Increasing provider competence for treating stress-related mental health conditions in low resource settings

提高医疗服务提供者在资源匮乏的环境中治疗与压力相关的心理健康状况的能力

• 批准号: 9340890
• 负责人: Corina Lelutiu-Weinberger
• 金额: $ 21.72万
• 依托单位: RBHS-SCHOOL OF NURSING
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-01 至 2019-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9340890
• 关键词: AIDS prevention; Address; Alcohol abuse; Alcohol consumption; Anal Sex; Anxiety; Attitude; Bisexual; Caring; Case Study; Client; Clinical; Clinical Skills; Companions; Competence; Consultations; Continuing Education; Counseling; Country; Coupled; Dangerousness; Data Collection; Disclosure; Discrimination; Educational Curriculum; Enrollment; Ensure; Europe; European; Feedback; Fright; Gays; General Population; Group Meetings; HIV; HIV risk; HIV/STD; Health; Health Communication; Health Personnel; Health Professional; Health Services; Health Surveys; Healthcare; Healthcare Systems; Heterosexuals; Homophobia; Homosexuality; Hour; Incidence; Individual; International; Intervention; Interview; Knowledge; LGBT Health; Lesbian; Lesbian Gay Bisexual Transgender; Medical; Mental Depression; Mental Health; Methodology; Modeling; Monitor; Morbidity - disease rate; Motivation; Names; Participant; Persons; Prevalence; Professional counselor; Provider; Psyche structure; Psychiatrist; Psychologist; Public Health; Randomized Controlled Trials; Reporting; Research; Research Infrastructure; Resources; Risk; Risk Behaviors; Romania; Science; Seeds; Self Efficacy; Services; Sexual Health; Sexuality; Stress; Structure; Suicide; Sum; Supervision; Techniques; Testing; Therapeutic; Training; Training Programs; Translating; United States National Institutes of Health; Universities; alcohol risk; base; clinical practice; condoms; cost effective; cost effectiveness; drinking; efficacy testing; evidence base; health care availability; health care service utilization; health disparity; health training; implementation science; improved; mHealth; meetings; men who have sex with men; mental training; multidisciplinary; peer; personalized medicine; physical conditioning; post intervention; programs; sex; skills; social stigma; stressor; tool; transgender; treatment planning; trial comparing; virtual

Project Summary Lesbian, gay, bisexual and transgender individuals (LGBTI) present increased morbidity compared to the general population, which is attributed to healthcare discrimination and lack of LGBT-specific expertise, especially in high-stigma countries. Motivated by fear, Romanian LGBTI conceal their identities and report significantly more barriers to healthcare access than heterosexuals. Poor mental health, specifically anxiety and depression, is elevated for Romanian LGBTI, and associated with poor physical health (e.g., HIV risk, alcohol abuse.) However, LGBT-competent mental health professionals (MHPs) are nearly non-existent in Romania, and thus the negative impact of homophobia on mental health cannot be ameliorated. Neither universities nor continuing education include LGBT identity and health curricula, to the contrary, the dominant discourse promotes homosexuality as a dangerous anomaly in need of eradication. Given that a pilot of our in- person LGBT-affirmative MHP training we tested recently in Romania showed significant receptivity and increased competence among MHPs, this training is now ripe for testing its feasibility and efficacy in creating significant change via mobile delivery, in a randomized controlled trial (RCT). Proving the efficacy of this first mobile training and supervision model has high potential for cost-effective and expeditious boundless dissemination. In Aim 1, we will test the relative feasibility and efficacy of our mHealth MHP training by conducting an RCT comparing a mobile training (MT) of our MHP LGBT-competency program (n=60) to the equivalent in-person training (IPT) (n=60) we recently piloted. Both programs' content and structure will be identical (3-day trainings and two boosters 6 months apart). At baseline, 4, 8, and 12 months, we will assess, in a mobile fashion, all MHPs' LGBT-related attitudes, knowledge of LGBT health needs and clinical practice, and LGBT caseload. In Aim 2, we will test the efficacy of a companion mHealth supervision and consultation program in maintaining LGBT competency and enhancing LGBT-friendly practice. Half of the MHPs in each group will receive our mHealth supervision and expert consultation program, consisting of monthly 2-hour virtual group meetings to discuss case studies, in order to determine the added benefit of mobile supervision. After the training, 10 MHPs will provide interview-based program feedback. In Aim 3, we will build mHealth research capacity among MHPs by demonstrating how to integrate mobile data collection tools in clinical practice to monitor client progress for personalized treatment plans. We have chosen four types of partners to maximize the project's sustainability and benefit from the power of their multidisciplinarity: academics, direct service agencies supporting LGBTI, practicing MHPs, and a technical developer. This first RCT testing of an mHealth training in LGBT-competent mental healthcare in Romania affords us an unparalleled opportunity to introduce much needed expertize and mHealth methodologies in universities and clinical practice, and create a seed infrastructure for an implementation science R01 of national and global public health significance.

项目概要 与正常人相比，女同性恋、男同性恋、双性恋和跨性别者 (LGBTI) 的发病率有所增加 一般人群，这是由于医疗保健歧视和缺乏 LGBT 特定专业知识， 尤其是在耻辱感很高的国家。出于恐惧，罗马尼亚 LGBTI 隐瞒身份并举报 与异性恋者相比，获得医疗保健的障碍明显更多。心理健康状况不佳，特别是焦虑 罗马尼亚 LGBTI 的患病率较高，并且与身体健康状况不佳（例如艾滋病毒风险、 酗酒。）然而，在美国几乎不存在具备 LGBT 能力的心理健康专业人员 (MHP)。 罗马尼亚，因此恐同症对心理健康的负面影响无法改善。两者都不 大学和继续教育都包括 LGBT 身份和健康课程，相反，主流教育 言论将同性恋视为一种需要根除的危险异常现象。鉴于我们的飞行员 我们最近在罗马尼亚测试的 LGBT 肯定性 MHP 培训显示出显着的接受度和 提高了 MHP 的能力，这种培训现在已经成熟，可以测试其在创建 在一项随机对照试验 (RCT) 中，移动交付带来了重大变化。首先证明这个的有效性 移动培训和督导模式具有巨大潜力，成本效益高且快捷无边 传播。在目标 1 中，我们将通过以下方式测试 mHealth MHP 培训的相对可行性和有效性： 进行一项随机对照试验，将我们的 MHP LGBT 能力计划 (n=60) 的移动培训 (MT) 与 我们最近试行了同等的面对面培训 (IPT) (n=60)。两个计划的内容和结构都将是 相同（为期 3 天的培训和两次间隔 6 个月的强化培训）。在基线、4、8 和 12 个月，我们将评估， 以移动方式收集所有 MHP 对 LGBT 相关的态度、LGBT 健康需求和临床实践的知识， 和 LGBT 案件数量。在目标 2 中，我们将测试伴随移动医疗监督和咨询的效果 保持 LGBT 能力和加强 LGBT 友好实践的计划。每个 MHP 的一半 小组将接受我们的 mHealth 监督和专家咨询计划，包括每月 2 小时 虚拟小组会议讨论案例研究，以确定移动监管的额外好处。 培训结束后，10 名 MHP 将提供基于访谈的计划反馈。在目标 3 中，我们将打造移动医疗 通过展示如何将移动数据收集工具集成到临床中来提高 MHP 的研究能力 练习监控客户个性化治疗计划的进展。我们选择了四种类型的合作伙伴 最大限度地提高项目的可持续性，并从多学科的力量中受益：学术、直接 支持 LGBTI、执业 MHP 和技术开发人员的服务机构。这是首次 RCT 测试 罗马尼亚 LGBT 相关心理保健领域的移动健康培训为我们提供了无与伦比的机会 在大学和临床实践中引入急需的专业知识和移动医疗方法，并创建一个 种子基础设施，用于实施具有国家和全球公共卫生意义的科学 R01。