Community Mental Health Services Clinical Trial
Official title:
Patient Navigators for Children's Community Mental Health Services in High Poverty Urban Communities
The purpose is to study a model of mental health navigation for African American and Latinx children (5-12 years) in high poverty urban communities focused on reducing key parental attitudinal barriers to care. Reducing persistent racial and ethnic disparities in children's mental health is a national priority and patient navigation is a highly promising approach that is rarely used in children's mental health services. The study will examine the effectiveness of paraprofessional (PP) navigators who have strong community knowledge, case manager (CM) navigators who are formally trained, and waitlist (WL) as usual condition. The study will examine specific mechanisms of navigator effectiveness in children's mental health and compare the two types of navigators to provide a rigorous test of the proposed mechanisms. The knowledge gained from this application may be important to reducing disparities and employing the workforce best suited to navigation in the community mental health system. Two community boards, one focused on identifying factors important to supporting navigators at the agencies (Implementation and Sustainability Community Board) will meet quarterly, and the other focused on implications for state and federal policy (Public Policy Board), will meet annually.
Navigation to promote entry into health services, originally developed to address racial disparities in cancer screening and treatment, is only recently gaining prominence in mental health. Recent reviews recommend navigation for many health-related services including mental health services for transition-age youth and for children with medical complexity and comorbid mental health disorders. Logistical barriers are common across the health care system. However, for mental health services, stigma is also a prominent barrier. Paraprofessionals (PPs) have been key in efforts to reduce disparities in access to social services both nationally and internationally, presumably because their similarities to families can facilitate families' access to and retention in mental health services given their ability to relate to families' struggles. In this study, the investigators will examine paraprofessionals' (PP's) effectiveness as navigators for children's mental services as contrasted with case managers (CMs) who are often assigned navigator tasks but may lack the relational advantages of PPs, and to waitlist (WL)-as-usual. Specific aims are to examine: 1. Initial entry into appropriate mental health services. a.Hypothesis: Caregivers assigned to a PP navigator will be more likely to initiate services for their child as compared to families assigned a CM navigator and to families on WL-as-usual, as mediated by reduced stigma and more positive attitudes towards mental health services; 2. Ongoing engagement in services. a.Hypothesis: Caregivers assigned a PP navigator will be more likely to retain their child in more sessions of ongoing care as compared to families assigned a CM navigator and to families on WL-as-usual, as mediated by PP's ability to act as a boundary spanner; 3. Child and parent outcomes at baseline, 6, 12, and 18 months post intake. 1. Hypothesis: Children and caregivers in the PP navigator condition will evidence stronger outcomes as compared to families assigned a CM navigator and families in WL-as-usual, as mediated by PP's integration into caregiver's social support network. The investigators will examine these hypotheses using an explanatory sequential mixed method design. Multi-level and longitudinal quantitative data will include information on (1) initial and ongoing use of services assessed via agency electronic medical record (EMR) data; (2) the type and rate of navigator services to families as assessed via EMR data and parent report of navigator endorsement of recommended services; (3) caregiver attitudes and services received, assessed through caregiver report; (4) integration of navigator into caregiver social support network assessed via caregiver report of a social support network; and (5) child and caregiver outcomes as assessed by the caregiver and therapist report collected during 6-month intervals up to 18 months post intake (baseline). Quantitative data will be analyzed by generalized estimating equations models (GEE) accounting for the clustering effect of agencies and navigators and adjusted for covariates. Qualitative analysis of independent focus groups with PPs, CMs, and caregivers will be conducted at the end of each cohort to contextualize and clarify the quantitative findings. Two community boards will provide an opportunity for inter-agency communication and support by sharing challenges and successes and providing insights into local and national policy. An Implementation and Sustainability Community Board will meet quarterly to address issues of fit within each organization and consistency with local system procedures, and a Public Policy Board will meet annually to consider how the research can inform local and national mental health policy ;
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