Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa (Jones); Division of Behavioral Health Services and Policies, New York State Psychiatric Institute, New York City (Basaraba, Piscitelli, Jewell, Nossel, Bello, Mascayano, Scodes, Marino, Wall, Dixon). Editor Emeritus Howard H. Goldman, M.D., Ph.D., served as decision editor on the manuscript.
Psychiatr Serv. 2021 Apr 1;72(4):399-407. doi: 10.1176/appi.ps.202000241. Epub 2021 Feb 3.
Little is known about clients' preferences for family involvement and subsequent family contact in naturalistic, community-based coordinated specialty care (CSC) settings. The study's primary goal was to characterize clients' preferences and longitudinal patterns of family contact with providers across the OnTrackNY network in New York.
Clinical administrative data collected at 3-month intervals and spanning 21 OnTrackNY CSC sites were used to analyze the preferences of 761 clients at baseline (unconditional involvement, conditional involvement, or no involvement) and patterns of family contact with program staff (always, sometimes, never, or early discharge) and their correlates during the initial 12-month service period. Data from clients discharged before 12 months were included for comparison.
At baseline, most clients requested some form of family involvement (unconditional, 59%; conditional, 35%; and none, 6%). Within each 3-month assessment period, rates of family contact ranged from 73% to 84%. Variables associated with both client preferences and contact patterns included baseline insurance status, housing status, race, frequency of family contact, and employment. Clients' preferences for no or conditional family involvement were associated with higher rates of early discharge (i.e., before 1 year).
Structuring family involvement around clients' preferences did not appear to negatively affect family contact, and for some clients, it seemed to bolster such contact. Additional mixed-methods research is needed to deepen the understanding of the contexts and reasoning underlying both client preferences for family involvement and subsequent levels of family contact.
对于在自然的、以社区为基础的协调专科护理（CSC）环境中客户对家庭参与的偏好以及随后的家庭接触，我们知之甚少。本研究的主要目标是描述在纽约的 OnTrackNY 网络中，客户对家庭参与的偏好以及与服务提供者的家庭接触的纵向模式。
使用在 3 个月间隔收集并跨越 21 个 OnTrackNY CSC 地点的临床行政数据，分析了 761 名基线客户（无条件参与、有条件参与或不参与）的偏好模式以及与项目工作人员的家庭接触模式（始终、有时、从不或提前出院）及其在最初 12 个月服务期间的相关性。包括在 12 个月前出院的客户的数据进行比较。
基线时，大多数客户要求某种形式的家庭参与（无条件，59%；有条件，35%；没有，6%）。在每个 3 个月评估期内，家庭接触率从 73%到 84%不等。与客户偏好和接触模式相关的变量包括基线保险状况、住房状况、种族、家庭接触频率和就业情况。对无或有条件家庭参与的偏好与提前出院（即在 1 年前）的较高比率相关。
围绕客户偏好构建家庭参与似乎并没有对家庭接触产生负面影响，而且对于一些客户来说，这似乎增强了这种接触。需要进一步的混合方法研究，以加深对客户对家庭参与的偏好以及随后的家庭接触水平的背景和推理的理解。
