Developing and Testing of a Peer-Delivered Intervention for Depression

描述(申请人提供)：这项拟议的探索性发展研究拨款(R21：PA-10-069)的主要目的是：(1)通过采用成熟的临床策略来开发同行交付的干预措施；(2)从关键利益攸关方(例如母亲、家庭同伴权益倡导者(FPA)和主管)的角度评估在非临床、社区环境中实施干预措施的可行性和可接受性，同时考虑到对FPA在非临床环境中提供干预措施的实施支持；以及(3)制定和测试干预措施保真度的初步指标。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没有被发现和解决。由于对心理健康和治疗的耻辱和误解，他们不太可能自己寻求治疗。鉴于母亲抑郁对孩子、母亲和家庭的风险，帮助母亲识别抑郁症状和参与临床服务的积极干预战略至关重要。FPA也是有精神需求的青少年的照顾者，他们处于履行这一角色的独特地位，因为他们被视为值得信赖、可信的榜样，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认为他们缺乏适当满足照顾者心理健康需求的技能和培训。因此，该项目的目标是开发和评估一种干预措施，以改善抑郁症的识别，并为主要是低收入的有色人种母亲改善与心理健康服务的联系，照顾有精神需求的青年。为了实现研究目标，调查小组将遵循以部署为重点的治疗开发和测试模式(DFM)，并采用参与式协作模式，与由拟议研究社区的政策制定者、消费者、研究人员和家庭保护和研究委员会组成的家庭倡导和研究委员会合作，制定干预措施。我们将培训10名FPA向20名有抑郁症状的照顾者提供干预，并收集来自母亲、FPA和主管的数据，以调查干预的可行性和可接受性。我们还将开发和初步测试保真度指标，以期进行更大规模的有效性研究。这项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，认识到照顾者心理健康的治疗本身至关重要；(2)临床策略源自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；(3)本研究采用社区参与方法，使用以部署为重点的模式，并与纽约心理健康办公室和家庭倡导和研究委员会建立紧密联系，以确保如果可行，该模式可能会在全州迅速传播。该项目的数据将完善干预措施和方案，并在DFM的指导下，在必要时为更大的R34或R01研究提供信息，检查照顾者和儿童的结局。 公共卫生相关性：这项拟议的研究与公共卫生相关，考虑到未经治疗的母亲抑郁对儿童、父母和家庭的众多不利影响，通过开发和评估创新的筛查和联系模式来改进抑郁症的识别和与心理健康服务的联系。

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.