Iwankapiya_Healing Historical Trauma Practice and Group IPT for American Indians

描述（由申请人提供）：该提案解决了美洲印第安人（AI）和普通美国人口之间在心理健康问题以及循证治疗（EBT）可用性方面的显著差异。有限的治疗参与和低保留率，通常被认为是精神卫生保健的主要障碍，有助于心理健康疾病患病率的差异问题。社会经济因素是减少治疗参与和过早、计划外终止的预测因素。这些特征包括：少数民族地位、低收入、缺乏健康保险、教育程度较低、对精神卫生保健的消极态度和物质使用（Edlund，2002; Wang，Bergland，et al.，2005年）的报告。 这项建议的重点是研究旨在制定战略，以处理三个显着的差异原因：（1）缺乏证据基础的文化适当的治疗人工智能;（2）参与和保留人工智能在治疗中的问题;（3）突出的历史创伤。 在这项试点研究中，我们将探索治疗参与和保留策略的可行性，接受度和可持续性，历史创伤和未解决的悲伤部落最佳实践（HTUG），以在EBT中参与和保留AI成年人，团体人际心理治疗（IPT），这可能非常适合治疗抑郁症和相关的精神障碍。HTUG专注于与跨代的AI集体大规模群体创伤相关的悲伤解决方案，并有可能通过承认殖民主义对幸福的负面影响和减少心理健康问题的耻辱来让AI参与EBT（勇敢的心，1998;勇敢的心，2003）。 我们将研究可行性的多个方面，包括招募，随机化，客户的参与和保留;临床医生的招募，培训，监督和保留;客户临床医生对HTUG和Group IPT的接受和满意度，客户和临床医生对客户筛选，过程监控和结果测量的研究措施的适当性的看法;客户（和临床医生）接受的措施，以检查他们的忠诚度的研究模型，临床成本方面的财务，空间使用，培训时间的临床医生，临床和工作人员的支持成本HTUG和集团IPT的实施。从长远来看，从这项拟议的研究中学到的东西可能对减少人工智能人群以及文化独特、弱势和服务水平低下的人群在心理健康治疗和疾病负担方面的差异具有重大意义。

DESCRIPTION (provided by applicant): This proposal addresses the significant disparity in mental health problems, as well as availability of Evidence Based Treatment (EBT), between American Indians (AIs) and the general U.S. population. Limited treatment engagement and poor retention rates, commonly regarded as major barriers to mental health care, contribute to the problem of disparities in mental health disorder prevalence. Socioeconomic factors are predictors of reduced treatment engagement and premature, unplanned termination. These characteristics include: minority status, low income, lack of health insurance, lower educational attainment, negative attitudes about mental health care, and substance use (Edlund, 2002; Wang, Bergland, et al., 2005). This proposal focuses on research designed to develop strategies to deal with three significant causes of the disparities: (1) the lack of an evidence base for culturally appropriate treatment for AIs; (2) problems of engagement and retention of AIs in treatment; and (3) the salience of historical trauma. In this pilot study, we will explore he feasibility, acceptance and sustainability of a treatment engagement and retention strategy, the Historical Trauma and Unresolved Grief Tribal Best Practice (HTUG) to engage and retain AI adults in an EBT, Group Interpersonal Psychotherapy (IPT), that may be well suited for treating depression and related mental disorders in this population. HTUG focuses on grief resolution related to AI collective massive group trauma across generations, and has potential for engaging AIs in EBTs through acknowledging the negative effects of colonialism on well-being and reducing the stigma of mental health problems (Brave Heart, 1998; Brave Heart, 2003). We will examine multiple aspects of feasibility, including recruitment, randomization, engagement and retention of clients; recruitment, training, supervision and retention of clinicians; client an clinician acceptance of and satisfaction with HTUG and Group IPT, client and clinician perceptions of the appropriateness of the research measures for client screening, process monitoring and outcome measurement; client (and clinician) acceptance of measures for examining their fidelity to the research model, clinic costs in terms of finances, space use, training time for clinicians, and clinical and staff support costs for HTUG and Group IPT implementation. Long term, what is learned from this proposed research could have significant promise for reducing disparities in mental health treatment and disease burden across AI populations and in culturally unique, disadvantaged and poorly served populations in general.