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的人（SMI）和精神病学史正在挣扎着机构累犯的循环（反复住院，监禁和无家可归），并且缺乏个人康复。这些问题部分是由零散的，无法访问的社区服务驱动的；未接触的当地利益相关者，他们可以在住院后成为社区支持的合作伙伴；经常进行警察联系，心理健康与警察之间的沟通不良；和有限的恢复支持。对于许多人来说，现代恢复概念化的承诺仍然是一个未实现的希望。开发了恢复（ODR）模型的开头，以帮助这些人减少机构累犯并进行康复。它通过向参与者提供由三名社区导航专家（CNSS）团队的社区支持来做到这一点：一名有执照的社会工作者（“专业CNS”），具有生活经验的同伴专家（“ Peer CNS”），以及有SMI的家庭成员，他们对SMI成员的经验受到SMI成员的经验，而SMI会受到家庭成员的压力，并具有复杂的心理健康系统和脆弱的心理健康系统。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：（1）确保适当的治疗，（2）维护安全住房，（3）开发有意义的一天，以及（4）使用技术支持恢复的情况，他们还提供了持续的恢复支持。 ODR的至少两个功能将其与其他基于社区的服务区分开来：一组合作的本地合作伙伴致力于支持ODR和CNSS的工作，并且与警察局的新型链接系统允许CNSS在其客户之一与当地执法部门相遇时立即做出回应。 ODR的所有这些组成部分共同努力减少制度累犯并促进康复。通过一个涉及100名参与者的大规模试点/示范项目，我们证明了可行性的各个方面，完全确定了不同利益相关者的可接受性，并在减少的住院和增强的康复方面表现出了有希望的影响。 ODR现在准备进行更确定的随机，对照试验，研究团队非常适合进行此类试验。与现有的社区支持团队（CST）模型（n = 120）相比，我们将在过去6个月中随机将240人随机分配到过去6个月的住院时间> 2> 2个住院时间（n = 120，随后持续12个月）。评估将在基线（出院时）以及4、8、12和18个月进行。我们的假设是ODR参与者的住院时间较少，逮捕较少，住房成果较少以及恢复更高的中心，后者以多种恢复措施（例如，社区调整，心理健康恢复，社区导航能力，有意义的一天的活动，希望，希望和授权）来衡量。如果证明了我们的假设，我们将拥有所需的证据，以进行这种新服务模型的传播活动。