Improving Assessment of Psychosis and Engagement in Treatment of BIPOC Individuals

黑人、土著和有色人种（BIPOC）更容易被误诊为黑色素瘤。 与非拉丁裔白色人相比， 患者除了系统性因素（例如，缺乏保险），造成差距的其他因素包括赤字 在患者-提供者通信中（例如，较少的患者参与），提供者对文化的忽视（例如，文化 疾病解释），以及健康的社会决定因素（例如，种族主义阻碍获得护理）。BIPOC 患者可能变得不满意，问得更少，隐瞒信息，并停止治疗。怎么-- 积极的沟通与围绕患者对疾病和治疗的看法达成共识有关 更多地参与服务。该项目旨在改善供应商与BIPOC的沟通， 在SZ和其他患者的门诊评估、治疗讨论、护理启动和维持期间的评估 精神病性障碍，通过调整3个会话的干预，文化制定面试参与援助（CFI- EA），精神病患者（CFI-EA/P）。这种干预是基于DSM-5文化表述 面试（CFI），一个16个项目，半结构化的面试，通过文化感知个性化的文化评估， 主动提供者通信行为（例如，开放式问题;激活语句）。CFI-EA/P在- 包括对情绪症状和健康的社会决定因素进行标准化评估，以减少误诊 SZ，并将提供者的注意力集中在参与的社会结构因素上。通过反复的利益相关者输入 （患者、临床医生、护理协调员、管理员）和混合（定性-定量）方法， 报告调整和修改框架增强（框架），我们建议调整， 在BIPOC患者占90%的大型门诊精神卫生系统中，实现和试点CFI-EA/P。 研究设计完成了NIH干预开发阶段模型的第一阶段，包括： CFI-EA/P手册、培训讲习班和保真度工具的改编（第1a阶段）; EA/P对患者和临床医生的可行性和可接受性（第1b阶段）;以及试点测试服务结果 （治疗参与、文化上有能力的沟通、共同决策、诊断一致性 研究评估）和患者结局（症状改善、生活质量和心理社会功能， 在一个小型随机对照试验中，为将来更大的试验提供信息（阶段1c）。与ALAC一致- RITY模式，CFI-EA/P将可立即在社区门诊诊所使用， BIPOC个人获得精神病治疗的护理中的着装差异。研究结果将 指导进一步研究CFI-EA/P。

Black, Indigenous and People of Color (BIPOC) individuals are more likely to be misdiagnosed with schizophre- nia (SZ) and other psychotic disorders and to disengage from mental health services than non-Latinx White patients. In addition to systemic factors (e.g., lack of insurance), other contributors to disparities include deficits in patient-provider communication (e.g., less patient participation), provider inattention to culture (e.g., cultural illness explanations), and social determinants of health (e.g., racism impeding access to care). Hence, BIPOC patients can become dissatisfied, ask fewer questions, withhold information, and discontinue treatment. How- ever, positive communication is linked to negotiating consensus around patients' views of illness and treatment with greater engagement in services. This project aims to improve provider communication with BIPOC individ- uals during outpatient assessment, treatment discussions, care initiation, and maintenance for SZ and other psychotic disorders by adapting a 3-session intervention, Cultural Formulation Interview-Engagement Aid (CFI- EA), for individuals with psychosis (CFI-EA/P). This intervention is based on the DSM-5 Cultural Formulation Interview (CFI), a 16-item, semi-structured interview to personalize cultural assessment through culturally sensi- tive provider communication behaviors (e.g., open-ended questions; activation statements). The CFI-EA/P in- cludes standardized assessments of mood symptoms and social determinants of health to reduce misdiagnosing SZ and to focus provider attention on socio-structural factors in engagement. With iterative stakeholder input (patients, clinicians, care coordinators, administrators) and mixed (qualitative-quantitative) methods guided by the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME), we propose to adapt, manu- alize, and pilot the CFI-EA/P in a large outpatient mental health system with a 90% BIPOC patient population. The study design completes Stage I of the NIH Stage Model of Intervention Development, including: iterative adaptation of the CFI-EA/P manual, training workshop, and fidelity instrument (Stage 1a); evaluation of the CFI- EA/P's feasibility and acceptability for patients and clinicians (Stage 1b); and pilot testing service outcomes (treatment engagement, culturally competent communication, shared decision making, diagnostic concordance with research assessment) and patient outcomes (symptom improvements, quality of life, and psychosocial func- tioning) in a small randomized controlled trial to inform a future larger trial (Stage 1c). Consistent with the ALAC- RITY model, the CFI-EA/P would be available for immediate use in community-based outpatient clinics to ad- dress disparities in the care of BIPOC individuals accessing care for psychotic disorders. Study findings will guide further research on the CFI-EA/P.