Multi-Method Ethnographic Assessment of Behavioral Health Reform in New Mexico

新墨西哥州行为健康改革的多方法民族志评估

• 批准号: 7026119
• 负责人: Cathleen E. Willging
• 金额: $ 27.28万
• 依托单位: BEHAVIORAL HEALTH RESEARCH CTR-SOUTHWEST
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-11-09 至 2006-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7026119
• 关键词: Hispanic Americans; Mexico; Native Americans; behavioral /social science research tag; caucasian American; clinical research; geographic difference; health behavior; health care cost /financing; health care service availability; health care service evaluation; health care service utilization; health disparity; health services research tag; human subject; interview; longitudinal human study; low socioeconomic status; medically underserved population; mental health services; patient care management; patient care personnel attitude; patient care personnel relations; patient oriented research; racial /ethnic difference; rural health; social support network; work site

DESCRIPTION (provided by applicant): The State of New Mexico will implement a major reform in managed mental health service delivery for low-income populations in July 2005. Seventeen state agencies will contract with a single behavioral health organization to oversee the delivery of all public mental health services. This reform is designed to decrease administrative costs and service fragmentation while improving access to culturally relevant, evidence-based mental health services, particularly in rural areas. However, concerns linger that managed mental health care programs may adversely affect access and services for vulnerable populations and may overly burden rural safety-net institutions. The 5-year R01 research project proposed in this application will use a multi-method ethnographic approach to examine: (1) the process of introducing the reform in a rural and multiethnic state and (2) the degree to which the reform results in improved access and quality of care for low-income seriously mentally ill (SMI) patients in public mental health programs and other safety-net institutions. This longitudinal study has three specific aims: (1) To examine changes in help-seeking behavior, access, and utilization of services by American Indian, Hispanic, and White SMI patients and their social supports (e.g., family and close peers) in three rural and three urban settings before, during, and after the reform. (2) To investigate changes in the work environment, attitudes, and behavior of frontline service providers and staff members of safety-net institutions in the targeted settings before, during, and after the reform. (3) To assess the impacts of the reform on the organization and financial condition of safety-net institutions in the targeted settings and statewide. Our multi-method ethnographic research strategy will employ both qualitative and quantitative methods in two sets of studies, conducted prior to and after the reform is implemented. The first set, consisting of administrative database reviews and ethnographic interviews and observations with SMI patients and frontline service providers, will describe changes in patterns of mental health care utilization and provider behavior. These studies will occur in three rural counties and three comparison urban counties. The second set, consisting of ethnographic interviews with state policymakers and structured surveys with clinical directors of rural and urban safety-net institutions, will identify changes in service provision for the SMI statewide. This latter statewide component will facilitate linking of the community-level ethnographic data with broader system change. The proposed ethnographic assessment of New Mexico's reform will offer new practical knowledge, grounded in the actual experiences of diverse stakeholders, that may improve state mental health policy for rural and minority SMI populations. In collaboration with the State of New Mexico, we will assess whether the reform decreases barriers to care for these underserved groups and how it affects the viability of existing services rendered in safety-net institutions. This research will fill a gap in research on statewide assessments of public health care initiatives, which do not typically focus on patient help-seeking behavior and the unique access and utilization problems faced by rural, racial and ethnic minorities. Since rural states may turn to the New Mexico reform as a model to reduce administrative costs and service fragmentation and to increase access for the SMI, this research is of great national relevance.

描述（由申请人提供）：新墨西哥州将于 2005 年 7 月对低收入人群的精神卫生服务管理实施重大改革。十七个州机构将与一个行为健康组织签订合同，监督所有公共精神卫生服务的提供。心理健康服务。这项改革旨在降低行政成本和服务分散化，同时改善获得与文化相关、基于证据的精神卫生服务的机会，特别是在农村地区。然而，人们仍然担心，管理型精神卫生保健计划可能会对弱势群体的获取和服务产生不利影响，并可能给农村安全网机构带来过度负担。本申请中提出的为期 5 年的 R01 研究项目将采用多方法民族志方法来研究：(1) 在农村和多民族国家引入改革的过程，以及 (2) 改革在多大程度上改善了公共心理健康项目和其他安全网机构为低收入严重精神疾病（SMI）患者提供护理的机会和质量。 这项纵向研究有三个具体目标：(1) 研究美国印第安人、西班牙裔和白人 SMI 患者的寻求帮助行为、获取和利用服务的变化及其社会支持（例如家庭和亲密同龄人）在三个方面的变化改革前、改革中、改革后农村和三个城市的情况。 （二）调查改革前、改革中、改革后有针对性的一线服务提供者和安全网机构工作人员工作环境、态度和行为的变化。 (3) 评估改革对目标地区和全州安全网机构的组织和财务状况的影响。 我们的多方法民族志研究策略将在改革实施之前和之后进行的两组研究中采用定性和定量方法。第一组包括行政数据库审查、人种学访谈以及对 SMI 患者和一线服务提供者的观察，将描述精神卫生保健利用模式和提供者行为的变化。这些研究将在三个农村县和三个比较城市县进行。第二组包括对州政策制定者的民族志访谈以及对农村和城市安全网机构临床主任的结构化调查，将确定全州 SMI 服务提供的变化。后一个全州范围的组成部分将促进社区层面的民族志数据与更广泛的系统变革的联系。 拟议的新墨西哥州改革民族志评估将提供新的实践知识，以不同利益相关者的实际经验为基础，这可能会改善针对农村和少数民族 SMI 人群的州心理健康政策。我们将与新墨西哥州合作评估改革是否减少了障碍 对这些服务不足的群体的照顾以及它如何影响安全网机构提供的现有服务的可行性。 这项研究将填补全州范围内公共卫生保健举措评估的研究空白，这些举措通常不关注患者的寻求帮助行为以及农村、种族和少数民族面临的独特的获取和利用问题。由于农村州可能会以新墨西哥州改革为模式，以减少行政成本和服务分散，并增加 SMI 的获取机会，因此这项研究具有重大的国家相关性。