomes include medically treated suicide attempts, all-cause injury and poisoning, service utilization, cost-effectiveness, and implementation data. This Hybrid Type I 2-year “Exploratory” Center project is fully powered, yielding definitive effectiveness results that can be scaled immediately to improve suicide prevention nationally.