Scaling a Parenting EBI for Latinx Youth Mental Health in Primary Care

项目摘要 预防青少年心理健康障碍是一种未得到充分利用但科学合理的方法， 改善公众的心理健康。18岁之前患有精神健康障碍的青少年 与没有心理健康的青年相比， 物质使用障碍西班牙裔青年报告抑郁和焦虑症状，吸毒， 自杀意念和企图，与非西班牙裔白色同龄人相比。旨在中断 心理健康障碍的后遗症和其他不良后果对于最大限度地提高 西班牙裔青年Familias Unidas，在美国国家科学院、工程院、 和药物预防报告，已被发现是有效和有效的减少和/或 预防青少年健康问题。Familas Unidas对内化产生了交叉效应， 症状的年轻人谁报告低家庭沟通，干预的主要中介途径。它 也降低了年轻人的自杀意念率，这些年轻人报告了贫困家庭的同样中介途径。 通信还发现，在线改编的《联合家庭》，即《联合家庭电子保健》， 减少青少年健康问题。然而，迄今为止，基于证据的预防性干预措施， Familias Unidas和eHealth Familias Unidas在很大程度上已经在学校进行了测试，主要由 研究人员。在真实的世界初级保健研究中评估这些干预措施， 促进或阻碍将干预措施纳入系统的实施过程， 改善美国的心理健康和减少差距。拟议应用程序的目标是评估 在一项有效性-实施I型混合试验中， 减少西班牙裔青年的抑郁和焦虑症状以及自杀行为。采用随机 18个诊所的推广设计，该研究的目的是：目的1：评估电子健康家庭联合会的有效性 心理健康在预防/减少抑郁，焦虑症状，自杀意念和行为， 在那些被筛选为家庭沟通不良或抑郁水平升高的人中， 焦虑症状，或自杀行为史（意念或企图）;目的2：确定是否 干预效果部分由家庭沟通和外化行为介导，包括药物 滥用，并由父母抑郁调节;探索性目标3：对心理健康的干预影响 药物滥用以及维持将因诊所和 临床医生将在基线、基线后3、6和18个月对受试者进行评估。

Project Summary The prevention of adolescent mental health disorders is an underused but scientifically justified approach to improving the public’s mental health. Youth with mental health disorders before the age of 18 have poorer outcomes in education, social, employment, and health compared with youth without mental health or substance use disorders. Hispanic youth report higher rates of depressive and anxiety symptoms, drug use, suicide ideation and attempts, compared to their non-Hispanic White peers. Interventions designed to interrupt the sequelae of mental health disorders and other poor outcomes are imperative for maximizing health among Hispanic youth. Familias Unidas, which was highlighted in the National Academies of Sciences, Engineering, and Medicine prevention report, has been found to be efficacious and effective in the reduction and/or prevention of adolescent health problems. Familas Unidas has had crossover effects on internalizing symptoms for youth who report low family communication, the intervention’s primary mediational pathway. It has also reduced suicide ideation rates for youth reporting this same mediational pathway of poor family communication. The online adaptation of Familias Unidas, eHealth Familias Unidas, has also been found to reduce adolescent health problems. However, to date, evidence-based preventive interventions such as Familias Unidas and eHealth Familias Unidas have largely been tested in schools and delivered mostly by research staff. Evaluating these interventions in real world studies of primary care and understanding the implementation processes that facilitate or impede the integration of interventions in systems is key to improving mental health and reducing disparities in the U.S. The goal of the proposed application is to evaluate in an effectiveness-implementation type I hybrid trial, an enhanced version of eHealth Familias Unidas for reducing depressive and anxious symptoms as well as suicide behavior in Hispanic youth. Using a randomized rollout design of 18 clinics, the study’s aims are: AIM 1: Evaluate the effectiveness of eHealth Familias Unidas for Mental Health in preventing/reducing depressive, anxiety symptoms, suicide ideation and behavior, and drug misuse among those screened as having poor family communication or elevated levels of depressive or anxiety symptoms, or a history of suicide behavior (ideation or attempts); AIM 2: Determine whether intervention effects are partially mediated by family communication and externalizing behaviors, including drug misuse, and moderated by parental depression; and Exploratory AIM 3: Intervention impact on mental health and drug misuse as well as sustainment will vary by quality of implementation at the levels of clinic and clinician. Participants will be assed at baseline, 3, 6, and 18-months post baseline.