Youth-PRIDES: Implementing integrated, mHealth care for adolescent depressionwithin primary care clinics of Mozambique

Youth-PRIDES：在莫桑比克初级保健诊所内针对青少年抑郁症实施综合移动医疗保健

• 批准号: 10900850
• 负责人: Kathryn Lynn Lovero
• 金额: $ 6.53万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-15 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10900850
• 关键词: Address; Adolescent; Adolescent Health Services; Adult; Africa South of the Sahara; Aftercare; Area; Award; Caregivers; Caring; Clinical; Cluster randomized trial; Communities; Competence; Consolidated Framework for Implementation Research; Country; Data; Depression screen; Development; Dissemination and Implementation; Evidence based practice; Friends; Goals; Group Therapy; Health; Health Policy; Health Professional; Health Services; Health Services Accessibility; Health Status; Human Resources; Income; Intervention; Interview; Knowledge; Measures; Medical; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Mentored Research Scientist Development Award; Mentors; Mentorship; Methods; Minority; Modeling; Mozambique; National Institute of Mental Health; Nursing Services; Pathway interactions; Patient Outcomes Assessments; Patient-Focused Outcomes; Patients; Phase; Policies; Practice Management; Primary Care; Proctor framework; Provider; Public Health; Publications; Randomized; Research; Research Infrastructure; Research Methodology; Resource-limited setting; Resources; Risk; Rural; School Drop-Outs; Schools; Services; Specialist; Student Dropouts; System; Training; Training Activity; Work; Youth; arm; burden of illness; care delivery; career; child depression; community engagement; contextual factors; design; disability; effectiveness/implementation trial; implementation evaluation; implementation outcomes; implementation research; implementation science; implementation strategy; innovation; interpersonal therapy; knowledge of results; low and middle-income countries; mHealth; novel; primary care clinic; primary care setting; primary health service; scale up; screening; skills; symposium; tool; treatment as usual

Globally, mental disorders are the largest contributor to burden of disease in adolescents, yet the vast majority of youth worldwide do not have access to treatment. Mental health services integrated within primary care and delivered by non-specialists (i.e., task-shifting) offer an efficient and sustainable method to close the adolescent mental health treatment gap. However, research is needed to determine how to effectively implement task-shifted, integrated adolescent mental health care, particularly in low-resource settings. The goal of this K01 Award is to expand the candidate’s expertise and prepare her to conduct independent research on the implementation and dissemination of evidence-based practices (EBPs) for managing adolescent mental disorders in low-resource settings. Through a combination of coursework and seminars, clinical observation, scientific conferences, collaborative publications, and mentorship from experts in global adolescent mental health and global mental health implementation research, the candidate will develop competency in 1) the development, expression, and treatment of global adolescent mental disorders; 2) mixed- methods, community-based assessment of parameters relevant to contextual adaptation and implementation of adolescent mental health interventions; and 3) conducting hybrid effectiveness-implementation trials of EBP for sustainably managing adolescent mental disorders in low-resource settings. The candidate will apply knowledge and skills gained through training activities to conduct a multi- phase study in Mozambique, the fourth poorest country in the world. Leveraging an existing partnership with the Ministry of Health and research infrastructure developed through the PRIDES study to evaluate pathways for scaling-up adult mental health services (U19MH113203), the candidate aims to design and evaluate a strategy to implement screening and treatment for adolescent depression integrated within primary care clinics. Community-based, mixed-methods research will identify cultural and contextual barriers and facilitators to implementing integrated adolescent depression services (Aim 1). This data will inform contextual adaptation of group interpersonal therapy for adolescents (IPT-A), an EBP for adolescent depression. It will also be used to develop a strategy to implement depression screening and IPT-A in which non-specialist providers are guided by mobile health (mHealth) tools that promote treatment fidelity (Aim 2). Patient and implementation outcomes of the depression management strategy will be evaluated in a pilot, cluster-randomized trial (Aim 3) and used to develop an R01 proposal for a hybrid effectiveness-implementation trial to assess scale-up of integrated adolescent depression care throughout Mozambique. Together, the training, research, and research-policy partnership in the proposed award will support the development of an innovative model for engaging with local stakeholders to adapt and implement mHealth, task-shifted EBPs for managing adolescent mental disorders in low-resource settings, contributing to the NIMH’s goal of maximizing public health impact of research.

在全球范围内，精神障碍是造成青少年疾病负担的最大因素，但绝大多数 全世界的青少年无法获得纳入初级保健和治疗的心理健康服务。 由非专家提供（即任务转移）提供了一种有效且可持续的方法来关闭 然而，需要研究来确定如何有效地解决青少年心理健康治疗的差距。 实施任务转移、综合的青少年心理保健，特别是在资源匮乏的环境中。 K01 奖的目标是扩展候选人的专业知识并帮助她做好独立的准备 关于管理循证实践（EBP）的实施和传播的研究 通过课程作业和研讨会的结合，解决资源匮乏地区的青少年精神障碍问题。 临床观察、科学会议、合作出版物以及全球专家的指导 青少年心理健康和全球心理健康实施研究，候选人将开发 1) 全球青少年精神障碍的发展、表达和治疗的能力；2) 混合- 方法、基于社区的与情境适应和实施相关的参数评估 青少年心理健康干预措施；3) 进行 EBP 混合有效性实施试验 可持续管理资源匮乏地区的青少年精神障碍。 候选人将运用通过培训活动获得的知识和技能来进行多项 利用与世界第四个最贫穷国家莫桑比克的现有伙伴关系进行阶段研究。 卫生部和通过 PRIDE 研究开发的研究基础设施，以评估途径 为了扩大成人心理健康服务（U19MH113203），候选人旨在设计和评估 在初级保健诊所内实施青少年抑郁症筛查和治疗的战略。 基于社区的混合方法研究将确定文化和背景的障碍和促进因素 实施综合青少年抑郁症服务（目标 1）。 青少年团体人际关系治疗（IPT-A），一种治疗青少年抑郁症的 EBP。 制定实施抑郁症筛查和 IPT-A 的策略，指导非专业提供者 通过提高治疗保真度的移动医疗 (mHealth) 工具（目标 2）。 抑郁症管理策略的评估将通过一项试点、整群随机试验（目标 3）进行评估并使用 制定混合有效性实施试验的 R01 提案，以评估综合试验的扩大规模 莫桑比克各地的青少年抑郁症护理共同开展培训、研究和研究政策。 拟议奖项中的伙伴关系将支持开发与当地合作的创新模式 利益相关者调整和实施移动医疗、任务转移的 EBP，以管理青少年精神障碍 资源匮乏的环境，有助于实现 NIMH 最大化研究对公共卫生影响的目标。