CEREMONY: Culturally Engaged REcovery - MOms connected through Native community

仪式：文化参与式恢复 - MOms 通过原住民社区建立联系

基本信息

批准号：
10748244
负责人：
Michelle Precourt Debbink
金额：
$ 56.35万
依托单位：
UNIVERSITY OF UTAH
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-08-17 至 2030-07-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10748244
关键词：
Address Adult Alaska Native American Indians Area Caring Cessation of life Cities Clinic Clinical Clinical Services Clinical effectiveness Communities Complement Contracts Counseling County Data Dependence Diné Nation Education Enrollment Evidence based practice Face Feedback Foundations Goals Health Personnel Hybrids Infant Intervention Interview Knowledge Length of Stay Manuals Maternal Mortality Measures Medical Records Mental Health Mental Health Services Modeling Morbidity - disease rate Mothers Native-Born Navajo Neonatal Not Hispanic or Latino Outcome Participant Patient-Focused Outcomes Perception Perinatal Perinatal Care Persons Phase Population Postpartum Period Pregnancy Pregnancy Outcome Prenatal care Process Assessment Production Protocols documentation Randomized Recovery Research Reservations Review Committee Risk Risk Reduction Rural Services Social support Sodium Chloride Substance Use Disorder Testing Toxicology Training Trauma Tribes Universities Urine Utah Work addiction care coordination clinical center clinical implementation cohort community based participatory research community engagement design disorder risk effectiveness/implementation study evidence base follow-up high risk human centered design hybrid type 1 design implementation evaluation implementation process implementation science improved informant innovation lens maternal morbidity maternal outcome medication for opioid use disorder mortality multidisciplinary neonatal outcome novel patient oriented peer support phase 2 testing postpartum care pregnant preventable death prospective resilience simulation social stigma substance use substance use prevention tribal community virtual experiments

项目摘要

ABSTRACT: PROJECT 1 CEREMONY Pregnant and postpartum American Indian and Alaska Native people (Native mothers) face a more than two- fold higher risk of maternal mortality compared to non-Hispanic White mothers. Deaths related to substance use (SU) and mental health conditions reflect a leading cause of preventable maternal mortality, including among Native mothers, making these conditions a strong target for reducing maternal mortality and morbidity. The Utah Maternal Mortality Review Committee (MMRC) has identified access to substance use disorder (SUD) treatment including medication for opioid use disorder (MOUD), mental health care, improved social support, decreased stigma against SUD, and care coordination, particularly in the postpartum period (when the majority of deaths occur) as actionable intervention points. The objective of our study, Culturally- Engaged REcovery – MOms connected through Native CommunitY (CEREMONY), is to adapt evidence-based perinatal care models that integrate pregnancy and postpartum care with SU/SUD treatment and care to meet the needs of Native mothers. With our partners at Sacred Circle Clinic, a federal Tribal Contract clinic operated by the Confederated Tribes of the Goshute Reservation, we are uniquely poised to respond to the expressed needs of Native mothers and stakeholders, who identified a lack of culturally-integrated SUD care as a significant gap in perinatal care for Native mothers. We will do this by building upon the strong, evidence- based foundation of our University of Utah integrated perinatal SUD clinic called Substance Use and Pregnancy – Recovery, Addiction, and Dependence (SUPeRAD). The SUPeRAD model directly addresses the actionable intervention points identified by the MMRC to prevent SUD-related maternal deaths, but is not specifically adapted to Native mothers’ needs. The rationale for this study is that there is a critical knowledge gap in the adaptation and implementation of integrated perinatal SUD care specifically for Native mothers. The CEREMONY study will fill this gap by adapting the SUPeRAD clinic model to the needs of Native mothers using the validated ADAPT-ITT adaptation framework, informed by human centered design and community-based participatory research (Aim 1); and then testing the adapted, culturally-integrated perinatal SUD care intervention at Sacred Circle Clinic using a Hybrid Type 1 effectiveness-implementation study (Aim 2a&b). The Hybrid Type 1 design will provide important, reliable data on the clinical effectiveness of culturally adapted perinatal SUD care for Native mothers (Aim 2a) while also producing novel data on the implementation process (Aim 2b). Successful completion of these Aims will provide implementation and training protocols that can be used to guide adaptation and implementation of culturally-adapted perinatal SUD care in other settings across the US. Our study is innovative and significant because it employs strong community engagement principles and a robust implementation science approach to produce novel clinical effectiveness and implementation data that can be rapidly disseminated to dramatically improve the care of Native mothers with SUD and reduce risks for maternal mortality and morbidity.

摘要：项目 1 仪式怀孕和产后的美洲印第安人和阿拉斯加原住民（原住民母亲）面临着两个以上的问题：与非西班牙裔白人母亲相比，与物质相关的死亡风险更高。使用（SU）和心理健康状况反映了可预防的孕产妇死亡的主要原因，包括土著母亲，使这些条件成为降低孕产妇死亡率的有力目标犹他州孕产妇死亡率审查委员会 (MMRC) 已确定药物使用的可及性。障碍 (SUD) 治疗，包括治疗阿片类药物使用障碍 (MOUD) 的药物、心理保健、改善社会支持、减少对 SUD 的耻辱以及护理协调，特别是在产后期（当大多数死亡发生时）作为可行的干预点，我们研究的目标是文化- 参与式恢复 – MOms 通过 Native CommunityY（CEREMONY）连接，旨在适应基于证据的将妊娠和产后护理与 SU/SUD 治疗和护理相结合的围产期护理模式，以满足与我们在 Sacred Circle Clinic 的合作伙伴合作，这是一家联邦部落合同诊所。戈舒特保留地的联盟部落，我们独特地准备回应这个表达土著母亲和利益相关者的需求，他们认为缺乏文化融合的 SUD 护理是一个问题土著母亲的围产期护理存在巨大差距，我们将通过强有力的证据来做到这一点。我们犹他大学综合围产期 SUD 诊所的基础名为物质使用和怀孕 – 恢复、成瘾和依赖 (SUPeRAD) SUPeRAD 模型直接解决了这一问题。 MMRC 确定了预防 SUD 相关孕产妇死亡的可行干预点，但并未专门适应本土母亲的需求。这项研究的理由是有关键知识。专门针对土著居民的综合围产期 SUD 护理的适应和实施方面的差距 CEREMONY 研究将通过调整 SUPeRAD 诊所模式来满足母亲的需求，从而填补这一空白。本土母亲使用经过验证的 ADAPT-ITT 适应框架，以人为本的设计基于社区的参与性研究（目标 1）；然后测试适应的、文化融合的研究； Sacred Circle Clinic 使用混合 1 型有效性实施的围产期 SUD 护理干预研究（目标 2a 和 b）。混合 1 型设计将为临床有效性提供重要、可靠的数据。为土著母亲提供适应文化的围产期 SUD 护理（目标 2a），同时还提供有关实施过程（目标 2b）成功完成这些目标将提供实施和可用于指导适应文化的围产期 SUD 的适应和实施的培训协议我们的研究具有创新性且意义重大，因为它采用了强大的技术。社区参与原则和强大的科学实施方法来制作临床小说可以快速传播有效性和实施数据，以显着改善患者的护理患有 SUD 的本土母亲可以降低孕产妇死亡和发病的风险。