A Culturally-Adapted, Trauma-Informed Cognitive Rehabilitation Intervention for Asylum-Seekers and Refugees with Traumatic Brain Injury

针对患有创伤性脑损伤的寻求庇护者和难民的文化适应、创伤知情的认知康复干预

• 批准号: 10505811
• 负责人: Altaf Saadi
• 金额: $ 20.09万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-12-01 至 2027-11-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10505811
• 关键词: Address; Advisory Committees; Affect; Agreement; Alzheimer' s Disease; Area; Attention; Award; Behavioral Model; Brain Concussion; Bypass; Caring; Client satisfaction; Clinical; Clinical Research; Clinical Trials Design; Cognitive; Communities; Community Health Aides; Country; Disparity; Economic Burden; Effectiveness; Employment; Enhancement Technology; Epidemiology; Equity; Evaluation; Exercise; Facilities and Administrative Costs; Family; Feedback; Focus Groups; Foundations; Future; Health; Healthcare; Heterogeneity; Home; Immigration; Impaired cognition; Individual; Institute of Medicine (U.S.); Interpersonal Violence; Intervention; Interview; K-Series Research Career Programs; Legal; Linguistics; Memory; Mentorship; Methods; Modeling; Morbidity - disease rate; National Institute of Neurological Disorders and Stroke; Neurobehavioral Manifestations; Neurologist; Outcome; Participant; Patients; Perception; Persons; Population; Post-Concussion Syndrome; Prevalence; Procedures; Questionnaires; Recommendation; Refugees; Rehabilitation therapy; Reporting; Research; Research Methodology; Research Personnel; Research Proposals; Sampling; Societies; Source; Strategic Planning; Surveys; Symptoms; System; Technology; Telemedicine; Testing; Therapeutic Intervention; Therapeutic Studies; Time; Torture; Training; Transportation; Trauma; Traumatic Brain Injury; Trust; Underserved Population; United States National Institutes of Health; Variant; Veterans; Violence; Visual; Vulnerable Populations; Waiting Lists; War; Work; arm; barrier to care; brain health; career; cognitive rehabilitation; cost; court; dementia risk; design; disability; disparity reduction; effectiveness trial; ethnic health disparity; ethnic minority; evidence base; executive function; experience; health care delivery; health care disparity; health disparity; health disparity populations; health equity; health equity promotion; high risk; improved; information gathering; intervention delivery; intervention refinement; low and middle-income countries; marginalized population; medical specialties; mild traumatic brain injury; multidisciplinary; neuropsychiatry; preference; primary outcome; psychoeducation; psychoeducational; racial disparity; racial minority; randomized trial; satisfaction; secondary outcome; skills; social stigma; translational model; trauma exposure

PROJECT SUMMARY Traumatic brain injury (TBI) is a common, costly, and at times devastating condition associated with cognitive impairment, disproportionately affecting U.S. racial/ethnic minorities and individuals in low and middle-income countries. Asylum-seekers and refugees represent one especially vulnerable group that have high rates of TBI due to experiences such as war, torture, and interpersonal violence. Existing cognitive rehabilitation interventions targeting cognitive symptoms following TBI present an effective and evidence-based approach to address the cognitive sequalae of TBI in this population; but they require adaptation and evaluation. The central objective of this research proposal is to optimize and evaluate the first culturally adapted, trauma-informed cognitive rehabilitation intervention (“SMART-Plus”) delivered by community health workers (CHWs) using video-based telemedicine. This approach addresses several individual and system-level challenges such as linguistic barriers, cultural variations in perception of, and stigma around TBI, high trauma exposure, healthcare mistrust, lack of access to specialty-trained clinicians, and transportation barriers that make in-person interventions less feasible. Given the epidemiology of TBI in this population and to reduce sample heterogeneity in the early stages of intervention adaptation, the project will focus on those with interpersonal violence related mild TBI. The three Specific Aims are: (1) To develop SMART-Plus for asylum-seekers and refugees with interpersonal related mild TBI using input from asylum-seekers and refugees to tailor content, incorporate intervention delivery preferences, and identify engagement determinants; (2) To conduct an open pilot of SMART-Plus delivered by trained CHWs using telemedicine and further refine the intervention, study procedures, and outcome targets; and (3) To conduct a pilot feasibility randomized trial of SMART-Plus compared to wait-list control to improve post-concussive and cognitive impairment symptoms. These aims are consistent with the NIH Stage Model, representing a Stage IA (Aim 1 and 2) and Stage 1B (Aim 3) study, as well as Barerra’s stage model for cultural adaptation that involves information gathering (Aim 1); preliminary adaptation design and testing (Aim 2), and full adaptation design and testing (Aim 3). The findings of this project will fill an existing gap in a high impact research area that will inform the care of a growing and vulnerable population. At the same time, it offers a translational model for cultural and trauma-informed adaptation for other health disparities populations experiencing cognitive impairment and similar barriers to care, both domestically and globally. The PI, Dr. Saadi, is an early-career clinician investigator and neurologist, who will use this career development award to enhance her skills in mixed methods research for intervention adaptation, cognitive rehabilitation therapy and neuropsychiatric outcomes, equity-centered technology-based approaches, and RCT design involving vulnerable groups. She will leverage this training to launch an independent research career in scalable, technology-enhanced, community- engaged interventions to promote brain health equity. Throughout the award period, Dr. Saadi will work closely with an expert, committed and multidisciplinary mentorship and advisory team to carry out her stated career objectives and specific aims.

项目摘要 创伤性脑损伤（TBI）是一种常见，昂贵的，有时与认知有关 损害不成比例地影响美国的种族/族裔少数群体和中等收入的个人 国家。寻求庇护者和难民代表一个特别脆弱的群体，由于 战争，酷刑和人际暴力等经历。现有的认知康复干预措施针对 TBI之后的认知症状提出了一种有效和基于证据的方法，可以解决 该人群中的TBI；但是它们需要适应和评估。该研究建议的核心目标是 优化和评估第一个文化适应，创伤性的认知康复干预措施（“ smart-plus”） 由社区卫生工作者（CHW）使用基于视频的远程医疗提供。这种方法解决了几个 个人和系统水平的挑战，例如语言障碍，感知的文化差异以及周围的污名 TBI，高创伤暴露，医疗保健不信任，缺乏专业训练的临床医生和运输障碍 这使得面对面的干预措施不那么可行。鉴于TBI在该人群中的流行病学并减少样本 在干预适应的早期阶段的异质性，该项目将集中于人际暴力的人 相关的轻度TBI。三个具体目标是：（1）与寻求庇护者和难民一起开发智能 人际关系相关的轻度TBI使用寻求庇护者和难民的输入来量身定制内容，并纳入干预措施 交付偏好，并确定参与性决定者； （2）执行由智能加油的开放式飞行员 使用远程医疗训练的CHW，并进一步完善干预，研究程序和结果目标； （3）到 与等待列表控制相比，进行智能智能的随机试验可行性，以改善脑后和 认知障碍症状。这些目标与NIH阶段模型一致，代表IA阶段（目标1 2）和第1B期（目标3）研究，以及Barrerra的文化适应模型，涉及信息 聚会（目标1）；初步适应设计和测试（AIM 2）以及完整的适应设计和测试（AIM 3）。这 该项目的调查结果将填补高影响力研究领域的现有空白，这将为您的增长和 脆弱的人口。同时，它为文化和创伤的改编提供了转化模型 其他健康分布人群遭受认知障碍和类似的护理障碍，无论是在国内和 全球。 PI Saadi博士是早期职业临床研究者和神经科医生，他将使用这种职业发展 奖励以提高她在混合方法研究中的技能，以进行干预适应，认知康复疗法和 神经精神病学结果，以股票为中心的技术方法以及涉及弱势群体的RCT设计。 她将利用这项培训在可扩展，技术增强，社区 - 参与干预措施以促进大脑健康公平。在整个奖项期间，萨迪博士将与 专家，承诺和多学科的心态和咨询团队，以实现她既定的职业目标和 具体目标。