A Family Navigator Model for Adolescents with Bipolar Disorder

About This Grant

Though adolescence is the peak onset period for many psychiatric disorders, only a minority of youth with a psychiatric disorder receive mental health (MH) services. Family Navigation (FN) is a service delivery model that improves engagement in and utilization of MH services by ensuring prompt movement through a complex health care system. Though FN is highly acceptable and efficacious, limited research has focused on FN for youth MH. Adolescents with bipolar disorder (BP) and their caregivers are an ideal population with whom to adapt and test an FN model for youth MH, given the complexity of clinical presentation and service needs of youth with BP, as well as the challenges faced by their caregivers. In response to PAR-23-104, in this R34 we will fill this key scientific gap by adapting and testing an extant FN model among families of 50 youth (ages 11-15) referred for treatment at the Child and Adolescent Bipolar Spectrum (CABS) Services specialty clinic at Western Psychiatric Hospital. FNs will provide education, care coordination, and support to families, and will address barriers to care. We will enhance the existing CABS electronic measurement-based care system with database (CABS MBC) to ensure FN-relevant data and outcomes are gathered. FNs will leverage the CABS MBC to evaluate the service and navigation needs of each family, inform the FN plan, and track service engagement. We will test knowledge of BP and of the healthcare system and self-efficacy for navigating the MH system as mechanisms underlying improvement in MH service engagement. We will first conduct qualitative interviews with families presenting to CABS, providers evaluating and treating youth with a complex mood disorder (BP or other mood disorder indicating a high risk of developing BP), and FNs in our region (n=10 each group) to inform adaptation and manualization of the FN intervention and training program and enhancing the CABS MBC system. We will conduct an open trial (n=10; families of youth (11-15y) with a complex mood disorder referred to CABS for treatment) to iteratively refine the FN intervention and implementation. Then we will conduct a hybrid type-I RCT (n=50) examining FN + CABS usual care vs. CABS usual care alone, testing the feasibility and effectiveness of the FN intervention and provider training, and identifying implementation factors. We hypothesize the FN intervention and training procedures will be feasible, acceptable, and appropriate, and satisfaction with FN will be high. We hypothesize families receiving FN + usual care will be more likely to have a MH visit within 45 days; report fewer days to first MH visit; and will attend more MH visits than usual care alone. FN knowledge of BP will significantly improve, and treatment integrity will be reached. We will also examine the effect of treatment on changes in psychopathology. Feedback from CABS providers and staff, and FNs, youth, and caregivers involved in the RCT will identify barriers and facilitators to FN implementation. This R34 will support the adaptation and implementation of effective service delivery interventions, and will inform a larger trial testing the effectiveness and implementation of FN.