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

基本信息

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
项目类别：
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

项目摘要

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、原住民和有色人种 (BIPOC) 个体更有可能被误诊为精神分裂症。尼亚 (SZ) 和其他精神障碍，并且比非拉丁裔白人更脱离心理健康服务患者。除了系统性因素（例如缺乏保险）之外，造成差异的其他因素还包括赤字在患者与提供者的沟通中（例如，患者参与较少），提供者对文化的忽视（例如，文化疾病解释）和健康的社会决定因素（例如阻碍获得护理的种族主义）。因此，BIPOC 患者可能会变得不满意、提出更少的问题、隐瞒信息并停止治疗。如何- 积极的沟通始终与围绕患者对疾病和治疗的看法达成共识有关更大程度地参与服务。该项目旨在改善提供商与 BIPOC 个人的沟通 SZ 和其他患者在门诊评估、治疗讨论、护理启动和维护期间的表现通过采用 3 次干预、文化形成访谈参与援助 (CFI- EA)，针对精神病患者 (CFI-EA/P)。该干预措施基于 DSM-5 文化公式面试 (CFI)，一项 16 项半结构化面试，通过文化敏感性进行个性化文化评估积极的提供者沟通行为（例如开放式问题；激活陈述）。 CFI-EA/P 中- 包括对情绪症状和健康社会决定因素的标准化评估，以减少误诊 SZ 并将提供商的注意力集中在参与的社会结构因素上。通过利益相关者的迭代输入（患者、临床医生、护理协调员、管理人员）和混合（定性-定量）方法报告改编和修改增强框架（FRAME），我们建议改编，制作并在一个拥有 90% BIPOC 患者群体的大型门诊精神卫生系统中试点 CFI-EA/P。该研究设计完成了 NIH 干预发展阶段模型的第一阶段，包括：改编 CFI-EA/P 手册、培训研讨会和保真度工具（第 1a 阶段）； CFI 的评估- EA/P 对患者和临床医生的可行性和可接受性（第 1b 阶段）；和试点测试服务结果（治疗参与、文化上的沟通、共同决策、诊断一致性与研究评估）和患者结果（症状改善、生活质量和心理社会功能）在一项小型随机对照试验中进行调整），为未来更大规模的试验（第 1c 阶段）提供信息。与 ALAC 一致 RITY 模型中，CFI-EA/P 将可立即在社区门诊诊所中使用，以适应 BIPOC 个体在接受精神障碍护理时的着装差异。研究结果将指导 CFI-EA/P 的进一步研究。