The role of state agencies in mental health services for individuals with co-occurring intellectual and developmental disabilities and mental illness

国家机构在为同时患有智力和发育障碍以及精神疾病的个人提供心理健康服务方面的作用

• 批准号: 10534976
• 负责人: Elizabeth Stone
• 金额: $ 3.51万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-02-10 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10534976
• 关键词: Accountability; Active Learning; Address; Adherence; Advocate; Aging; Antidepressive Agents; Antipsychotic Agents; Area; Clinical; Data; Developmental Disabilities; Down Syndrome; Eligibility Determination; Emergency department visit; Face; Fellowship; Funding; General Population; Goals; Health; Health Services Accessibility; Health Services Research; High Prevalence; Hospitalization; Human; Improve Access; Individual; Intellectual functioning disability; Interview; Legal; Measures; Medication Management; Mental Health; Mental Health Services; Mental disorders; Mentors; Mentorship; Methods; Monitor; National Institute of Mental Health; Outcome; Performance; Persons; Pharmaceutical Preparations; Population; Prevalence; Privatization; Process; Provider; Public Health Schools; Qualitative Methods; Quality Indicator; Regulation; Research; Research Personnel; Research Support; Resources; Role; Schizophrenia; Services; Strategic Planning; Structure; System; Techniques; Texas; Training; Underserved Population; autism spectrum disorder; care coordination; care providers; career; design; disability; evidence base; follow-up; health service use; improved; insurance claims; mental state; payment; programs; service delivery; service organization; service programs; symposium

PROJECT SUMMARY/ABSTRACT The goal of the proposed fellowship is to prepare the applicant, Elizabeth Stone, for an independent research career focused on improving services and systems for underserved populations with mental illness, including those with co-occurring mental illness and intellectual or developmental disabilities (IDD). The proposed fellowship will help Ms. Stone prepare for a career as an independent investigator by allowing opportunities for individualized training toward three goals: (1) to attain proficiency in applying mixed methods approaches that integrate advanced statistical techniques with in-depth qualitative methods, (2) to build expertise in issues related to mental health services for individuals with co-occurring IDD and mental illness, and (3) to develop an in-depth understanding of the legal and regulatory framework through which state mental health and IDD agencies, independently and in coordination, impact mental health services for individuals with co-occurring IDD and mental illness. To achieve these goals, Ms. Stone will complete activities including mentored research, didactic and informal training, experiential learning, and attendance and presentations at seminars and conferences. Throughout the training period, she will be supported by a rich array of resources at the Johns Hopkins Bloomberg School of Public Health and a strong mentorship team with complementary expertise in health services research, mixed methods, advanced causal inference methods, and issues related to psychiatric services for individuals with co-occurring IDD and mental illness. The mentored research will consist of a mixed methods study focused on the role of state agencies in mental health services for individuals with co-occurring IDD and mental illness. Despite elevated prevalence of mental illness among people with IDD compared to the general population, those with both IDD and mental illness face significant barriers to the receipt of mental health care. This is due, in part, to fragmented mental health and IDD service delivery systems. In an attempt to address fragmentation, Texas restructured their Health and Humans Services (HHS) system in 2017, eliminating the state’s IDD agency and moving those programmatic and regulatory responsibilities to HHS, which also houses the mental health agency. The purpose of this integration was to improve access to and quality of services by decreasing administrative burden, better integrating similar services and programs, and clarifying lines of accountability and performance measures. The proposed research examines the effects of this agency integration on mental health service utilization and quality indicators among individuals with co-occurring IDD and mental illness using a concurrent mixed methods design combining in-depth qualitative interviews with state agency staff and IDD and mental health advocates with augmented synthetic control analyses of administrative insurance claims data. This proposed research is well-aligned with NIMH’s Strategic Plan Objective 4.1 to support research on improving the reach of mental health services through research with a focus on an important and underserved population.

项目概要/摘要 拟议奖学金的目标是让申请人伊丽莎白·斯通 (Elizabeth Stone) 为独立的 研究生涯的重点是改善服务不足的精神疾病人群的服务和系统， 包括同时患有精神疾病和智力或发育障碍 (IDD) 的人。 拟议的奖学金将帮助斯通女士为独立调查员的职业生涯做好准备 为实现三个目标而进行个性化培训的机会：(1) 熟练应用混合方法 将先进的统计技术与深入的定性方法相结合的方法，（2）建立 为同时患有 IDD 和精神疾病的个人提供心理健康服务相关问题的专业知识， (3) 深入了解国家心理所依据的法律和监管框架 卫生和 IDD 机构独立并协调地影响为患有以下疾病的个人提供的心理健康服务： 为了实现这些目标，斯通女士将完成包括 IDD 和精神疾病在内的同时发生的活动。 指导研究、教学和非正式培训、体验式学习以及出席和演讲 在整个培训期间，她将得到丰富的资源支持。 约翰·霍普金斯大学彭博公共卫生学院的强大导师团队 卫生服务研究、混合方法、高级因果推理方法和相关问题方面的专业知识 为同时患有 IDD 和精神疾病的个人提供精神科服务。 指导研究将包括一项混合方法研究，重点关注国家机构在 尽管 IDD 和精神疾病的患病率较高，但仍为同时患有 IDD 和精神疾病的个人提供心理健康服务。 IDD 患者与普通人群（同时患有 IDD 和精神疾病的人）相比，患有精神疾病的人 患病者在接受精神卫生保健方面面临重大障碍，部分原因是精神支离破碎。 为了解决分散化问题，德克萨斯州重组了其医疗和 IDD 服务提供系统。 2017 年健康与人类服务 (HHS) 系统取消了州 IDD 机构并将其转移 美国卫生与公众服务部 (HHS) 的计划和监管责任，该机构还设有心理健康机构。 这种整合的目的是通过减少行政管理来改善服务的获取和质量 负担，更好地整合类似的服务和计划，并澄清责任和绩效的界限 拟议的研究探讨了该机构整合对心理健康服务的影响。 使用同时发生的 IDD 和精神疾病的个体的利用率和质量指标 混合方法设计结合对国家机构工作人员的深入定性访谈以及 IDD 和心理 健康倡导者对行政保险索赔数据进行增强综合控制分析。 拟议的研究与 NIMH 的战略计划目标 4.1 非常一致，以支持改进研究 通过研究重点关注重要且服务不足的人群，扩大心理健康服务的覆盖面。