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.

较长的未治疗精神病（DUP）持续时间与第一集精神病的结果较差有关（FEP）。由纽约州的Ontrackny计划举例说明的协调专业护理（CSC）通过早期的多组分护理成果；但是，DUP仍然是不可接受的。有证据参与刑事司法（CJ）系统的FEP的年轻人（那里可能有很多与普通人群相比，未发现，未经治疗的精神病的患病率更高） DUP。尽管初级保健环境（例如诊所）和教育机构（例如，大学）可能是重要的站点以进行早期检测，需要在CJ系统中建立早期检测服务（尤其是城市监狱），并创建从CJ参与到CSC入学的途径。依靠先前的研究，相关理论以及我们对DUP的发现，护理途径，CSC和CJ 系统，我们提出了4个干预开发目的。首先，我们将实施“公共信息运动” （PIC）在纽约市的Rikers Island的2个监狱中，该岛将较早发现FEP，减少我们的DUP-1（精神病）发作到药物倡议），并将侦探转介到早期检测小组（EDT）。图片将通过三个可测量的目标/调解器（累积的印刷材料传播）来实现这一目标在监狱中，累积的惩教人员和惩教卫生服务人员在早期接受培训精神病以及如何参考EDT，以及3种社会认知理论构建的分数变化[研究1]）。其次，我们将在同一2监狱中实施EDT，这将增加推荐细节的可能性发现有FEP与CSC互动（例如，详细信息的居住区中的一项Ontrackny计划）发行后，并减少我们的DUP-2（精神病发作为CSC入学）。 EDT将完成这些通过关键目标/调解员的目标（在监狱和电话中与细节的面对面接触会分钟联系以下版本）。提到EDT的细节的临床访谈将完成研究2。第三，我们将彻底研究基于监狱的PIC和EDT的可接受性和可行性，这将为我们提供在大型多站点，确定性的有效性试验之前需要的信息。关于可接受性，我们将与新干预的所有最终用户进行利益相关者的访谈和焦点小组（PIC+EDT）[研究3]。就大型试验的可行性而言，将收集许多指标的数据。第四，我们将准备一份干预手册，以在潜水员监狱和进一步的正式研究中更广泛使用。总而言之，城市和县监狱可能患有未被发现的年轻人数量相对较高未经治疗的FEP，是由于精神疾病的犯罪，CJ和精神之间的分裂卫生部门，以及迄今为止这种情况下缺乏早期检测计划。一旦图片和EDT 在这个理想的试点测试中成功实施，一旦可接受性和可行性是对于这个特别脆弱的群体而言，建立，DUP可能会减少并与CSC增强。