CRISOL Mente: A Multilevel Community Intervention to Reduce Mental Health Disparities Among Latinos

CRISOL Mente：减少拉丁裔心理健康差异的多层次社区干预

基本信息

批准号：
10597875
负责人：
Mariana Lazo Elizondo
金额：
$ 111.96万
依托单位：
DREXEL UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-19 至 2027-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10597875
关键词：
Acute Address Adherence Advocacy Awareness COVID-19 pandemic Caring Client Clinic Clinical Data Communication Communities Community Outreach Community Surveys Complex Coupled Data Development Discrimination Economics Education Education and Outreach Educational Background Effectiveness Evaluation Evidence based treatment Fright Health Health Insurance Health Resources Health Services Accessibility Healthcare Immigrant Intervention Interview Language Latina Latino Latino Population Legal Limited English Proficiency Linguistics Mental Depression Mental Health Mental Health Services Mental disorders Methods Modeling Newsletter Not Hispanic or Latino Occupations Outcome Patients Phase Philadelphia Population Poverty Provider Public Health Radio Reach Effectiveness Adoption Implementation and Maintenance Reduce health disparities Reporting Research Resource-limited setting Resources Respondent Rest Risk Sampling Services Site Social Conditions Social Work Stress Supervision Surveys Symptoms Syndrome Testing Time Training Woman barrier to care base bilingualism clinical anxiety cohort community engaged research community intervention community setting cost cost effective cultural competence design disparity reduction effectiveness testing experience follow-up health care availability health disparity improve minority health improved informant member men novel outreach peer post-COVID-19 post-traumatic stress programs psychological distress racism recruit screening social stigma syndemic

项目摘要

Latinos in the U.S. experience significant disparities in access to mental health services due to lack of health insurance, cost of services, limited awareness of mental health resources, mental health stigma, and fear of deportation. Limited English proficiency coupled with an acute lack of bilingual and culturally competent providers further impede Latinos’ adequate access to quality mental health services. The COVID-19 pandemic has only amplified the need for mental health care and exacerbated mental health disparities for Latino communities, making it urgent to identify low-cost, effective strategies to reduce these gaps. This 5-year project seeks to develop and test a multi-level, community intervention to improve mental health outcomes and promote access to culturally appropriate mental health treatment for Latino communities in Philadelphia. CRISOL Mente will include components at various levels of the socio-ecological model: a clinic-based, stepped-care program relying on Latino lay health workers (LHW) for the delivery of mental health services (Aim 1), outreach and education activities to reduce mental health stigma in the community (Aim 2), and efforts to strengthen Latino-serving organizations’ capacity to address mental health and other syndemic conditions contributing to untreated mental health among Latinos (Aim 3). To improve mental health symptoms and engagement in care, we will recruit, train and supervise a cohort of Latino LHW who will be embedded into two Latino-serving clinics, extending the reach and effectiveness of the clinics’ mental health services. We will compare the impact of three different levels of LHW involvement: a) community outreach/navigation (i.e. screening and referral of community members); b) auxiliary care (i.e. screening, referral, and help overcoming barriers to better mental health); and c) task shifting (i.e. screening, referral, assistance, and supervised delivery of basic mental health treatment). The LHWs will also conduct outreach/education activities in the community (e.g. radio talks, info sessions, tables in community venues) to reduce mental health stigma. Our experienced and largely Latino community-academic research team will also engage in capacity building activities (i.e. monthly town halls, annual retreats, weekly newsletters, provision of trainings and technical support) with the Latino Health Collective, a coalition of Latino-serving organizations. Using mixed-methods and the RE-AIM framework, CRISOL Mente’s impact will be evaluated with clinical data, baseline and 6-month patient survey data (N=200 from each level of LHW involvement), and qualitative interviews with community members (N=30) referred to mental health services by the LHW (Aim 1); pre/post mental health stigma data from two respondent driven sampling (RDS) surveys of Latinos (N=400 each) conducted in 2022 (preliminary study) and in 2027 (Aim 2); community capacity indicators from three surveys of Latino-serving organizations conducted in 2019, 2021 (preliminary studies) and 2027, and key informant interviews (KII) with Latino-serving providers (N=30) in 2019 (preliminary study) and 2027 (Aim 3).

由于缺乏心理健康服务，美国的拉丁裔在获得心理健康服务方面存在巨大差异健康保险、服务成本、对心理健康资源的认识有限、心理健康耻辱以及担心被驱逐出境，英语水平有限，加上严重缺乏双语和文化能力。 COVID-19 大流行进一步阻碍了拉丁美洲人充分获得优质心理健康服务。只会扩大对心理健康护理的需求，并加剧拉丁裔的心理健康差异社区，因此迫切需要确定低成本、有效的战略来缩小这五年的差距。项目旨在开发和测试多层次的社区干预措施，以改善心理健康成果并促进拉丁裔获得适合其文化的心理健康治疗费城的 CRISOL Mente 社区将包括社会生态各个层面的组成部分。模式：基于诊所的分级护理计划，依靠拉丁裔非专业卫生工作者 (LHW) 提供心理健康服务（目标 1）、外展和教育活动，以减少人们对心理健康的耻辱社区（目标 2），以及加强拉丁裔服务组织解决心理健康问题的能力的努力以及导致拉丁裔心理健康得不到治疗的其他综合症（目标 3）。心理健康症状和护理参与度，我们将招募、培训和监督一批拉丁裔 LHW 他们将被纳入两个拉丁裔服务诊所，扩大诊所服务的范围和有效性我们将比较三种不同程度的 LHW 参与的影响：a) 社区外展/导航（即社区成员的筛查和转介）； b) 辅助护理（即社区成员的筛查和转介）；筛查、转诊和帮助克服改善心理健康的障碍）；以及 c) 任务转移（即筛查、 LHW 还将开展基本心理健康治疗的转介、援助和监督实施。社区内的外展/教育活动（例如广播讲座、信息发布会、社区场所的桌子）我们经验丰富且主要是拉丁裔的社区学术研究团队将减少对心理健康的耻辱。还参与能力建设活动（即每月的市政厅、年度务虚会、每周的时事通讯、与拉丁裔健康集体（拉丁裔服务联盟）合作提供培训和技术支持）将使用混合方法和 RE-AIM 框架来评估 CRISOL Mente 的影响。包含临床数据、基线和 6 个月患者调查数据（LHW 参与的每个级别的 N=200），以及对由 LHW 转介心理健康服务的社区成员 (N=30) 进行定性访谈（目标 1）；前/后心理健康耻辱数据来自两名受访者对拉丁裔的抽样 (RDS) 调查 (N=400 每个）于 2022 年（初步研究）和 2027 年（目标 2）进行了三个社区能力指标； 2019 年、2021 年（初步研究）和 2027 年对拉丁裔服务组织进行的调查以及关键 2019 年（初步研究）和 2027 年（目标 3）对拉丁裔服务提供者 (N=30) 进行知情人访谈 (KII)。