A Family Navigator Intervention to Improve ADHD- Related Treatment Adherence (I2-ART) for Minority Children

家庭导航干预可提高少数民族儿童 ADHD 相关治疗依从性 (I2-ART)

• 批准号: 10526402
• 负责人: Kelly Kamimura-Nishimura
• 金额: $ 18.92万
• 依托单位: CINCINNATI CHILDRENS HOSP MED CTR
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-12-01 至 2025-11-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10526402
• 关键词: Address; Adherence; Advocacy; African American; Area; Attention deficit hyperactivity disorder; Behavior; Behavior Disorders; Behavior Therapy; Behavioral; Behavioral Model; Belief; Caregivers; Child; Childhood; Clinical; Clinical Research; Clinical Trials; Clinical Trials Design; Communities; Data; Development; Development Plans; Developmental Disabilities; Elements; Environment; Evidence based intervention; Evidence based treatment; Faculty; Failure; Family; Feedback; Feeling; Focus Groups; Funding; Goals; Grant; Guidelines; Health Personnel; Health Services Accessibility; Healthcare; Healthcare Systems; Impairment; Improve Access; Intervention; K-Series Research Career Programs; Latinx; Latinx population; Link; Literature; Manuals; Manuscripts; Mental Health; Mental Health Services; Mentorship; Methodology; Minority; Minority Groups; Modeling; Modification; Motivation; National Institute of Mental Health; Neurodevelopmental Disorder; Outcome; Parent-Child Relations; Parents; Pediatric Hospitals; Perception; Pharmaceutical Preparations; Phase; Population; Positioning Attribute; Productivity; Qualitative Methods; Randomized, Controlled Trials; Recommendation; Research; Research Personnel; Source; Stimulant; Symptoms; Testing; Training; Trust; Uncertainty; Underserved Population; United States National Institutes of Health; Work; Writing; Youth; acceptability and feasibility; behavioral outcome; career development; cohort; community partnership; design; distrust; empowerment; ethnic disparity; experience; health care disparity; health disparity; improved; medication compliance; medication nonadherence; member; minority children; motor vehicle injury; navigator intervention; novel; patient oriented; pediatrician; racial disparity; research clinical testing; side effect; therapy development; treatment adherence; treatment as usual; treatment planning

PROJECT SUMMARY/ABSTRACT I am a developmental-behavioral pediatrician who has earned an MS in Clinical Research. My long-term goal is to become an independent researcher focused on advancing developmental-behavioral outcomes of children from diverse, underserved groups by improving their adherence to treatment plans for mental health conditions, including attention-deficit hyperactivity disorder (ADHD). My current objective, which represents the next step in pursuit of this goal, is to develop a culturally-tailored family navigator Intervention to Improve ADHD-Related Treatment adherence (I2-ART) for minority children using a systematic, patient-centered, iterative approach consistent with the ORBIT model for behavioral intervention development. Key elements of the career development plan to support both my long-term goal and current objective include training in (1) the design and evaluation of clinical and mental health services trials to improve treatment adherence, (2) health disparities and community-partnered research, and (3) effective grant and manuscript writing. My mentorship team includes NIH-funded investigators with expertise in ADHD, clinical trial design, treatment adherence, health disparities, and community-partnership research. Furthermore, Cincinnati Children’s Hospital, which ranks #2 among U.S. children’s hospitals for NIH funding, provides an outstanding research environment and strong support for junior faculty, including >30 current recipients of NIH Career Development Awards. Proposed Research: ADHD is the most common pediatric neurodevelopmental disorder and is associated with significant long-term impairments. Current guidelines recommend stimulant medication and/or behavioral therapy as first-line treatments for ADHD. Despite evidence that consistent treatment is important for effectively managing ADHD symptoms, treatment adherence remains suboptimal and is especially problematic among minority children. Hypothesized reasons for racial/ethnic disparities in ADHD treatment include uncertainties about medication efficacy and side effects, distrust of the health care system, and decreased access to mental health services. This study aims to develop and test the I2-ART intervention to improve treatment adherence in minority (Latinx and African American) children with ADHD. The proposed study involves three ORBIT phases: During phase 1a, we will conduct focus groups with key stakeholders (i.e., caregivers, clinicians, and family navigators, n=24) to identify and develop I2-ART’s basic elements. Next, during phase 1b, we will train four family navigators to implement I2-ART with caregivers of treatment-naïve children with ADHD (n=8-12) in order to determine feasibility and acceptability. In phase 2, we will use phase 1b findings to modify I2-ART as needed, and then will evaluate the preliminary efficacy of the revised I2-ART (n=40), compared to the “usual care” control condition (n=20), on ADHD treatment adherence. The preliminary data collected during the proposed study will inform a subsequent R01 randomized controlled trial to examine I2-ART efficacy.

项目总结/摘要 我是一名发展行为儿科医生，获得了临床研究硕士学位。我的长期目标 是成为一名独立的研究人员，专注于推进发展行为的结果， 来自不同的，服务不足的群体的儿童，通过提高他们对心理健康治疗计划的依从性， 注意力缺陷多动障碍（ADHD）。我目前的目标是， 追求这一目标的下一步，是开发一个文化定制的家庭导航干预，以改善 ADHD相关治疗依从性（I2-ART）的少数民族儿童使用系统的，以患者为中心， 迭代方法与行为干预开发的ORBIT模型一致。的关键要素 支持我长期目标和当前目标的职业发展计划包括以下方面的培训： 设计和评估临床和精神卫生服务试验，以提高治疗依从性，（2）健康 差异和社区合作研究，（3）有效的赠款和手稿写作。我的导师 该团队包括NIH资助的研究人员，他们在ADHD、临床试验设计、治疗依从性 健康差距和社区伙伴关系研究。此外，辛辛那提儿童医院， 在美国NIH资助的儿童医院中排名第二，提供了出色的研究环境， 对初级教师的大力支持，包括超过30名NIH职业发展奖的获得者。 建议的研究：ADHD是最常见的儿科神经发育障碍， 严重的长期损害。目前的指南建议使用兴奋剂药物和/或行为药物。 作为ADHD的一线治疗。尽管有证据表明，一致的治疗是重要的， 管理ADHD症状，治疗依从性仍然不是最佳的，特别是在 少数民族儿童。ADHD治疗中种族/民族差异的假设原因包括不确定性 关于药物疗效和副作用，对医疗保健系统的不信任，以及精神疾病的获得减少， 保健服务这项研究旨在开发和测试I2-ART干预，以提高治疗依从性， 少数民族（拉丁裔和非洲裔美国人）ADHD儿童。拟议的研究包括三个轨道阶段： 在第1a阶段，我们将与主要利益相关者（即，护理人员、临床医生和家属 导航员，n=24），以确定和发展I2-ART的基本要素。接下来，在第1b阶段，我们将训练四名 家庭导航员与未经治疗的ADHD儿童（n=8-12）的照顾者一起实施I2-ART， 以确定可行性和可接受性。在第2阶段，我们将使用第1b阶段的发现来修改I2-ART， 需要，然后将评估修订的I2-ART（n=40）的初步疗效，与“通常”相比， 护理”控制条件（n=20），ADHD治疗依从性。调查期间收集的初步数据 拟议的研究将为随后的R 01随机对照试验提供信息，以检查I2-ART的疗效。