Reducing the Duration of Untreated Illness Among Youth in the Juvenile Justice System with Psychosis-Spectrum Disorders

缩短少年司法系统中患有精神病谱系障碍的青少年未治疗疾病的持续时间

• 批准号: 9763661
• 负责人: Anthony Spirito
• 金额: $ 24.43万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-15 至 2021-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9763661
• 关键词: Adolescence; Adolescent; Adolescent and Young Adult; Age; Applications Grants; Attitude; Awareness; Caring; Client; Clinical; Community Health; Criminal Justice; Data; Delusions; Disease; Early Intervention; Early identification; Enrollment; Ethnic Origin; Family; Future; Gender; Goals; Hallucinations; Hand; Healthcare; Human Resources; Individual; Institutes; Intake; Interview; Justice; Literature; Maps; Massachusetts; Measures; Mental Health; Mental disorders; Motivation; Outcome; Pathway interactions; Patients; Penetration; Phase; Procedures; Prognostic Factor; Protocols documentation; Psychotic Disorders; Questionnaires; Race; Recording of previous events; Reporting; Research; Rhode Island; Risk; Role; Sampling; Sensitivity and Specificity; Services; Structure; Symptoms; System; Telephone; Testing; Text Messaging; Thinking; Training; United States; Youth; associated symptom; attenuated psychosis syndrome; care systems; clinically significant; court; critical period; design; experience; first episode psychosis; follow-up; improved; instrument; intervention effect; juvenile justice system; medical specialties; population based; programs; psychiatric symptom; psychotic symptoms; screening; service intervention; standard care

Project Summary Among adolescents in the Juvenile Justice System (JJS), an estimated 3% have a psychotic illness, and it can be reasonably assumed that many more experience subthreshold psychotic- spectrum symptoms that may be indicative of risk. Evidence suggests that as many as 25% of those with first episode psychosis (FEP) have their first contact with care through criminal justice agencies. Duration of untreated psychosis (DUP), a negative prognostic factor, has been shown to be longer among those within the criminal justice system. This suggests that youth with psychotic symptoms who end up in the JJS may not receive appropriate mental health care. The current study will be conducted in the Rhode Island Family Court Juvenile Intake Department where all youth receive a mental health screen (Massachusetts Youth Screening Instrument – 2nd Ed; MAYSI -2). All youth who screen positive on the MAYSI-2 Thought Disturbance scale, and a second gate screening with the Prodromal Questionnaire – Brief Version (PQ-B), will be given referral information for Coordinated Specialty Care (CSC) services by JJS staff. Enrolled families will also participate in the research assessment, regardless of whether they pursue the CSC referral, which involves the Structured Interview for Psychosis-risk Syndromes [SIPS] and other measures to thoroughly assess history of psychotic symptoms, comorbid difficulties, and mental health care engagement. A comparison sample of youth who screen negative on the MAYSI-2 Thought Disturbance subscale will also be assessed with the SIPS to determine accuracy of the MAYSI-2/PQ-B screen in the identification of psychosis-risk. During the first phase of the study, JJS staff will follow standard procedures in referring youth to the state CSC. In the second phase of the study, JJS will be instructed in an enhanced referral/linkage to care protocol, including a “warm hand-off” where referrals will be put in direct and immediate contact with CSC staff. CSC staff will also be trained in procedures to increase the likelihood of follow through with the referral to the CSC. Three month follow-up qualitative interviews and quantitative assessments regarding referral pathways, bottlenecks and gaps in care, youth psychiatric symptoms, and JJS contacts will be conducted. This design maps onto the stated goals of PAR 16- 264 including: 1) Identify baseline rates of DUP within the JJS (and we will also look at rates of psychosis-spectrum symptoms and disorders); 2) Map referral pathways to CSC; 3) Identify implementation and service level factors that create bottlenecks and gaps in linkage to the CSC; 4) Investigate the relationship between treatment linkage and psychotic symptoms/DUP; and, 5) Pilot test feasible strategies for reducing DUP.

项目摘要 在青少年司法系统（JJS）的青少年中，估计有3％的人患有精神病 疾病，可以合理地假设，更多的经验亚阈值subsithold spechaties- 可能表明风险的频谱症状。有证据表明多达25％ 那些患有精神病（FEP）的人首次通过刑事与 正义机构。未经治疗的精神病持续时间（DUP）是一个负面的预后因素，已经是 在刑事司法系统中显示的人更长。这表明青年 最终出现在JJS的精神病症状可能无法获得适当的心理健康 关心。当前的研究将在罗德岛家庭法院少年摄入量进行 所有年轻人都会收到心理健康屏幕的部门（马萨诸塞州青年筛查 乐器 - 第二版； Maysi -2）。所有对Maysi-2思想呈现阳性的年轻人 干扰量表，并使用前驱问题问卷进行第二门筛查 - 简短 版本（PQ-B）将获得协调专业护理（CSC）服务的推荐信息 由JJS工作人员。注册家庭也将参加研究评估 他们是否追求CSC推荐，涉及精神病风险的结构化访谈 综合征[SIPS]和其他措施，以彻底评估精神病症状的病史， 合并的困难和心理保健参与。一个年轻人的比较样本 Maysi-2思维干扰子量表上的屏幕否为负面 SIPS在鉴定精神病风险中确定Maysi-2/PQ-B筛查的准确性。 在研究的第一阶段，JJS工作人员将遵循标准程序，将青年推荐给 州CSC。在研究的第二阶段，将在增强的 转介/链接到护理方案，包括“温暖的交接”，将转介直接投入转介 并立即与CSC员工联系。 CSC员工还将接受有关增加的程序的培训 遵循转介到CSC的可能性。三个月的随访定性 有关推荐途径，瓶颈和差距的访谈和定量评估 将进行护理，青年精神病症状和JJS接触。此设计映射到 既定的目标16-264的目标包括：1）确定JJS内的DUP基线率（和 我们还将研究精神病症状和疾病的率）； 2）地图转介 通往CSC的途径； 3）确定创建瓶颈的实施和服务水平因素 和与CSC的链接差距； 4）调查治疗联系与 精神病症状/DUP； 5）试点测试可行的策略，以减少DUP。