Assisted Identification and Navigation of Early Mental Health Symptoms in Children

儿童早期心理健康症状的辅助识别和导航

基本信息

批准号：
10330457
负责人：
Robert B. Penfold
金额：
$ 76.79万
依托单位：
KAISER FOUNDATION RESEARCH INSTITUTE
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-01-18 至 2024-11-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10330457
关键词：
12 year old Abnormal coordination Accident and Emergency department Address Adolescent Adult Antipsychotic Agents Appointment California Caring Case Manager Child Childhood Chronic Disease Clinic Clinical Communities Consent Data Diagnosis Disease Documentation Dose Early identification Eligibility Determination Enrollment Family Family health status Goals Health Personnel Health Services Accessibility Health system Healthcare Systems Home Individual Integrated Health Care Systems Intervention Intervention Studies Logistic Regressions Machine Learning Medical Records Mental Depression Mental Health Mental Health Services Mental disorders Modeling Monitor Natural Language Processing Nurses Outcome Patients Persons Pharmaceutical Preparations Primary Health Care Process Professional counselor Provider Psyche structure Psychotherapy Registries Reporting Research Role Schedule Social Workers Symptoms Systems Integration Testing Text Therapeutic Time Videoconferencing Visit Washington Work Youth adjudication arm base burden of illness care providers child mental health service comparison intervention follow-up improved improved outcome machine learning algorithm medical specialties motivational enhancement therapy outreach peer pragmatic trial prediction algorithm predictive modeling prevent primary outcome programs random forest randomized trial recruit secondary outcome severe mental illness skills social stigma structured data time use tool treatment arm treatment as usual trial design urgent care usual care arm video visit waiver

项目摘要

ABSTRACT About 55% of children with significant mental health difficulties receive treatment and up to 80% of children with sub-clinical symptoms receive no treatment. Treatments are often not initiated until issues are significantly impacting the child and family. This study aims to conduct a pragmatic randomized trial in two non-academic health care systems to test a mental health family navigator model to promote early access to, engagement in, and coordination of needed mental health services for children. The first task of the study will focus on the implementation of a predictive model to identify symptomatic children with no diagnosed mental health disorder(s) or treatments initiated. The tool identifies patients with documentation of mental health symptoms or complaints in the free text of a progress note from a recent primary care or urgent care visit. Using this predictive algorithm, we will conduct a pragmatic randomized trial comparing intervention and usual care arm patients enrolled from Kaiser Permanente (KP) Washington and KP Northern California. The trial will enroll 200 patients per arm (n=400). Children with (1) a new mental health diagnosis but no treatment initiated; (2) a new mental health medication ordered with no mental health diagnosis; and (3) symptoms identified by the predictive model with no new mental health diagnosis or treatment initiated will be recruited. The study intervention will offer 6 months of support to the family by a mental health navigator (social worker). The navigator will perform an initial needs and barriers assessment with the family around mental health services, conduct ongoing motivational interviewing around mental health care, provide up to 4 psychotherapy sessions (when appropriate) via clinic-to-home video visits, help the family find and schedule with appropriate mental health providers in the community, and reach out ad hoc if mental health appointments or medication refills are missed. The primary outcome is the percentage of youth initiating psychotherapy. The secondary outcome is the percentage of youth with at least 4 mental health visits. We hypothesize that the intervention arm will have higher rates of psychotherapy use compared to the control arm. We will also assess initiation of psychotropic medications. All primary analyses will follow an intent-to-treat approach. A waiver of consent will be obtained to include data for all individuals offered the intervention in the analysis, regardless of the amount of intervention (“dose” of navigation) received.

抽象的大约55％的心理健康困难的儿童接受治疗，多达80％的儿童接受治疗带有临界症状没有治疗。直到问题显着之前，通常不会开始治疗影响孩子和家庭。这项研究旨在在两个非学术中进行务实的随机试验卫生保健系统测试心理健康家庭导航器模型，以促进早期进入，参与，以及为儿童提供所需的心理健康服务的协调。研究的第一个任务将重点放在实施预测模型以识别没有诊断性心理健康的有症状儿童疾病或启动的治疗方法。该工具识别出患有精神健康症状文献的患者或在最近的初级保健或紧急护理访问中的进度注释的自由文本中投诉。使用此预测算法，我们将进行一项务实的随机试验，以比较干预和通常的护理部门来自Kaiser Permanente（KP）华盛顿和KP北加州的患者。审判将注册200 每臂患者（n = 400）。患有（1）新的心理健康诊断的儿童，但没有开始治疗；（2）一个新没有心理健康诊断的心理健康药物；（3）由没有新的心理健康诊断或治疗的预测模型将被招募。研究干预将由心理健康导航员（社会工作者）为家庭提供6个月的支持。导航员将在心理健康服务方面与家人一起进行初始需求和障碍评估，进行精神卫生保健周围的持续动机访谈，提供多达4个心理治疗课程（在适当的情况下）通过诊所到家的视频访问，帮助家人以适当的心理查找和安排社区中的卫生提供者，如果心理健康任命或药物补充措施是临时的错过。主要结果是青年开始心理治疗的百分比。次要结果是至少4次心理健康就诊的青年百分比。我们假设干预部门将拥有与对照组相比，心理治疗的使用率更高。我们还将评估精神病的开始药物。所有主要分析将遵循意图对治疗方法。将获得同意的审判包括所有个人提供干预的数据，无论干预量如何（导航的“剂量”）收到。