Assisted Identification and Navigation of Early Mental Health Symptoms in Children

儿童早期心理健康症状的辅助识别和导航

• 批准号: 10094734
• 负责人: Robert B. Penfold
• 金额: $ 81.08万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-01-18 至 2024-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10094734
• 关键词: 12 year old; Abnormal coordination; Accident and Emergency department; Address; Adolescent; Adult; Antipsychotic Agents; Appointment; California; Caring; Case Manager; Child; Childhood; Chronic Disease; Clinic; Clinical; Communities; Consent; Data; Diagnosis; Disease; Documentation; Dose; Early identification; Eligibility Determination; Enrollment; Family; Family health status; Goals; Health Personnel; Health Services Accessibility; Health system; Healthcare; Healthcare Systems; Home; Individual; Integrated Health Care Systems; Intervention; Intervention Studies; Logistic Regressions; Machine Learning; Medical Records; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Modeling; Monitor; Natural Language Processing; Nurses; Outcome; Patients; Pharmaceutical Preparations; Primary Health Care; Process; Professional counselor; Provider; Psyche structure; Psychotherapy; Registries; Reporting; Research; Role; Schedule; Social Workers; Symptoms; Systems Integration; Testing; Text; Therapeutic; Time; Videoconferencing; Visit; Washington; Work; Youth; adjudication; arm; base; burden of illness; care providers; child mental health service; comparison intervention; follow-up; improved; improved outcome; machine learning algorithm; medical specialties; motivational enhancement therapy; outreach; peer; pragmatic trial; prediction algorithm; predictive modeling; prevent; primary outcome; programs; random forest; randomized trial; recruit; secondary outcome; severe mental illness; skills; social stigma; structured data; time use; tool; treatment arm; treatment as usual; trial design; urgent care; usual care arm; video visit; waiver

ABSTRACT About 55% of children with significant mental health difficulties receive treatment and up to 80% of children with sub-clinical symptoms receive no treatment. Treatments are often not initiated until issues are significantly impacting the child and family. This study aims to conduct a pragmatic randomized trial in two non-academic health care systems to test a mental health family navigator model to promote early access to, engagement in, and coordination of needed mental health services for children. The first task of the study will focus on the implementation of a predictive model to identify symptomatic children with no diagnosed mental health disorder(s) or treatments initiated. The tool identifies patients with documentation of mental health symptoms or complaints in the free text of a progress note from a recent primary care or urgent care visit. Using this predictive algorithm, we will conduct a pragmatic randomized trial comparing intervention and usual care arm patients enrolled from Kaiser Permanente (KP) Washington and KP Northern California. The trial will enroll 200 patients per arm (n=400). Children with (1) a new mental health diagnosis but no treatment initiated; (2) a new mental health medication ordered with no mental health diagnosis; and (3) symptoms identified by the predictive model with no new mental health diagnosis or treatment initiated will be recruited. The study intervention will offer 6 months of support to the family by a mental health navigator (social worker). The navigator will perform an initial needs and barriers assessment with the family around mental health services, conduct ongoing motivational interviewing around mental health care, provide up to 4 psychotherapy sessions (when appropriate) via clinic-to-home video visits, help the family find and schedule with appropriate mental health providers in the community, and reach out ad hoc if mental health appointments or medication refills are missed. The primary outcome is the percentage of youth initiating psychotherapy. The secondary outcome is the percentage of youth with at least 4 mental health visits. We hypothesize that the intervention arm will have higher rates of psychotherapy use compared to the control arm. We will also assess initiation of psychotropic medications. All primary analyses will follow an intent-to-treat approach. A waiver of consent will be obtained to include data for all individuals offered the intervention in the analysis, regardless of the amount of intervention (“dose” of navigation) received.

抽象的 大约 55% 患有严重心理健康问题的儿童接受治疗，高达 80% 的儿童接受治疗 具有亚临床症状的患者通常不接受治疗，直到问题明显为止。 这项研究旨在对两个非学术领域进行务实的随机试验。 医疗保健系统测试心理健康家庭导航器模型，以促进早期接触、参与、 和协调儿童所需的心理健康服务。 实施预测模型来识别未诊断出心理健康状况的有症状儿童 该工具可识别有精神健康症状记录的患者。 或最近一次初级保健或紧急护理访问的进度说明的自由文本中的投诉。 预测算法，我们将进行一项实用的随机试验，比较干预组和常规护理组 来自华盛顿州 Kaiser Permanente (KP) 和北加州 KP 的患者入组 该试验将入组 200 名患者。 每组患者（n=400）（1）有新的心理健康诊断但未开始治疗；（2）有新的心理健康诊断； 未经心理健康诊断而订购的心理健康药物；以及 (3) 经医生诊断的症状； 该研究将招募没有新的心理健康诊断或治疗的预测模型。 干预措施将由心理健康导航员（社会工作者）为家庭提供 6 个月的支持。 导航员将与家人一起围绕心理健康服务进行初步需求和障碍评估， 围绕心理健康护理进行持续的动机访谈，提供最多 4 次心理治疗课程 （在适当时）通过诊所到家庭视频访问，帮助家人找到并安排适当的心理咨询 社区中的医疗服务提供者，如果需要心理健康预约或药物补充，则可以临时联系 主要结果是开始心理治疗的青少年的百分比。 至少接受过 4 次心理健康检查的青少年比例 与对照组相比，心理治疗的使用率更高。我们还将评估精神药物的启动情况。 所有主要分析都将遵循意向治疗方法，并获得同意。 包括在分析中接受干预的所有个人的数据，无论干预量是多少 （导航的“剂量”）收到。