A Trial of "Opening Doors to Recovery" for Persons with Serious Mental Illnesses

为严重精神疾病患者“打开康复之门”试点

• 批准号: 9414809
• 负责人: MICHAEL T COMPTON
• 金额: $ 34.78万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-01-20 至 2019-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9414809
• 关键词: Trial; Opening; Doors; Recovery; Persons

DESCRIPTION (provided by applicant): Many persons with serious mental illnesses (SMI) and a history of psychiatric hospitalizations are struggling with a cycle of institutional recidivim (repeated hospitalizations, incarcerations, and homelessness) and a lack of personal recovery. These problems are in part driven by fragmented, inaccessible community services; unengaged local stakeholders who could be partners in community support after hospitalization; frequent police contacts and poor communication between mental health and the police; and limited recovery support. For many, the promise of modern conceptualizations of recovery remains an unrealized promise. The Opening Doors to Recovery (ODR) model was developed to help such persons reduce institutional recidivism and engage in recovery. It does this by providing the participant with community support from a team of three Community Navigation Specialists (CNSs): a licensed social worker (the "Professional CNS"), a peer specialist with lived experience (the "Peer CNS"), and a family member of someone with SMI who has experience with the stress imposed on family members by the SMI and a complex, fragmented mental health system (the "Family CNS"). This team provides community navigation (mapping of all available community resources) and is embedded within the local community. They also provide ongoing recovery support by focusing on: (1) ensuring adequate treatment, (2) maintaining safe housing, (3) developing a meaningful day, and (4) using technology to support recovery. At least two other features of ODR distinguish it from other community-based services: a group of collaborative local partners is committed to supporting ODR and the work of the CNSs, and a novel linkage system with the police allows CNSs to respond immediately when one of their clients has an encounter with local law enforcement. All of these components of ODR work together to reduce institutional recidivism and promote recovery. Through a large-scale pilot/demonstration project involving 100 participants, we have demonstrated all aspects of feasibility, thoroughly established acceptability from diverse stakeholders, and shown promising effects in terms of reduced hospital stays and enhanced recovery. ODR is now ready for a more definitive randomized, controlled trial, and the research team is ideally suited and highly experienced to carry out such a trial. We will randomize 240 persons with SMI and a history of >2 inpatient stays in the past 6 months to ODR (n=120, followed for 12 months, with a maximum CNS caseload of 40) versus the existing Community Support Team (CST) model (n=120). Assessments will be conducted at baseline (at hospital discharge), and at 4, 8, 12, and 18 months. Our hypotheses center on ODR participants having fewer days of hospitalization, fewer arrests, better housing outcomes, and greater recovery, the latter measured with a diverse set of recovery measures (e.g., community adjustment, mental health recovery, community navigation competencies, meaningful day activities, hope, and empowerment). If our hypotheses are proven, we will have the needed evidence to move forward with dissemination activities for this new service model.

描述（由申请人提供）：许多患有严重精神疾病（SMI）并有精神病住院史的人正在与机构惯犯（反复住院、监禁和无家可归）和缺乏个人康复的循环作斗争。这些问题的部分原因是社区服务分散、无法获得；未参与的当地利益相关者可以成为住院后社区支持的合作伙伴；警察接触频繁，心理健康与警察之间沟通不畅；和有限的恢复支持。对于许多人来说，现代康复概念的承诺仍然是一个未实现的承诺。康复之门（ODR）模型的开发是为了帮助这些人减少机构累犯并参与康复。它通过为参与者提供由三名社区导航专家 (CNS) 组成的团队的社区支持来实现这一目标：一名有执照的社会工作者（“专业 CNS”）、一名具有生活经验的同伴专家（“同伴 CNS”）和一名SMI 患者的家庭成员，曾经历过 SMI 和复杂、支离破碎的心理健康系统（“家庭 CNS”）给家庭成员带来的压力。该团队提供社区导航（所有可用社区资源的映射）并嵌入本地社区。他们还通过关注以下方面提供持续的康复支持：(1) 确保充分的治疗，(2) 维持安全的住房，(3) 度过有意义的一天，以及 (4) 使用技术支持康复。 ODR 至少有两个其他特征将其与其他基于社区的服务区分开来：一组当地合作伙伴致力于支持 ODR 和 CNS 的工作，并且与警方的新颖联动系统允许 CNS 在以下情况之一时立即做出响应：他们的客户与当地执法部门发生冲突。 ODR 的所有这些组成部分共同努力减少机构累犯并促进康复。通过涉及100名参与者的大规模试点/示范项目，我们展示了各方面的可行性，彻底建立了不同利益相关者的可接受性，并在减少住院时间和促进康复方面显示出可喜的效果。 ODR 现在已准备好进行更明确的随机对照试验，研究团队非常适合且经验丰富，可以开展此类试验。我们将随机抽取 240 名患有 SMI 且过去 6 个月内住院次数超过 2 次的患者进行 ODR（n=120，随访 12 个月，CNS 病例数最多为 40），与现有的社区支持团队 (CST) 模型进行比较（n=120）。评估将在基线（出院时）以及 4、8、12 和 18 个月时进行。我们的假设集中在 ODR 参与者的住院天数更少、逮捕更少、住房结果更好以及康复程度更高，后者通过一系列不同的康复措施（例如社区调整、心理健康恢复、社区导航能力、有意义的日常活动）来衡量、希望和赋权）。如果我们的假设得到证实，我们将拥有所需的证据来推进这种新服务模式的传播活动。