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.

项目概要 创伤性脑损伤 (TBI) 是一种与认知相关的常见、昂贵且有时具有破坏性的疾病 损害，对美国少数种族/族裔以及低​​收入和中等收入个人的影响尤为严重 寻求庇护者和难民是一个特别脆弱的群体，其 TBI 发病率很高。 现有的认知康复干预措施包括战争、酷刑和人际暴力等经历。 TBI 后的认知症状提供了一种有效且基于证据的方法来解决以下认知后遗症： 该人群的 TBI；但需要适应和评估 本研究提案的中心目标是 优化和评估第一个适应文化、创伤信息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此方法解决了几个问题。 个人和系统层面的挑战，例如语言障碍、认知上的文化差异以及周围的耻辱 TBI、高创伤暴露、医疗保健不信任、缺乏接受过专业培训的超级明星以及交通障碍 考虑到该人群中 TBI 的流行病学并减少样本，使得亲自干预变得不太可行。 由于干预适应早期阶段存在异质性，该项目将重点关注那些遭受人际暴力的人 相关的轻度 TBI 的三个具体目标是： (1) 为寻求庇护者和难民开发 SMART-Plus。 与人际相关的轻度创伤性脑损伤，利用寻求庇护者和难民的意见来定制内容，纳入干预措施 （二）开展SMART-Plus开放试点 使用远程医疗对社区卫生工作者进行培训，并进一步完善干预措施、研究程序和结果目标；以及 (3) 进行 SMART-Plus 与等待名单控制相比的试点可行性随机试验，以改善脑震荡后和 这些目标与 NIH 阶段模型一致，代表 IA 阶段（目标 1）。 2) 和阶段 1B（目标 3）研究，以及涉及信息的文化适应 Barerra 阶段模型 收集（目标1）；初步适应设计和测试（目标2），以及全面适应设计和测试（目标3）。 该项目的研究成果将填补高影响力研究领域的现有空白，为日益增长和健康的儿童的护理提供信息 同时，它为弱势群体提供了一种文化和创伤适应的转化模型。 其他健康差异人群在国内和国外都经历认知障碍和类似的护理障碍 首席研究员 Saadi 博士是一名职业生涯早期的临床研究者和神经科医生，他将利用这一职业发展机会。 奖项旨在提高她在干预适应、认知康复治疗和混合方法研究方面的技能 神经精神结果、以公平为中心的基于技术的方法以及涉及弱势群体的随机对照试验设计。 她将利用这次培训在可扩展、技术增强、社区领域开展独立研究生涯。 在整个奖励期间，萨阿迪博士将与一个致力于促进大脑健康公平的干预措施密切合作。 专家、忠诚和多学科的指导和咨询团队来实现她既定的职业目标和 具体目标。