Family Spirit Strengths: A home visiting strategy to support parents and caregivers with mental distress and substance misuse

家庭精神优势：家访策略，为患有精神困扰和药物滥用的父母和看护者提供支持

• 批准号: 10622234
• 负责人: Emily Haroz
• 金额: $ 64.34万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-15 至 2028-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10622234
• 关键词: Address; Age; Alaska Native; Ally; American Indians; Anxiety; Area; COVID-19 pandemic; Caregivers; Caring; Cessation of life; Child; Child Rearing; Chronic; Communities; Community Participation; Country; Development; Diagnostic; Discrimination; Disparity; Distress; Education; Educational Curriculum; Effectiveness; Elements; Emotional; Enrollment; Evidence based practice; Family; Feedback; Foundations; Funding; Genocides; Goals; Growth; Health; Health Services; Heterogeneity; Home; Home visitation; Hybrids; Indigenous; Individual; Inequity; Institutional Racism; Intervention; Kinship Networks; Maternal Health; Measures; Mediator; Mental Depression; Mental Health; Modeling; Morbidity - disease rate; Mothers; NIH Program Announcements; Nutritional; Nutritional Support; Outcome; Parents; Participant; Personal Satisfaction; Premature Mortality; Prevention; Prevention approach; Prevention program; Prevention strategy; Primary Prevention; Process; Psyche structure; Randomized; Research; Research Personnel; Risk; Role; Secondary Prevention; Services; Source; Spirituality; Substance Use Disorder; Suicide; Supervision; Symptoms; System; Testing; Therapeutic; Training; Trauma; Tribes; United States; Violence; Woman; Work; active control; age group; anxiety symptoms; behavioral health; budget impact; community setting; cost; cost effectiveness; cost estimate; cultural competence; depressive symptoms; design; early childhood; effectiveness evaluation; effectiveness testing; effectiveness/implementation design; evidence base; experience; family support; high risk; implementation barriers; implementation design; implementation facilitators; implementation strategy; implementation/effectiveness; incremental cost-effectiveness; indigenous community; interest; intergenerational; member; mortality; novel; perinatal mental health; preventive intervention; primary caregiver; primary outcome; programs; protective factors; reduce symptoms; reduced substance use; resilience; response; scale up; skills; substance misuse; substance use; theories; therapy design; tribal community

PROJECT SUMMARY/ABSTRACT Mental health and substance misuse pose some of the greatest risks to the health and wellbeing of American Indian and Alaska Native (AI/AN) communities and result in intergenerational morbidity and mortality. These risks are the legacy of historical trauma, ongoing discrimination, and chronic underfunding of mental health and substance use care, resulting in massive care and treatment gaps. Simultaneously, many AI/AN communities emphasize a holistic view of wellbeing centered around family and community, and prefer upstream preventative and family-based interventions with potential to disrupt intergenerational cycles of trauma and adversity. Our team of Indigenous and allied researchers has worked closely with participating communities to design and pilot the Family Spirit Strengths (FSS) intervention, designed to provide transdiagnostic skills- based preventive strategies to mothers and primary caregivers at elevated risk for mental health and substance use disorders. We propose a Hybrid Type I Effectiveness-Implementation design with the primary goal of testing FSS effectiveness at reducing symptoms of depression, anxiety, and substance use, among N = 188 primary caregivers across three diverse Tribal settings and contexts. Participants will be randomized to receive FSS or a beneficial control, which is an evidence-based nutritional support program called Family Spirit Nurture. Primary outcomes will be measured at 6 months post-enrollment. We will also seek to characterize heterogeneity in and mechanisms of FSS effects by exploring moderators and mediators, respectively, guided by both Western and Indigenous theories of action. As part of our Hybrid approach, we will estimate FSS costs, cost-effectiveness, and budget impact. Finally, we will undertake a process with National stakeholders to understand barriers to and facilitators of FSS implementation across the country, including co-design of implementation strategies to support FSS at scale across diverse AI/AN communities. This study is responsive to Program Announcement PAR-20-238 and focuses on key areas of interest including the testing of evidence- based practices in community settings (MH-22-170) and expanding perinatal mental health interventions (MH- 21-215, MH-21-270). Our overall objective is to rigorously test a secondary preventative intervention designed to be embedded in home visiting programs so that we can extend the reach of mental and behavioral health services in AI/AN communities across the country.

项目摘要/摘要 精神健康和滥用物质对美国的健康和福祉构成了一些最大的风险 印度和阿拉斯加本地人（AI/AN）社区，并导致代际发病率和死亡率。这些 风险是历史创伤，持续歧视和长期资助心理健康和长期资助的风险 物质使用护理，导致大量护理和治疗差距。同时，许多AI/A A/A社区 强调以家庭和社区为中心的福祉的整体观点，并且更喜欢上游 预防和基于家庭的干预措施，可能会破坏创伤和 逆境。我们的土著研究人员团队与参与社区紧密合作， 设计和驾驶家庭精神优势（FSS）干预措施，旨在提供经诊断的技能 - 基于对母亲和初级护理人员的预防策略，其心理健康风险较高 物质使用障碍。我们建议使用主要的I型I型有效性设计设计 测试FSS在减轻抑郁症，焦虑和药物使用症状方面有效性的目标，n = 188个三个不同部落环境和环境的主要护理人员。参与者将被随机 接收FSS或有益控制，这是一个基于证据的营养支持计划，称为家庭精神 培育。主要结果将在注册后6个月进行测量。我们还将寻求描述 通过探索主持人和介体的指导，FSS效应的异质性和机制的异质性和机制 由西方和土著的行动理论。作为混合方法的一部分，我们将估计FSS 成本，成本效益和预算影响。最后，我们将与国家利益相关者进行一项程序 了解全国FSS实施的障碍和促进者，包括 实施策略以支持各种AI/A/A社区的FSS。这项研究反应灵敏 为公告计划PAR-20-238，重点关注关键领域，包括测试证据 - 社区环境（MH-22-170）的基于基于的实践，并扩大了围产期心理健康干预措施（MH- 21-215，MH-21-270）。我们的总体目标是严格测试设计的二级预防干预措施 要嵌入家庭访问计划中，以便我们可以扩展心理和行为健康的影响力 全国各地的AI/A社区的服务。