Developing a piot intervention to increase child mental health service utilizatio

尽管除抑郁症外，所有儿童期严重和持续性精神疾病的患病率相似， 在使用心理健康服务方面存在明显的种族差异。与种族主义有关的各种因素， 耻辱感、家庭和疾病特征以及服务系统属性可能是这些因素的原因 差异，但以前对AA儿童的研究局限于这些领域。我们想把这个领域从简单的 列举和描述这些差异，以提供文化敏感的帮助方式的干预措施 非裔美国人家庭为患有这些疾病的儿童提供及时和适当的护理。我们 我利用了现有的证据，我们小组进行的初步焦点小组的结果，以及我们的 广泛的临床工作与AA家庭处理早发性精神分裂症，严重的情感障碍， 和孤独症，为干预设计的初始阶段提供信息。我们建议制定干预措施， 增强知识和动力，以寻求及时和适当的护理，以及如何导航 （1）通过以下具体目标改进拟议干预措施的内容： 确定AA家庭认为损害或促进其使用心理健康服务的因素 使用焦点小组方法为患有SPMI的孩子提供帮助;通过确定相对人群患病率 和这些因素的影响，使用AA家庭的大样本调查（N= 300），并通过评估 参与者对本干预中使用的干预后所涵盖主题和材料的满意度 评价。(2)根据中期调查结果完善拟议干预措施的结构， 和（3）进行一项小型随机试点试验的拟议干预措施，以估计关键参数， 通过评估其在以下方面的可行性，设计具有充分把握度的严格疗效研究 招聘、完成率和参加会议的比例;通过确定最适当和 可能测量的敏感结果测量，包括精神卫生保健的数量和/或类型 收到的，关于疾病的知识，关于精神卫生保健系统的知识，感知的强度 精神卫生保健是有益的和可取的，自我效能评级，和照顾者的压力; 估计与对照条件相比干预的效应量和相关置信度 关键成果的局限性。我们认为这个独立的研究项目是一个长期的 长期研究议程集中在AA家庭和心理健康服务。紧接着的下一步 与此项目相关的是提交R 01申请，以测试 家庭社会心理干预在这项研究中试点。我们相信我们有远见，研究能力， 承诺制定一项可持续的研究计划，重点是减少心理健康方面的差距 AA家庭及其子女使用的服务。

Despite similar prevalence of all childhood severe and persistent mental illness except depression, there are pronounced racial disparities in use of mental health services. A variety of factors related to racism and stigma, family and illness characteristics, and service system attributes are likely to account for these disparities, but prior research on AA children is limited in these areas. We want to shift the field from simple enumeration and description of these disparities to interventions that offer culturally-sensitive ways of helping African-American families to access timely and appropriate care for their children with these illnesses. We have drawn on available evidence, results from initial focus groups conducted by our group, and our extensive clinical work with AA families dealing with early onset schizophrenia, severe affective disorders and autism to inform the initial stage of intervention design. We propose to develop an intervention to enhance knowledge and motivation to seek timely and appropriate care as well as the know-how to navigate services by means of the following specific aims: (1) To refine the'content of the proposed intervention by identifying factors that AA families feel have compromised or facilitated their use of mental health services for their children with SPMI using focus group methods; by determining the relative population prevalence and impact of these factors using a large sample survey of AA families (N= 300); and by assessing participant satisfaction with topics covered and materials employed in this intervention using postintervention evaluations. (2) To refine the structure of the proposed intervention based on interim findings, and (3) To conduct a small randomized pilot trial of the proposed intervention to estimate key parameters for the design of an adequately powered rigorous efficacy study by assessing its feasibility in terms of recruitment, completion rates, and proportion of sessions attended; by determining the most appropriate and sensitive outcome measures from possible measures including amount and/or type of mental health care received, knowledge about illnesses, knowledge about the mental health care system, strength of perception that mental health care is beneficial and desirable, self-efficacy ratings, and caregiver stress; and by estimating the effect size of the intervention compared to the control condition and associated confidence limits of key outcomes. We see this independent research project as the foundational component of a long term research agenda focused upon AA families and mental health services. The immediate next step associated with this project would be the submission of an R01 application to test the cost-efficacy of the family psychosocial intervention piloted in this study. We believe we have the vision, research capacity, and commitment to develop a sustainable research program focused on lessening disparities in mental health service use by AA families and their children.