Multilevel Community-Based Mental Health Intervention to Address Structural Inequities and Adverse Disparate Consequences of COVID-19 Pandemic on Latinx Immigrants and African Refugees

基于社区的多层次心理健康干预措施，以解决结构性不平等以及 COVID-19 疫情对拉丁裔移民和非洲难民造成的不同不利后果

• 批准号: 10470344
• 负责人: JESSICA R GOODKIND
• 金额: $ 67.16万
• 依托单位: UNIVERSITY OF NEW MEXICO
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-16 至 2026-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10470344
• 关键词: Address; Advocacy; Affect; African; Awareness; Behavioral; Black Populations; Black race; COVID-19; COVID-19 pandemic effects; Collaborations; Communities; Complex; Control Groups; Data; Disasters; Discrimination; Economics; Education; Effectiveness of Interventions; Enrollment; Essential worker; Exposure to; Face; Family; Goals; Grief reaction; Health Insurance; Housing; Immigrant; Immigration; Incidence; Individual; Insurance Coverage; Intervention; Interview; Language; Latinx; Latinx population; Learning; Legal; Low income; Mediating; Mental Health; Mental Health Services; Methods; Modeling; Occupations; Participant; Pathway interactions; Personal Satisfaction; Persons; Plant Roots; Policies; Probability Samples; Prognosis; Randomized; Refugees; Research; Research Design; Resources; Sampling; Science; Site; Social Change; Social support; Stress; System; Testing; Time; United States; Waiting Lists; Work; Youth; adverse outcome; barrier to care; base; community based participatory research; comparison group; comparison intervention; design; disparity reduction; economic impact; effectiveness testing; experience; food insecurity; health care availability; health care economics; health disparity; health economics; health service use; improved; innovation; intervention effect; marginalized population; mental health education; mutual learning; pandemic disease; peer; physical conditioning; primary outcome; protective factors; psychological distress; recruit; research study; response; secondary outcome; social; social determinants; socioeconomics; stressor; trauma exposure; treatment as usual; university student

PROJECT SUMMARY The goal of this study is to test a multilevel approach to reduce adverse consequences of the COVID-19 pandemic with disparate impacts on Latinx and Black immigrants and refugees by observing and implementing three nested levels of intervention: 1) an efficacious 6-month peer advocacy and mutual learning model (Refugee and Immigrant Well-being Project, RIWP); 2) engagement with community-based organizations (CBOs); and 3) structural policy changes expected to be enacted in response to the pandemic, such as a state disaster relief proposal for mixed status Latinx families and expanded statewide health insurance coverage. This community-based participatory research (CBPR) study builds on a long-standing collaboration with five community-based organizations (CBOs) that focus on mental health, education, legal issues, and system change efforts to improve the well-being of Latinx immigrants and African refugees. By including 240 Latinx immigrants and 60 African refugees recruited from CBO partners who are randomly assigned to treatment-as- usual CBO involvement or the RIWP intervention and a random sample comparison group of 300 Latinx immigrants, this mixed methods longitudinal waitlist control group design study with seven time points over 36 months will test the effectiveness of the RIWP intervention and engagement with CBOs to reduce psychological distress, daily stressors, and economic precarity and increase protective factors (social support, critical awareness of/access to resources, English proficiency, cultural connectedness, and mental health service use). This study will also test the ability of the RIWP intervention and engagement with CBOs to increase access to the direct benefits of structural interventions (local/state relief-related policies) for Latinx and Black immigrants and refugees. Mechanisms of intervention effectiveness will be explored by testing mediating relationships between primary outcomes and protective factors. We will also track local/state policy changes and obtain preliminary quantitative estimates of effects of these structural interventions on psychological distress, stressors, and economic precarity using propensity score matching. Qualitative interview data from a purposive subsample of participants and CBO staff will enable additional exploration of mechanisms of change, the effects of policy interventions on individuals, how CBOs contribute to enacting policies and helping people benefit from them, and the context of RIWP implementation at each site. This research is innovative and significant because it employs cutting-edge research design and intervention strategies to advance the science of multilevel mental health interventions that aim to understand and address underlying structural inequities and resulting mental health disparities that have been highlighted and exacerbated by the pandemic. Thus, this study will contribute not only to reducing the disparate adverse mental health, behavioral, and socioeconomic consequences of the COVID-19 pandemic but also to our ability to eliminate mental health disparities among Latinx and Black populations.

项目概要 本研究的目的是测试一种多层次的方法来减少 COVID-19 的不利后果 通过观察和实施，流行病对拉丁裔和黑人移民和难民产生不同的影响 三个嵌套层次的干预：1）有效的 6 个月同伴倡导和相互学习模式 （难民和移民福祉项目，RIWP）； 2) 与社区组织的合作 （国会预算办公室）； 3）预计为应对疫情而实施的结构性政策变化，例如国家 针对混合身份拉丁裔家庭的救灾提案以及扩大全州医疗保险覆盖范围。 这项基于社区的参与性研究 (CBPR) 研究建立在与五个组织的长期合作基础上 专注于心理健康、教育、法律问题和系统的社区组织 (CBO) 改变努力以改善拉丁裔移民和非洲难民的福祉。包括 240 个拉丁裔 移民和从 CBO 合作伙伴招募的 60 名非洲难民被随机分配到治疗组 通常 CBO 参与或 RIWP 干预以及 300 名拉丁裔的随机样本比较组 移民，这项混合方法纵向候补名单对照组设计研究有 7 个时间点超过 36 几个月将检验 RIWP 干预以及与 CBO 合作的有效性，以减少 心理困扰、日常压力和经济不稳定，并增加保护因素（社会支持、 对资源、英语水平、文化联系和心理健康的批判性认识/获取 服务使用）。这项研究还将测试 RIWP 干预以及与 CBO 合作的能力： 增加拉丁裔获得结构性干预措施（地方/州救济相关政策）直接好处的机会 以及黑人移民和难民。通过测试探索干预效果的机制 主要结果和保护因素之间的中介关系。我们还将跟踪当地/州政策 变化并获得这些结构性干预措施的影响的初步定量估计 使用倾向评分匹配来评估心理困扰、压力源和经济不稳定。定性 来自参与者和 CBO 工作人员的有目的子样本的访谈数据将有助于进一步探索 变革机制、政策干预对个人的影响、社区组织如何促进制定 政策并帮助人们从中受益，以及每个地点 RIWP 实施的背景。这 研究具有创新性和意义，因为它采用了尖端的研究设计和干预 推进多层次心理健康干预科学的战略，旨在理解和解决 潜在的结构性不平等以及由此产生的心理健康差异已得到强调和 因疫情而加剧。因此，这项研究不仅有助于减少不同的不利因素 COVID-19 大流行对心理健康、行为和社会经济造成的影响，也对我们的能力造成影响 消除拉丁裔和黑人之间的心理健康差异。