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.

项目概要/摘要 心理健康和药物滥用对美国人的健康和福祉构成了最大的风险 印第安人和阿拉斯加原住民 (AI/AN) 社区，导致代际发病率和死亡率。这些 风险是历史创伤遗留下来的、持续存在的歧视以及心理健康和心理健康领域长期资金不足的问题。 物质使用护理，导致巨大的护理和治疗差距。同时，许多 AI/AN 社区 强调以家庭和社区为中心的整体福祉观，更喜欢上游 预防性和基于家庭的干预措施有可能破坏创伤和创伤的代际循环 逆境。我们的土著和相关研究人员团队与参与社区密切合作， 设计和试点家庭精神优势（FSS）干预措施，旨在提供跨诊断技能 - 针对心理健康风险较高的母亲和主要照顾者制定基于预防策略 物质使用障碍。我们提出了一种混合型 I 型有效性实施设计，其中主要 测试 FSS 在减少抑郁、焦虑和药物滥用症状方面的有效性的目标，其中 N = 188 位主要照顾者来自三个不同的部落环境和背景。参与者将被随机分配到 接受 FSS 或有益对照，这是一项名为 Family Spirit 的循证营养支持计划 培育。主要结果将在入组后 6 个月进行测量。我们还将寻求表征 通过分别探索调节因子和调节因子，引导 FSS 效应的异质性和机制 西方和本土的行动理论。作为我们混合方法的一部分，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一起开展一个进程，以 了解全国范围内实施 FSS 的障碍和促进因素，包括共同设计 实施战略，以支持跨不同 AI/AN 社区大规模的 FSS。这项研究是响应性的 计划公告 PAR-20-238 并重点关注关键领域，包括证据测试 基于社区环境的实践（MH-22-170）和扩大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 纳入家访计划，以便我们能够扩大心理和行为健康的影响范围 为全国各地的 AI/AN 社区提供服务。