Early Stage Identification and Engagement to Reduce the Duration of Untreated Psychosis: Evaluating the Impact of Screening and Systematic Communication

早期识别和参与以缩短未经治疗的精神病的持续时间：评估筛查和系统沟通的影响

• 批准号: 10676948
• 负责人: Yulia Landa
• 金额: $ 81.28万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-04 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10676948
• 关键词: Administrator; Age; Attitude; Caring; Client satisfaction; Clinic; Communication; Communication Methods; Communities; Consolidated Framework for Implementation Research; Consultations; Coordinated Specialty Care; Data; Detection; Early Diagnosis; Early Intervention; Early identification; Economics; Equipment and supply inventories; Family; Future; Health system; Hybrids; Impairment; Individual; Intervention; Interview; Knowledge; Measures; Mediating; Mental Health; Mental Health Services; Methods; Modeling; National Institute of Mental Health; Netherlands; New York; Outcome; Patients; Population; Procedures; Psychoses; Questionnaires; Randomized; Randomized, Controlled Trials; Recommendation; Recovery of Function; Research; Schizophrenia; Services; Societies; Structure; Symptoms; Taxonomy; Time; Training; Treatment Cost; Treatment outcome; Youth; aged; attenuated psychosis syndrome; clinical high risk for psychosis; community clinic; design; disability; duration of untreated psychosis; effectiveness testing; first episode psychosis; functional restoration; help-seeking behavior; implementation barriers; implementation determinants; implementation facilitators; implementation strategy; implementation study; improved; innovation; medical specialties; practice setting; productivity loss; programs; psychiatric disability; psychosis risk; psychosocial; psychotic symptoms; public health relevance; recruit; reduce symptoms; routine practice; routine screening; screening; service engagement; social stigma; trial design; Administrator; Age; Attitude; Caring; Client satisfaction; Clinic; Communication; Communication Methods; Communities; Consolidated Framework for Implementation Research; Consultations; Coordinated Specialty Care; Data; Detection; Early Diagnosis; Early Intervention; Early identification; Economics; Equipment and supply inventories; Family; Future; Health system; Hybrids; Impairment; Individual; Intervention; Interview; Knowledge; Measures; Mediating; Mental Health; Mental Health Services; Methods; Modeling; National Institute of Mental Health; Netherlands; New York; Outcome; Patients; Population; Procedures; Psychoses; Questionnaires; Randomized; Randomized, Controlled Trials; Recommendation; Recovery of Function; Research; Schizophrenia; Services; Societies; Structure; Symptoms; Taxonomy; Time; Training; Treatment Cost; Treatment outcome; Youth; aged; attenuated psychosis syndrome; clinical high risk for psychosis; community clinic; design; disability; duration of untreated psychosis; effectiveness testing; first episode psychosis; functional restoration; help-seeking behavior; implementation barriers; implementation determinants; implementation facilitators; implementation strategy; implementation study; improved; innovation; medical specialties; practice setting; productivity loss; programs; psychiatric disability; psychosis risk; psychosocial; psychotic symptoms; public health relevance; recruit; reduce symptoms; routine practice; routine screening; screening; service engagement; social stigma; trial design

PROJECT SUMMARY/ABSTRACT Studies find a substantial delay between the onset of psychosis and the initiation of specialty treatment for first episode psychosis (FEP), with the duration of untreated psychosis (DUP) typically over one year in the U.S. Better strategies are needed to improve identification of individuals with FEP and to rapidly engage them in Coordinated Specialty Care (CSC) aimed at restoring functioning. This study will investigate whether a U.S. adaptation of a successful detection approach from the Netherlands enhanced by an innovative model of communicating information about psychosis and treatment options to patients and families (ComPsych), can reduce DUP. Our collaborators in the Netherlands compared screening of a consecutive help-seeking population entering mental health services to clinician referral from mental health clinics and found that screening captured significantly more individuals at clinical high risk for psychosis (CHR) and with FEP. Based on the Dutch model, within the Mount Sinai Health System in New York, we have piloted and established the feasibility of screening help-seeking youth entering mental health services with the aim of improving early identification of FEP cases and rapid referral to specialty care (Early Stage Identification and Engagement to Reduce DUP study (EaSIE), supported by NIMH R34). Individuals entering services are screened with the Prodromal Questionnaire-Brief Version (PQ-B). Those who screen positive are assessed by Structured Interview for Psychosis Risk Syndromes (SIPS) and referred to stage-specific specialty care (FEP or CHR services). To facilitate service engagement we developed, piloted, and established feasibility of the ComPsych model. While our data showed that compared to clinician referral, systematic screening method (SM) can substantially reduce DUP by identifying a greater number of patients earlier in the course of illness, more research is needed to evaluate the impact of ComPsych on FEP treatment initiation and engagement in order to further reduce DUP. We will use a stepped-wedge cluster randomized controlled trial design to compare a systematic screening and communication method (SCM) to SM. Following a 6-month baseline period of SM, 12 mental health clinics will be randomized (2 clinics at a time) to transition from SM to SCM at 6-month intervals. In both conditions, individuals aged 12-30 who screen positive on PQ-B will be assessed with SIPS by trained clinicians in each clinic and referred to FEP and CHR services as appropriate. In SCM condition the ComPsych model will be used to facilitate initiation of CHR and FEP services. We will measure DUP for patients who meet psychosis criteria. We hypothesize that: (1) SCM will result in a higher number of individuals initiating CHR and FEP services compared to SM; (2) The mean DUP of FEP individuals in SCM condition will be lower than the mean DUP of FEP individuals in SM condition, due to the reduced time to initiate FEP services. We will also examine multi-level implementation factors that can inform the identification of implementation strategies for future deployment of SCM in routine practice.

项目摘要/摘要 研究发现，精神病的发作与首次专业治疗的开始之间存在大幅延迟 情节精神病（FEP），未经治疗的精神病（DUP）的持续时间通常在美国一年 需要更好的策略来改善对FEP的个人的识别并迅速参与 协调专业护理（CSC）旨在恢复功能。这项研究将调查美国是否 通过创新模型改善了荷兰成功检测方法的改编 向患者和家庭（Compsys）传达有关精神病和治疗方案的信息，可以 减少DUP。我们在荷兰的合作者比较了连续寻求帮助的筛查 从心理健康诊所转诊至临床医生转诊的人口，发现 筛查在临床高风险（CHR）和FEP上捕获了更多的人。基于 在荷兰模型上，在纽约西奈山卫生系统中，我们已经驾驶并确定了 筛查寻求帮助青年进入心理健康服务的可行性，目的是提早改善 识别FEP病例并迅速转介到专业护理（早期识别和参与度 减少DUP研究（EASIE），由NIMH R34支持）。进入服务的个人将筛选 前驱问卷 - brief版本（PQ-B）。那些屏幕阳性的人通过结构化评估 精神病风险综合症访谈（SIP），并参考了特定阶段的专业护理（FEP或CHR 服务）。为了促进我们开发，试验和确定的Compsys的可行性的服务参与 模型。尽管我们的数据显示，与临床医生的转诊相比，系统筛查方法（SM）可以 通过在疾病过程中确定更多患者，从而大大减少DUP，更多 需要研究以评估Compsys对FEP治疗开始和参与的影响 进一步减少DUP。我们将使用阶梯式斜角群集随机对照试验设计进行比较 系统筛选和通信方法（SCM）。在SM的6个月基线期之后， 12个心理健康诊所将被随机分组​​（一次2个诊所），以在6个月中从SM到SCM过渡 间隔。在这两种情况下，年龄在12-30岁的人对PQ-B筛选阳性的个人将通过SIP进行评估 由训练有素的临床医生在每个诊所中，并适当地转介FEP和CHR服务。在SCM条件下 Compsych模型将用于促进CHR和FEP服务的启动。我们将衡量DUP 符合精神病标准的患者。我们假设：（1）SCM将导致更多个体 与SM相比，启动CHR和FEP服务； （2）在SCM状态下FEP个体的平均DUP将 由于启动FEP的时间减少，低于SM状态下FEP个体的平均DUP 服务。我们还将研究可以告知标识的多层次实施因素 实施策略在常规实践中未来部署SCM。