Improving Assessment of Psychosis and Engagement in Treatment of BIPOC Individuals

改善 BIPOC 个体治疗中的精神病评估和参与度

• 批准号: 10623755
• 负责人: Neil Krishan Aggarwal
• 金额: $ 15.19万
• 依托单位: NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-04-01 至 2028-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10623755
• 关键词: Acculturation; Address; Administrator; Ambulatory Care Facilities; Antipsychotic Agents; Appointment; Attention; Behavior; Black Populations; Black, Indigenous, People of Color; Caring; Clinic; Clinical; Clozapine; Communication; Communities; Consensus; Criminal Justice; DSM-V; Data; Decision Making; Diagnostic; Discrimination; Disparity; Dose; Economics; Educational workshop; Evaluation; Focus Groups; Formulation; Future; Goals; Hallucinations; Health Services Accessibility; Health system; Hospitalization; Individual; Injectable; Institution; Insurance; Intervention; Interview; Label; Link; Longevity; Maintenance; Manuals; Mediating; Mediation; Mental Health; Mental Health Services; Methods; Modeling; Modification; Outcome; Outpatients; Paranoia; Pathway interactions; Patient Participation; Patient-Focused Outcomes; Patients; Pharmaceutical Preparations; Provider; Psychoses; Psychotic Disorders; Quality of Care; Quality of life; Randomized, Controlled Trials; Reporting; Research; Research Design; Schizophrenia; Services; Standardization; Structure; Symptoms; Training; Trust; United States National Institutes of Health; acceptability and feasibility; alternative treatment; arm; communication behavior; community based research; cultural competence; design; diagnostic criteria; efficacy study; ethnoracial disparity; experience; follow-up; health care disparity; improved; inattention; instrument; intervention effect; mood symptom; patient population; patient-clinician communication; people of color; personalized intervention; pilot test; pilot trial; preference; prevent; provider communication; psychosocial; psychotic; psychotic symptoms; racism; research clinical testing; restraint; satisfaction; shared decision making; side effect; social; social health determinants; social structure; structural determinants; symptomatic improvement; testing services; therapy development; treatment adherence; treatment as usual; verbal

Black, Indigenous and People of Color (BIPOC) individuals are more likely to be misdiagnosed with schizophre- nia (SZ) and other psychotic disorders and to disengage from mental health services than non-Latinx White patients. In addition to systemic factors (e.g., lack of insurance), other contributors to disparities include deficits in patient-provider communication (e.g., less patient participation), provider inattention to culture (e.g., cultural illness explanations), and social determinants of health (e.g., racism impeding access to care). Hence, BIPOC patients can become dissatisfied, ask fewer questions, withhold information, and discontinue treatment. How- ever, positive communication is linked to negotiating consensus around patients' views of illness and treatment with greater engagement in services. This project aims to improve provider communication with BIPOC individ- uals during outpatient assessment, treatment discussions, care initiation, and maintenance for SZ and other psychotic disorders by adapting a 3-session intervention, Cultural Formulation Interview-Engagement Aid (CFI- EA), for individuals with psychosis (CFI-EA/P). This intervention is based on the DSM-5 Cultural Formulation Interview (CFI), a 16-item, semi-structured interview to personalize cultural assessment through culturally sensi- tive provider communication behaviors (e.g., open-ended questions; activation statements). The CFI-EA/P in- cludes standardized assessments of mood symptoms and social determinants of health to reduce misdiagnosing SZ and to focus provider attention on socio-structural factors in engagement. With iterative stakeholder input (patients, clinicians, care coordinators, administrators) and mixed (qualitative-quantitative) methods guided by the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME), we propose to adapt, manu- alize, and pilot the CFI-EA/P in a large outpatient mental health system with a 90% BIPOC patient population. The study design completes Stage I of the NIH Stage Model of Intervention Development, including: iterative adaptation of the CFI-EA/P manual, training workshop, and fidelity instrument (Stage 1a); evaluation of the CFI- EA/P's feasibility and acceptability for patients and clinicians (Stage 1b); and pilot testing service outcomes (treatment engagement, culturally competent communication, shared decision making, diagnostic concordance with research assessment) and patient outcomes (symptom improvements, quality of life, and psychosocial func- tioning) in a small randomized controlled trial to inform a future larger trial (Stage 1c). Consistent with the ALAC- RITY model, the CFI-EA/P would be available for immediate use in community-based outpatient clinics to ad- dress disparities in the care of BIPOC individuals accessing care for psychotic disorders. Study findings will guide further research on the CFI-EA/P.

黑人，土著和有色人种（BIPOC）个体更有可能被精神分裂误诊 NIA（SZ）和其他精神病性疾病，并与非LATINX WHITH脱离心理健康服务 患者。除了系统性因素（例如缺乏保险）外，其他差异的贡献者还包括赤字 在患者提供者的沟通（例如，患者参与度更少）中，提供者对文化（例如，文化 疾病解释）和健康的社会决定因素（例如，种族主义阻碍了接受护理的机会）。因此，Bipoc 患者可能会变得不满意，提出更少的问题，扣留信息并停止治疗。如何- 曾经，积极的沟通与围绕患者对疾病和治疗的观点的共识有关 随着服务的更多参与。该项目旨在改善提供商与BIPOC个人的沟通 - 在门诊评估，治疗讨论，护理启动以及SZ和其他维护期间的UALS 通过适应三疗干预，文化配方面试辅助援助（CFI-），精神病障碍 EA），对于精神病患者（CFI-EA/P）。该干预措施基于DSM-5文化配方 访谈（CFI）是16个项目的半结构化访谈，以通过文化敏感的方式个性化文化评估 提供者的沟通行为（例如，开放式问题；激活语句）。 CFI-EA/P in- Cludes对心情症状和健康决定因素的标准化评估，以减少误诊 SZ并将提供者的注意力集中在参与中的社会结构因素上。迭代利益相关者的投入 （患者，临床医生，护理协调员，管理员）和由指导的混合（定性定性）方法 报告改编和修改增强的框架（框架），我们建议适应，manu- Alize，并在大型门诊精神卫生系统中驾驶CFI-EA/P，BIPOC患者人数为90％。 研究设计完成了NIH阶段开发模型的I期，包括：迭代 适应CFI-EA/P手册，培训研讨会和富达工具（第1A阶段）；评估CFI- EA/P对患者和临床医生的可行性和可接受性（第1B期）；和试点测试服务结果 （治疗参与，具有文化胜任的沟通，共享决策，诊断和解 进行研究评估）和患者预后（症状改善，生活质量和社会心理功能 Tioning）在一项小型随机对照试验中，以告知将来的较大试验（第1C阶段）。与Alac-一致 难道模型，CFI-EA/P可以立即在社区的门诊诊所中使用，以备 Bipoc个人的护理差异，以获得精神病的护理。研究结果将 指导有关CFI-EA/p的进一步研究。