Iwankapiya_Healing Historical Trauma Practice and Group IPT for American Indians

描述（由申请人提供）：本提案解决了美国印第安人（AIs）和美国普通人口之间在心理健康问题以及基于证据的治疗（EBT）的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视为精神卫生保健的主要障碍，造成了精神卫生障碍患病率差异的问题。社会经济因素是减少治疗参与和过早、计划外终止治疗的预测因素。这些特征包括：少数民族身份、低收入、缺乏医疗保险、受教育程度较低、对精神保健的消极态度和药物使用（Edlund， 2002年；Wang， Bergland等，2005年）。本提案侧重于旨在制定策略以应对差异的三个重要原因的研究：(1)缺乏文化上适当的人工智能治疗的证据基础；(2)人工智能在治疗中的参与和保留问题；(3)历史创伤的突出性。在这项试点研究中，我们将探索一种治疗参与和保留策略的可行性、接受性和可持续性，即历史创伤和未解决的悲伤部落最佳实践（HTUG），以吸引和保留人工智能成年人参与EBT，群体人际心理治疗（IPT），这可能非常适合治疗这一人群的抑郁症和相关精神障碍。HTUG专注于与人工智能集体大规模群体创伤相关的悲伤解决，并有可能通过承认殖民主义对福祉的负面影响和减少心理健康问题的耻辱感来吸引人工智能参与ebt （Brave Heart, 1998; Brave Heart, 2003）。我们将从多个方面考察可行性，包括客户的招募、随机分配、参与和保留；招聘、培训、监督和保留临床医生；病人和临床医生对HTUG和小组IPT的接受程度和满意度，病人和临床医生对病人筛选、过程监测和结果测量的研究措施的适当性的看法；客户（和临床医生）对检查其对研究模型的忠实度的措施的接受程度，在财务方面的临床成本，空间使用，临床医生的培训时间，以及HTUG和小组IPT实施的临床和员工支持成本。从长远来看，从这项拟议的研究中吸取的教训可能对减少人工智能人群以及文化独特、处境不利和服务不足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.