Reducing Duration of Untreated Psychosis through Early Detection in a Large Jail System

通过在大型监狱系统中进行早期检测来缩短未经治疗的精神病的持续时间

基本信息

批准号：
9976613
负责人：
MICHAEL T COMPTON
金额：
$ 30.75万
依托单位：
COLUMBIA UNIVERSITY HEALTH SCIENCES
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-07-15 至 2022-10-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9976613
关键词：
African American Age Antipsychotic Agents Australia Canada Caring Cities Clinic Clinical Communities Complement Consensus County Crime Criminal Justice Data Disadvantaged Disease remission Early Diagnosis Early Intervention Education Enrollment Focus Groups Funding Future General Population Goals Grant Health Services Imprisonment Individual Institutes Institution International Intervention Interview Island Jail Justice Knowledge Lead Link Manuals Measurable Measures Mediator of activation protein Mental Health Mental disorders Modeling National Institute of Mental Health New York New York City Outcome Pathway interactions Patients Persons Pharmaceutical Preparations Population Positioning Attribute Prevalence Process Psychotic Disorders Quality of life Recording of previous events Research Sampling Self Efficacy Services Severities Site Social Workers Specialist Symptoms System Telephone Testing Time Training Universities Vulnerable Populations Western Europe Work Youth base behavioral construct care systems college community clinic design dissemination research effectiveness research effectiveness trial efficacy study evidence base expectation experience first episode psychosis health disparity improved outcome innovation interest medical specialties novel peer person centered posters primary care setting programs psychotic symptoms residence screening shared decision making skills social cognitive theory social disadvantage stem success theories therapy development young adult

项目摘要

Longer duration of untreated psychosis (DUP) is linked to poorer outcomes in first-episode psychosis (FEP). Coordinated Specialty Care (CSC), exemplified by New York State’s OnTrackNY programs, improves outcomes through early, multi-component care; however, DUP remains unacceptably long. There is evidence that young adults with FEP who are involved in the criminal justice (CJ) system (where there is likely a much greater prevalence of undetected, untreated psychosis than in the general population) have an alarmingly long DUP. Thus, although primary care settings (e.g., clinics) and educational institutions (e.g., colleges) may be important sites for early detection, there is a need to establish early detection services within the CJ system (and in particular, urban jails) and to create pathways from CJ involvement to CSC enrollment. Relying on prior research, relevant theory, and our findings on DUP, pathways to care, CSC, and the CJ system, we propose 4 intervention development aims. First, we will implement a “Public Information Campaign” (PIC) in 2 jails at New York City’s Rikers Island, which will detect FEP earlier, reduce our DUP-1 (psychosis onset to medication initiation) and lead to referrals of detainees to the Early Detection Team (EDT). The PIC will accomplish this via three measurable targets/mediators (cumulative number of print materials disseminated in the jail, cumulative number of Corrections Officers and Correctional Health Services staff trained in early psychosis and how to refer to EDT, and change in scores on 3 Social Cognitive Theory constructs [Study 1]). Second, we will implement an EDT in the same 2 jails, which will increase the likelihood of referred detainees found to have FEP engaging with CSC (e.g., an OnTrackNY program in the detainee’s borough of residence) upon release, and reduce our DUP-2 (psychosis onset to CSC enrollment). The EDT will accomplish these goals via a key target/mediator (minutes of face-to-face contact with the detainee while in jail and telephone contact following release). Clinical interviews with detainees referred to the EDT will comprise Study 2. Third, we will thoroughly study acceptability and feasibility of the jail-based PIC and EDT, which will give us information needed in advance of a larger, multi-site, definitive effectiveness trial. Regarding acceptability, we will conduct stakeholder interviews and focus groups with all relevant end-users of the new intervention (PIC+EDT) [Study 3]. In terms of feasibility for a larger trial, data on a number of metrics will be collected. Fourth, we will prepare an Intervention Manual for broader use in diverse jails and further formal research. In summary, city and county jails likely have a relatively high number of young people with undetected and untreated FEP, stemming from the criminalization of mental illnesses, fragmentation between CJ and mental health sectors, and a lack of early detection initiatives in such settings to date. Once the PIC and EDT are successfully implemented in this ideal site for pilot testing, and once acceptability and feasibility are established, DUP may be reduced, and engagement with CSC enhanced, for this especially vulnerable group.

未经治疗的精神病 (DUP) 持续时间越长，首发精神病的预后越差 (FEP)，以纽约州 OnTrackNY 计划为代表的协调专业护理 (CSC) 得到了改善。通过早期、多方面的护理获得的结果；然而，有证据表明 DUP 的持续时间仍然过长，令人无法接受。参与刑事司法 (CJ) 系统的患有 FEP 的年轻人（该系统中可能存在很多未发现、未治疗的精神病的患病率高于普通人群），其持续时间长得惊人因此，尽管初级保健机构（例如诊所）和教育机构（例如大学）可能是早期检测的重要场所，有必要在CJ系统内建立早期检测服务（特别是城市监狱）并建立从 CJ 参与到 CSC 注册的途径。依赖于先前的研究、相关理论以及我们对 DUP、护理途径、CSC 和 CJ 的研究结果系统中，我们提出4个干预发展目标：首先，我们将实施“公共信息运动”。（PIC）在纽约市 Rikers 岛的 2 个监狱中，这将更早地检测到 FEP，减少我们的 DUP-1（精神病）并导致被拘留者转介至早期检测小组 (EDT)。将通过三个可衡量的目标/调解者（分发的印刷材料的累计数量）来实现这一目标在监狱中，早期接受培训的惩教官员和惩教卫生服务人员的累计人数精神病以及如何参考 EDT，以及 3 个社会认知理论构建的分数变化 [研究 1]）。其次，我们将在同一两个监狱中实施 EDT，这将增加转介被拘留者的可能性被发现有 FEP 与 CSC 合作（例如，被拘留者居住区的 OnTrackNY 计划）释放后，并减少我们的 DUP-2（精神病发作至 CSC 入组） EDT 将完成这些任务。通过关键目标/调解人实现目标（在监狱中与被拘留者面对面接触的时间和电话）对提交 EDT 的被拘留者进行临床访谈将包括研究 2。第三，我们将深入研究基于监狱的PIC和EDT的可接受性和可行性，这将为我们提供帮助关于可接受性，我们在进行更大规模、多地点、明确的有效性试验之前需要提供信息。将与新干预措施的所有相关最终用户进行利益相关者访谈和焦点小组讨论 (PIC+EDT) [研究 3] 就更大规模试验的可行性而言，将收集一些指标的数据。第四，我们将准备一份干预手册，以便在不同的监狱中更广泛地使用和进一步的正式研究。总而言之，市县监狱可能有相对较多未被发现和未发现的年轻人。未经治疗的 FEP，源于对精神疾病的刑事定罪、CJ 和精神疾病之间的分裂卫生部门，而且迄今为止，在此类环境中缺乏 PIC 和 EDT 的早期检测举措。在这个理想的试点测试地点成功实施，一旦可接受性和可行性得到满足对于这个特别脆弱的群体，DUP 的建立可能会减少，并且与 CSC 的接触会得到加强。