The overall aim of this 3-year exploratory/developmental R21) application is to devise and pre-test a peer support intervention for minority patients with early phase psychosis and drug use comorbidity who have not been successfully engaged in needed mental health and substance abuse treatment services. The proposed effort is an outgrowth of an ongoing N.I.D.A.-funded longitudinal study of 400 men and women with this pathology admitted to psychiatric emergency departments of Columbia-affiliated hospitals in New York City in which non-involvement in treatment is widespread, and associated with rehospitalization, incarceration, and homelessness. Critical elements of the new peer support intervention will be identified through qualitative interviews with study subjects and group discussion involving the research team, peer specialists, and staff of service programs. Two peer specialists will be recruited from an established peer support training program to work with the psychiatric emergency teams of New York-Presbyterian and Harlem hospitals. The peer support intervention will be pre-tested with 20 subjects enrolled in the longitudinal study who are admitted to the emergency department for a second crisis episode associated with treatment non-compliance. Half the sample will be African-American, and half will be Hispanic. The intervention will be carried out for a period of one year for each subject. Peer specialists will work in concert with the psychiatric emergency teams of the study facilities, and will be supervised by psychiatrist co-investigators. The process of the intervention will be carefully described in a procedure manual. The effectiveness of the peer intervention will be based on whether the subject has been successfully engaged in mental health or substance abuse treatment services by the end of the one-year intervention period. Individual case profiles and timelines will chronicle what does and does not work in the engagement process, and the duration of time required to achieve success. Long-term outcomes will be contrasted with those of subjects in the longitudinal study who experience a second crisis episode and are offered usual care. The application addresses the need for culturally-sensitive interventions to engage uninvolved patients in needed mental health and substance abuse treatment services early in the course of psychosis and drug use comorbidity.
