Patient Navigators for Children's Community Mental Health Services in High Poverty Urban Communities

NCT05294042 | Recruiting

• 1 other identifier: 2021-0709
• Study Type: interventional
• Target: 154
• Locations: 1 country
• Sites: 1

Brief Summary

The purpose is to study a model of mental health navigation for African American and Latinx children (0-14 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 and waitlist as usual condition (active wailt list \[AWL\]. The study will examine specific mechanisms of navigator effectiveness in children's mental health and compare an AWL 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.

Conditions

Community Mental Health Services

Keywords

Child Mental Health Services; Racial and Ethnic Disparities; Urban Poverty; Navigation; Paraprofessional

Outcome Measures

Primary Outcomes (13)

• Initiation of services by caregiver

  Investigators will calculate time elapsed between assignment to condition and first session of recommended services and solicit navigator and caregiver report

  Up to 18 months

• Attendance in services; navigator and caregiver report

  Number of times attended services; endorsement of service engagement

  18 months

• Change from Baseline Measure of Perceived Homophily at 6, 12, and 18 months

  (McCroskey, Richmond, \& Daley, 1975).The Measure of Perceived Homophily is a 16-item, four-factor continuous measure of an individual's perceived similarity and dissimilarity of another individual. This measure will be used to determine how similar the caregiver perceives their navigator on the four dimensions. The four dimensions include: Attitude, Background, Value, and Appearance. Each dimension includes 4 items, which are rated from 1 to 7 (e.g., 1 = Doesn't think like me to 7 = Thinks like me). Cronbach's α ranges from .51 to .93 (McCroskey et al., 2006)

  Baseline, 6 months, 12 months, 18 months

• Change from Baseline Social Network Assessment of Boundary Spanning at 6, 12, and 18 months

  (Marsden, 2011). Caregivers will be asked two questions at each assessment time point to determine sources of influence on services recommended by providers: 1) "Has your provider recommended services or practices to help with your child's mental health or family needs?If yes, please name them" and for each service or practice named by the caregiver, 2) Did you talk with anyone besides your provider about the service or practice? If yes, please indicate who you talked to about this service or practice. These questions will allow us to assess whether navigators are serving as a boundary spanner. Specifically, at each time point, we will calculate the proportion of services or practices recommended by the provider that were also discussed with the navigator.

  Baseline, 6 months, 12 months, 18 months

• Change from Baseline Norbeck Social Support at 6, 12, and 18 months

  (NSSQ; Norbeck et al., 1983). The NSSQ examines multiple components of caregiver social support. The Total Network Support Subscale (3 items) is the sum of the total number of members (up to 24) parents identify in their support network, frequency of contact with each member (1= once a year or less to 5 = daily), and length of the relationship with each member on a 5 point-scale (1 = less than 6 months to 5 = more than 5 years). The Total Functional Support Subscale (6 items) measures the sum of perceived affective/emotional (n = 4 items) and instrumental/tangible support (n = 2 items; 0 = not at all to 4 = a great deal). In addition, the NSSQ will also be used to examine the extent to which navigators provided context-relevant social support to caregivers. Scores range from 0 (not named or named but no support) to 24 (maximum support).

  Baseline, 6 months, 12 months, 18 months

• Change from Baseline Parental Attitudes Toward Psychological Services at 6, 12, and 18 months

  (PATPSI; Turner, 2012). This scale is a 26-item scale that assesses parental attitudes toward outpatient mental health services across three domains: Help-seeking attitudes, help-seeking intentions, and mental health stigma. Items are rated from 0 (strongly disagree) to 5 (strongly agree). The PATPSI has demonstrated discriminant validity as well as adequate internal consistency (Cronbach's α ranging from .72 to .92) and test-retest reliability (Pearson r ranging from .66 to .82).

  Baseline, 6 months, 12 months, 18 months

• Change from Baseline Family Empowerment at 6, 12, and 18 months

  Rodriguez et al., 201 The adapted version of the original FES was designed to assess empowerment for families whose children have emotional disabilities (Rodriguez et al., 011). It consists of 34 items and three subscales: Family Empowerment (the ability to manage day-to-day life of the family, 12 items), Service System Empowerment (the caregiver's sense of ability to interact with the services system to obtain needed services,12 items), and Community/Political Empowerment (the caregiver's sense of ability to advocate for improved services, 10 items). Each subscales' internal consistency is high with Cronbach's alpha coefficients ranging from .87 to .88. Test-retest reliability is also high, ranging from .77-.85 (Koren et al. 1992), with high alpha reliability for the adapted version (.94; Rodriguez et al., 2011).

  Baseline, 6 months, 12 months, 18 months

• Change from Baseline Vanderbilt Mental Health Self Efficacy at 6, 12, and 18 months

  (Bickmanet al., 1991) This measure consists of 25 items measuring parents' self-efficacy beliefs and behavior expectations about mental health treatment for their children on a 5-point scale (1=strongly agree, 5=strongly disagree). The questionnaire has been used with both normative and high-risk samples with high internal consistency (alpha=.93 for normative and high-risk samples; Godwin, 2004). Construct validity has been established, with higher scores related to more parent collaboration with providers, increased social support, and more mental health service knowledge (Bickmanet al., 1998).

  Baseline, 6 months, 12 months, 18 months

• Change from Baseline Barriers to Treatment Participation at 6,12, and 18 months

  (BTPS; Kazdinet al. 1997). This measure is a 44-item scale that is administered via caregiver interview assessing barriers to participation in children's treatment. Items are rated from 1 (never a problem) to 5 (very often a problem), measuring four different areas: stressors or obstacles that compete with treatment, treatment demands, perceived relevance of treatment, and relationship with the therapist, with high internal consistency (Cronbach's α = .86; Nock \& Photos, 2006)

  Baseline, 6 months, 12 months, 18 months

• Change from Baseline PROMIS Global Health Scale at 6, 12, and 18 months

  (Broderick et al., 2013).This 10-item self-report scale was developed to evaluate individuals' perceptions of overall health status and its impact on quality of life (Hays et al., 2009). The scale produces two subscale scores: Physical Health (GPH) and Mental Health (GMH). Items are reported on a Likert scale of 1 to 5, with the exception of an overall pain scale, which is rated from 1 (No pain) to 10 (Worst pain). Each scale has high internal consistency (GMH: alpha=.86, GPH: alpha=.81), and high convergent validity with other measures of health-related quality of life (Hays et al, 2009).

  Baseline, 6 months, 12 months, 18 months

• Change from Baseline OHIO Scales at 6, 12, and 18 months

  (Ogles et al., 2001) The OHIO scales isa broad measure of functioning for youth age 5 to 18 years. It includes two subscales addressing (a) problem areas (α = .86) and (b) positive areasof functioning (α = .91). Each subscale contains 20 items. There is a parent report and a clinician report. We will utilize the Functioning subscale.

  Baseline, 6 months, 12 months, 18 months

• Change from Baseline Strength and Difficulties at 6, 12, and 18 months

  (SDQ, Goodman, 2001). Caregivers will complete the SDQ at baseline to derive three scores of child symptoms: symptom severity, externalizing difficulties, and internalizing difficulties. The SDQ is a 25-item screening tool for youth ages 3-17. The response scale has three anchors (0 = Not true, 1 = Somewhat true, and 2 = Certainly true). Internal consistency for the parent report total difficulties score is 0.8 and inter-rater agreement is 0.44 (Stone et al. 2010)

  Baseline, 6 months, 12 months, 18 months

• Demographics

  Child age, gender, and ethnicity, as well as other demographics, will be reported by the caregiver via REDCap. Caregiver demographics will be collected by research assistants via REDCap.

  Baseline

Study Arms (2)

Paraprofessional Navigation Condition

EXPERIMENTAL

Paraprofessional Navigators will implement a model of navigation with caregivers focused on reducing logistical and attitudinal barriers to care.

Other: Navigation

Wait-List as Usual

NO INTERVENTION

Participants will be assigned as wait-list as usual (active wait list) at each agency.

Interventions

Navigation OTHER

The intervention in this study is a model of navigation for families seeking services at the two mental health agencies collaborating on this study. Navigators will implement a model of navigation with caregivers focused on reducing logistical and attitudinal barriers to care.

Paraprofessional Navigation Condition

Eligibility Criteria

• Age: Up to 14 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17)

You may qualify if:

• African American and Latinx Children between 0 and 14 years of age and their caregiver
• New referrals on the waitlist for outpatient mental health services; families interested and engaged in social services from two state supported projects.
• Have been screened and deemed appropriate for services at one of two social service participating community mental health agencies; or engaged in services via navigation projects

You may not qualify if:

• N/A

Sponsors & Collaborators

• University of Illinois at Chicago: lead

Study Sites (1)

University of Illinois at Chicago

Chicago, Illinois, 60608, United States

RECRUITING

Related Publications (6)

• Bieling PJ, Madsen V, Zipursky RB. A 'navigator' model in emerging mental illness? Early Interv Psychiatry. 2013 Nov;7(4):451-7. doi: 10.1111/eip.12078. Epub 2013 Jul 24.

  PMID: 23889846 BACKGROUND

• Glassgow AE, Martin MA, Caskey R, Bansa M, Gerges M, Johnson M, Marko M, Perry-Bell K, Risser HJ, Smith PJ, Van Voorhees B. An innovative health-care delivery model for children with medical complexity. J Child Health Care. 2017 Sep;21(3):263-272. doi: 10.1177/1367493517712063. Epub 2017 Jun 5.

  PMID: 29119824 BACKGROUND

• Mehta TG, Lakind D, Rusch D, Walden AL, Cua G, Atkins MS. Collaboration with Urban Community Stakeholders: Refining Paraprofessional-led Services to Promote Positive Parenting. Am J Community Psychol. 2019 Jun;63(3-4):444-458. doi: 10.1002/ajcp.12316. Epub 2019 Mar 1.

  PMID: 30825221 BACKGROUND

• Barnett ML, Gonzalez A, Miranda J, Chavira DA, Lau AS. Mobilizing Community Health Workers to Address Mental Health Disparities for Underserved Populations: A Systematic Review. Adm Policy Ment Health. 2018 Mar;45(2):195-211. doi: 10.1007/s10488-017-0815-0.

  PMID: 28730278 BACKGROUND

• Ahmed SM, Lemkau JP, Nealeigh N, Mann B. Barriers to healthcare access in a non-elderly urban poor American population. Health Soc Care Community. 2001 Nov;9(6):445-53. doi: 10.1046/j.1365-2524.2001.00318.x.

  PMID: 11846824 BACKGROUND

• Lalji R, Koh L, Francis A, Khalid R, Guha C, Johnson DW, Wong G. Patient navigator programmes for children and adolescents with chronic diseases. Cochrane Database Syst Rev. 2024 Oct 9;10(10):CD014688. doi: 10.1002/14651858.CD014688.pub2.

  PMID: 39382077 DERIVED

Study Officials

• Tara Mehta, PhD

  University of Illinois at Chicago

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Tara G Mehta, PhD

CONTACT

312-996-3910; tmehta@uic.edu

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NON RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, CARE PROVIDER
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Associate Professor

Study Record Dates

• First Submitted: February 2, 2022
• First Posted: March 24, 2022
• Study Start: March 3, 2022
• Primary Completion: December 31, 2025
• Study Completion: February 28, 2026
• Last Updated: February 21, 2025

Record last verified: 2025-02

Locations

US (1)