A Family Peer Navigator Model to Increase Access and Initial Engagement in Coordinated Specialty Care Programs Among Black Families

摘要 家庭成员在促进心理健康服务的启动方面发挥着关键作用。然而，黑人/非洲人 美国家庭经常遇到获得协调专科护理的障碍和延误 程序。这些延迟可以归因于个人(例如，知识)、人际(例如， (例如，联系)、社区(例如，接入)和社会(例如，歧视)因素。在其他与健康相关的领域 在地区，同行导航员模式改善了获得急需的服务的机会，并促进了更多积极的 个人和他们的家庭之间的经验。然而，一直没有家庭同行导航员 为解决影响黑人/非裔美国家庭改善准入的复杂性而开发的模式 到协调的特殊护理项目。初步研究表明，大约70%的黑人/非洲人 美国家庭成员报告称，在首次诊断和接受服务之前没有与临床医生接触 治疗早期精神病。在黑人/非裔美国人中，家庭成员在服务前和服务期间参与 首发精神病的治疗显著影响青年的临床和功能结果 登记参加协调的特殊护理计划。在形成性研究的基础上，这种混合方法研究 将分三个阶段开发、完善和试运行多组件家庭对等导航器 旨在增加黑人家庭获得和参与协调的特殊护理计划的模式。 一个社区咨询委员会将在每个第二阶段和第三阶段提供反馈，以完善导航员模型。 家庭对等导航器模式将利用基于电话的策略，并涵盖文化 制定访谈，为家庭心理教育和护理协调量身定做。第一阶段和第二阶段利用 探索性-序贯混合方法设计改进家庭对等导航器模型及实现 策略。第一阶段包括与协调的专科护理主任和提供者进行定性访谈，以及 代理级管理员。第二阶段是一个为期4个月的公开试验，将招募多达10个黑人家庭。阶段 III将由嵌入式混合方法设计的家庭Peer Navigator随机试点试验组成 在两个协调的专科护理项目中，针对低重症护理协调的模式。这个 可接受性、可行性和初步影响将在40名黑人/非裔美国人的样本中进行评估 亲人有精神病风险或正在经历第一次精神病发作的家庭。其他 结果包括建议的治疗目标(自我效能、知识、社会联系)、初步 影响结果(协调专业护理计划的时间、最初的家庭参与)，以及 执行结果(可接受性、可行性、适当性)。这项研究将建立一个创新的 了解文化信息的家庭同行导航员模型并生成初步数据以支持类型II混合 有效性-实施R01应用程序。

ABSTRACT Family members have a key role in facilitating the initiation of mental health services. Yet, Black/African American families often encounter barriers and experience delays accessing coordinated specialty care programs. These delays can be attributed to individual (e.g., knowledge), interpersonal (e.g., connectedness), community (e.g., access), and societal (e.g., discrimination) factors. In other health related areas, peer navigator models improve access to much needed services and promote more positive experiences among individuals and their families. However, there are have been no family peer navigator models developed to address the complexities that impact Black/African American families to improve access to coordinated specialty care programs. Preliminary research suggests approximately 70% of Black/African American family members report no contact with clinicians prior to initial diagnosis and the receipt of services for early psychosis. Among Black/African Americans, family member engagement prior to services and during treatment for first episode psychosis significantly impacts clinical and functional outcomes among youth enrolled in coordinated specialty care programs. Building upon formative research, this mixed methods study will be conducted in three phases to develop, refine, and pilot-test a multi-component Family Peer Navigator model designed to increase access and engagement in coordinated specialty care programs Black families. A community advisory board will provide feedback during each Phase II and III to refine the navigator model. The Family Peer Navigator model will utilize telephone-based strategies and encompass the Cultural Formulation Interview to tailor family psychoeducation and care coordination. Phase I and Phase II utilize an exploratory-sequential mixed methods design to refine the Family Peer Navigator model and implementation strategy. Phase I involves qualitative interviews with coordinated specialty care directors and providers, and agency-level administrators. Phase II is a 4-month open trial that will recruit up to 10 Black families. Phase III will consist of an embedded mixed methods designed randomized pilot trial of the Family Peer Navigator model against a low-intensive care coordination in two coordinated specialty care programs. The acceptability, feasibility, and preliminary impact will be assessed in a sample of 40 Black/African American families with a loved one at risk for psychosis or currently experiencing their first episode of psychosis. Other outcomes include proposed treatment targets (self-efficacy, knowledge, social connectedness), preliminary impact outcomes (time to coordinated specialty care programs, initial family engagement), and implementation outcomes (acceptability, feasibility, appropriateness). This study will establish an innovative culturally informed family peer navigator model and generate preliminary data to support a Type II hybrid effectiveness-implementation R01 application.