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

项目摘要 预防青少年精神健康障碍是一种未得到充分利用但有科学依据的方法 改善公众的心理健康。18岁之前有心理健康障碍的年轻人更差 在教育、社会、就业和健康方面的结果与没有心理健康或 物质使用障碍。西班牙裔青年的抑郁和焦虑症状、吸毒、 自杀意念和企图，与他们的非西班牙裔白人同龄人相比。干预措施旨在打断 精神健康障碍的后遗症和其他不良后果对于最大限度地促进 西班牙裔青年。Familas Unidas，在美国国家科学院、工程院、 和药物预防报告，已被发现在减少和/或 预防青少年健康问题。家庭联盟在内部化方面产生了交叉效应 报告家庭沟通不足的年轻人的症状，这是干预的主要调解途径。它 也降低了报告贫困家庭这一中介途径的年轻人的自杀意念率 沟通。在线改编的Familias Unidas、eHealth Familias Unidas也被发现 减少青少年健康问题。然而，到目前为止，基于证据的预防干预措施，如 Familas Unidas和eHealth Familias Unidas在很大程度上在学校进行了测试，并主要由 研究人员。在初级保健的真实世界研究中评估这些干预措施，并理解 促进或阻碍将干预措施纳入系统的实施进程是 在美国改善心理健康和缩小差距。这项申请的目的是评估 在有效性-实施类型I混合试验中，eHealth Familias Unidas的增强版本 减少西班牙裔青年的抑郁和焦虑症状以及自杀行为。使用随机化的 18个诊所的推广设计，研究的目的是：目标1：评估eHealth Familias Unidas的效果 在预防/减少抑郁、焦虑症状、自杀意念和行为方面的精神健康，以及 被筛查为家庭沟通不良或抑郁或抑郁水平升高的人滥用药物 焦虑症状或自杀行为史(意念或企图)；目标2：确定 家庭沟通和外化行为(包括药物)在一定程度上调节了干预效果 误用，并受到父母抑郁的影响；探索性目标3：干预对心理健康的影响 药物滥用和维持将因在临床和医疗机构一级的执行质量而有所不同。 临床医生。参与者将在基线、基线后3个月、6个月和18个月时进行评估。

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.