A Multimodal Parent-focused Intervention for Vulnerable Populations in the Bronx

针对布朗克斯弱势群体的以家长为中心的多模式干预

• 批准号: 10414991
• 负责人: JONATHAN Edward ALPERT
• 金额: $ 84万
• 依托单位: ALBERT EINSTEIN COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-06-01 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10414991
• 关键词: Address; Adherence; Age; Anxiety; Autoimmune; COVID-19; COVID-19 impact; COVID-19 pandemic; COVID-19 pandemic effects; Caregivers; Caring; Case Manager; Cellular Phone; Cessation of life; Child; Child Rearing; Clinic; Clinical; Community Psychiatry; Complex; Data; Disadvantaged; Distress; Education; Effectiveness; Emotional; Enrollment; Face; Family; Family health status; Food; Generations; Health; Health Insurance Portability and Accountability Act; Health Personnel; Health system; Housing; Infrastructure; Institutional Review Boards; Intervention; Machine Learning; Measures; Mediating; Medical; Medical center; Mental Health; Minority; Modeling; Moods; Mothers; New York City; Outcome; Outcome Measure; Parents; Participant; Patients; Pattern; Pilot Projects; Population; Poverty; Procedures; Psyche structure; Psychological Stress; Psychopathology; Randomized Controlled Trials; Research; Resources; Risk; Sample Size; School-Age Population; Schools; Social Distance; Stress; Surveys; Technology; Testing; Therapeutic; Trauma; United States National Institutes of Health; Vulnerable Populations; Work; anxiety symptoms; arm; barrier to care; base; clinical infrastructure; cohort; community intervention; comorbidity; dashboard; design; digital; efficacy evaluation; ethnic minority population; evidence base; experience; follow-up; health care availability; health disparity; improved; innovation; maltreatment; member; mood symptom; multimodality; online care; outcome prediction; pandemic disease; pandemic stress; perceived stress; primary caregiver; programs; prospective; psychologic; psychological distress; racial minority; relative effectiveness; response; smartphone Application; social health determinants; substance use treatment; telehealth; therapy design; vulnerable community

PROJECT SUMMARY / ABSTRACT In response to PAR-20-237, “community interventions to address the consequences of the COVID-19 pandemic among health disparity and vulnerable populations,” we propose to study a parent-focused mentalizing intervention with a smartphone health platform in vulnerable populations in the Bronx. The Bronx—the poorest borough in New York City (NYC) with 84% of its population comprised of minorities—has been hit disproportionally by the COVID-19 pandemic. For caregivers in the Bronx, the pandemic has caused unprecedented psychological distress; in addition to combating social determinants of health (SDOH), these families now face greater financial insecurity and challenges related to their school-aged children. Furthermore, social distancing requirements and limited telehealth resources for Bronx families have posed greater barriers to healthcare. Such parental distress contributes to heightened risk of transgenerational cycles of psychological stress, trauma and maltreatment. Addressing these challenges, we propose a multimodal study tackling both parental vulnerability and healthcare access. a) Targeting parental vulnerability, we propose to build upon our 12-session therapeutic CARE program, which utilizes Mentalization Based Therapy and designed for parents of children in treatment in a community psychiatry clinic in our health system. Multiple randomized controlled trials (RCTs) of attachment-based parenting interventions, including from our group in disadvantaged cohorts from the Bronx. b) Targeting healthcare access, we propose to utilize the HIPAA-compliant and IRB-approved Valera Health smartphone application (“app”), which has been studied in our health system in selected cohorts and resulted in greater access to healthcare. Building upon our work and clinical infrastructure, we hypothesize that both the CARE program and the Valera app will mitigate the psychological effects of COVID-19 while enhancing access to healthcare in the Bronx. The study will take place at Montefiore Medical Center (MMC), the largest health system in the Bronx, which serves predominantly racial and ethnic minority individuals from underserved families. We will focus on three highly vulnerable cohorts: a) caregivers of children with psychiatric conditions (N=130); b) caregivers of children with autoimmune illnesses (N=130), and; c) caregivers who are frontline healthcare workers at MMC (N=100); all presenting with moderate stress. A RCT with 4 arms (2 x 2 design) will test our hypothesis: a) CARE program alone; b) CARE program + Valera app; c) Parent Education (PE) alone; d) PE + Valera app. Smartphones and connectivity will be provided as needed. Surveys at study enrollment, 6-, 12- and 24-weeks will assess parental stress, mentalizing capacity (reflective functioning), access to healthcare, mood and anxiety and additional parent and child clinical measures. Machine learning approaches will explore complex patterns as predictors of outcome including COVID-19 illness/deaths, medical comorbidity, housing, poverty, psychopathology, age, family functioning, and trauma. Impact. This multimodal study addresses key strategies to mitigate the psychological and health impact of COVID-19 in vulnerable populations.

项目概要/摘要 针对 PAR-20-237，“解决 COVID-19 大流行后果的社区干预措施 健康差异和弱势群体”，我们建议研究一种以父母为中心的心理化方法 通过智能手机健康平台对布朗克斯区最贫困的弱势群体进行干预。 纽约市 (NYC) 的一个行政区，其 84% 的人口是少数族裔，已受到打击 对于布朗克斯区的护理人员来说，COVID-19 大流行造成了不成比例的影响。 心理困扰；除了应对健康的社会决定因素（SDOH）之外，这些 家庭现在面临着更大的经济不安全感和与学龄儿童有关的挑战。 布朗克斯家庭的社交距离要求和有限的远程医疗资源构成了更大的障碍 这种父母的痛苦会导致跨代心理周期的胃肠道风险。 为了应对这些挑战，我们提出了一项多模式研究来应对这些挑战。 a) 针对父母的脆弱性，我们建议在我们的 12 个疗程的 CARE 治疗计划，采用基于心理化的疗法，专为父母设计 儿童在我们卫生系统的社区精神病学诊所接受治疗 多项随机对照试验。 基于依恋的育儿干预措施（随机对照试验），包括来自我们小组的弱势群体 b) 针对医疗保健获取，我们建议使用符合 HIPAA 且经 IRB 批准的 Valera。 健康智能手机应用程序（“应用程序”），已在我们的医疗系统中对选定的队列进行了研究， 基于我们的工作和临床基础设施，我们勇敢地面对这一点。 CARE 计划和 Valera 应用程序都将减轻 COVID-19 的心理影响，同时增强 该研究将在布朗克斯区最大的蒙蒂菲奥里医疗中心 (MMC) 进行。 布朗克斯区的卫生系统主要为服务不足的种族和族裔个体提供服务 我们将重点关注三个高度脆弱的群体：a) 患有精神疾病的儿童的照顾者。 (N=130)；b) 患有自身免疫性疾病的儿童的护理人员 (N=130)，以及；c) 一线护理人员 MMC 的医护人员（N=100）；所有患者均接受 4 组随机对照试验（2 x 2 设计）。 检验我们的假设：a) 单独 CARE 计划；b) CARE 计划 + Valera 应用程序；c) 单独家长教育 (PE)； d) 将根据需要在学习注册时提供 PE + Valera 应用程序和连接。 12 周和 24 周将评估父母的压力、心智化能力（反思功能）、获得医疗保健的机会、 将探索情绪和焦虑以及其他家长和儿童临床措施。 复杂的模式作为结果的预测因素，包括 COVID-19 疾病/死亡、医疗合并症、住房、 贫困、精神病理学、年龄、家庭功能和创伤是一项多模式研究的重点。 减轻 COVID-19 对弱势群体心理和健康影响的策略。