Developing and Testing of a Peer-Delivered Intervention for Depression

描述（由申请人提供）：本研究计划的主要目的（R21：PA-10-069）将：（1）通过调整完善的临床策略，制定同行提供的干预措施，（2）从主要利益相关者的角度，评估非临床社区环境中干预措施的可行性和可接受性（3）制定和测试对干预措施忠诚度的初步指标。低收入的有色人种妇女和寻求FPA提供服务的母亲患抑郁症的风险很高，但她们的心理健康需求往往未被发现和解决。由于对心理健康和治疗的污名化和误解，他们不太可能自行寻求治疗。积极的干预策略，以帮助母亲在识别抑郁症状和从事临床服务是至关重要的风险，产妇抑郁症的儿童，母亲和家庭。FPAs也是有精神病需要的青少年的照顾者，他们在履行这一角色方面处于独特的地位，因为他们被视为值得信赖的，可信的榜样，他们提供希望，赋予参与者权力并提高对服务的满意度。然而，许多FPA认为他们缺乏适当解决照顾者心理健康需求的技能和培训。因此，该项目的目标是制定和评估一项干预措施，以改善对抑郁症的识别，并将其与主要为低收入、照顾有精神病需要的青年的有色人种母亲提供的心理健康服务联系起来。为了实现研究目标，研究团队将以治疗开发和测试的部署重点模型（DFM）为指导，并采用参与式合作模式，与由政策制定者，消费者，研究人员和FPA组成的家庭倡导和研究委员会合作开发干预措施。我们将培训10名FPA，为20名有抑郁症状的照顾者提供干预，并从母亲、FPA和主管那里收集数据，以调查干预的可行性和可接受性。我们还将开发并初步测试保真度措施，以期待更大的有效性研究。拟议的研究在以下三个方面具有创新性：（1）它直接关注母亲的心理健康需求，承认照顾者心理健康的治疗本身就很重要，（2）临床策略来自于通常由临床医生提供的成熟策略，但尚未被FPA在非临床环境中使用，以及，（3）本研究采用社区参与的方法，使用以部署为重点的模型，并与纽约州心理健康办公室和家庭倡导和研究委员会建立密切联系，以确保在可行的情况下，该模型可能会在全州范围内迅速传播。该项目的数据将完善干预措施和方案，并在DFM的指导下，将为更大的R34或R 01研究提供信息，以检查护理人员和儿童的结局（如有必要）。 公共卫生相关性：拟议的研究与公共卫生有关，考虑到未经治疗的母亲抑郁症对儿童，父母和家庭的许多不良影响，通过开发和评估一种创新的筛查和联系模型，以提高抑郁症的识别和与精神卫生服务的联系。

DESCRIPTION (provided by applicant): The main aims of this proposed Exploratory Developmental Research Grant (R21: PA-10-069) are to: (1) develop a peer-delivered intervention by adapting well-established clinical strategies, (2) evaluate the feasibility and acceptability of the intervention in non-clinical, community-based settings from the perspective of key stakeholders (e.g. mothers, Family Peer Advocates (FPA), and supervisors), taking into account implementation supports for FPA to deliver the intervention in non-clinical settings; and (3) develop and test preliminary indicators of fidelity to the intervention. Low-income women of color and mothers who seek FPA- delivered services are at high risk for depression, yet their mental health needs are often undetected and unaddressed. They are unlikely to seek treatment on their own due to stigma and misperceptions about mental health and treatment. Active intervention strategies to assist mothers in identifying depressive symptoms and engage in clinical services are critical given the risks of maternal depression upon the child, mother, and family. FPAs, who are also caregivers of youth with psychiatric needs, are in a unique position to fulfill this role because they are viewed as trustworthy, credible role models who provide hope, empower participants and enhance satisfaction with services. However, many FPAs feel that they lack the skills and training to appropriately address caregivers' mental health needs. Thus, the goal of this project is to develop and evaluate an intervention to improve the identification of depression and linkage to mental health services for predominantly low-income, mothers of color caring for youth with psychiatric needs. To fulfill the study aims, the investigative team will be guided by the Deployment-Focused Model (DFM) of treatment development and testing, and adopt a participatory collaborative model to develop an intervention in partnership with a Family Advocacy and Research Board composed of policy-makers, consumers, researchers and FPA from the proposed study sties. We will train 10 FPA to deliver the intervention to 20 caregivers evidencing depressive symptoms, and gather data from mothers, FPA, and supervisors in order to investigate the feasibility and acceptability of the intervention. We will also develop and preliminarily test fidelity measures in anticipation of a larger effectiveness study. The proposed study is innovative in the following three ways: (1) it directly focuses on the mental health needs of mothers, recognizing the treatment of caregiver mental health as critical in its own right, (2) the clinical strategies are derived from well-established strategies typically delivered by clinicians, but have not yet been utilized by FPA in non-clinical settings, and, (3) this study adopts a community engagement approach, use of a Deployment-Focused Model, and strong linkages to NYS Office of Mental Health and a Family Advocacy and Research Board to ensure that if feasible, this model will likely be rapidly disseminated across the state. Data from this project will refine the intervention and protocol, and guided by the DFM, will inform a larger R34 or R01 study examining caregiver and child outcomes if warranted. PUBLIC HEALTH RELEVANCE: The proposed study is relevant to public health considering the numerous adverse effects associated with untreated maternal depression on the child, parent, and family by developing and evaluating an innovative screening and linkage model to improve the identification of depression and linkage to mental health services.