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

项目 2：订户司法系统参与自杀预防的管理护理更新

• 批准号: 10441874
• 负责人: Sarah A Arias
• 金额: $ 28.28万
• 依托单位: MICHIGAN STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-22 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10441874
• 关键词: Address; Admission activity; Adult; Algorithms; Appointment; Books; Budgets; Caring; Client; Communities; County; Data; Direct Costs; Drops; Effectiveness; Ensure; Ethics; Feeling suicidal; Funding; Future; General Population; Goals; Health; Health Care Visit; Health Services; Healthcare; Healthcare Systems; Hybrids; Individual; Information Systems; Injury; Inpatients; Instruction; Intervention; Investments; Jail; Justice; Lead; Legal; Letters; Life; Link; Managed Care; Mediator of activation protein; Medicaid; Medical; Mental Health; Mental Health Services; Morbidity - disease rate; National Institute of Mental Health; Notification; Ohio; Outcome; Outcome Study; Outpatients; Persons; Poisoning; Population; Practice based research; Pregnant Women; Prevention Research; Prisons; Provider; Publishing; Randomized; Reporting; Request for Proposals; Research; Risk Assessment; Role; Running; Safety; Savings; Services; Suicide; Suicide attempt; Suicide prevention; Symptoms; System; Testing; Time; Training; Update; Vendor; behavioral health; care coordination; clinical care; cost; cost effectiveness; design; evidence base; experience; implementation outcomes; implementation process; implementation strategy; implementation trial; improved; innovation; intervention effect; mortality; program costs; reducing suicide; research to practice; scale up; service member; service utilization; stressor; suicidal behavior; suicidal risk; suicide rate

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.

摘要（项目2：托管护理更新） 每年有超过1000万人通过美国监狱。自杀风险在监狱中特别高 发布。当个人失去护理和经历后悔症状时，他们通常会被捕。监狱 拘留可能会破坏现有的护理并提供其他压力源。但是，高监狱入场和 排放量（每年> 10,000,000），监狱停留只持续几天，并且理解意味着 美国大多数约3,100个县和当地监狱都没有协调护理的能力。在监狱外，许多人 涉及正义的个人得到了公共资助系统中的专业人员的支持，他们通常是 不知道他们的客户正在监狱中，可能会因失踪的任命而放弃客户。导致缺乏护理 或分散的护理导致不必要的骑自行车进出监狱，并与自杀有关的发病率和死亡率。 县监狱与医疗保健系统之间更好地协调护理 至关重要但很难在大规模上实现。为了解决这个问题，大型医疗补助托管组织 （MCO; Caresource）和一个司法数据供应商合作跟踪县监狱预订和发布俄亥俄州的数据 使用算法使用公开可用的数据来关注其他医疗保健/MCOS。这 目标是帮助CareSource确保订户在监狱后与所需的社区护理联系 释放并最大程度地减少因监禁拘留而造成的任何现有护理的中断。像Caresource这样的MCOS是理想的 组织跨越多重行为健康（BH）护理的组织，以解决系统分裂 系统（仅在俄亥俄州就有400个）和多个县监狱（仅俄亥俄州就有88个）。 2019年，有43,000（5.4％） Caresource在俄亥俄州的800,000名成人总订户（包括2,306名孕妇）在监狱中度过了一段时间。 Caresource正在探索确保这些订户获得所需护理的方法。 该提案涉及两项研究的研究 Caresource司法通知，在2x2阶乘设计中。第一个研究将随机将Caresource的 〜43,000个俄亥俄订户，他们在12个月内经过监狱，收到发送的关怀联系信 照顾或照常照顾。第二项研究（同时运行）将涉及约6,000的子集 在6个月中12个大型BH机构之一中，有43,000名通过监狱中的订户中有一个 在监禁之前。使用阶梯楔形设计，这12个机构将随着时间的推移在线上 接收（a）通知监狱拘留/释放，并通过指示重新参与服务的客户； （b） 在安全计划干预措施以及通知中使用该通知时使用它的培训 从监狱中释放出处理过的自杀企图（由Caresource通过索赔数据确定）。结果包括 受过医学治疗的自杀企图，全因伤害和中毒，服务利用，成本效益和 实施数据。这个I型I型2年“探索”中心项目已完全动力，产生 可以立即扩展的确定有效性结果，以改善全国范围内的自杀预防。