Developing a Peer Advocate Intervention for Rural LGBT Populations

描述（由申请人提供）：十年的研究证实，女同性恋，男同性恋，双性恋和变性人（LGBT）的人遭受不成比例的心理健康和物质使用问题相比，他们的异性恋同行。这一人群中较高的疾病患病率最合理的解释是少数民族的压力，这里指的是耻辱，偏见，歧视和对社会弱势群体的暴力。我们以前在农村和多民族的新墨西哥州的形成性研究表明，专业提供者经常未能认识到少数民族压力的经验如何影响农村LGBT人群，往往准备不足，为这一人群提供优质的服务。农村男女同性恋、双性恋和变性者，特别是那些与支持性社交网络隔绝的人，在需要心理健康和药物使用问题援助时，几乎没有专门针对男女同性恋、双性恋和变性者的资源可供利用。我们建议使用训练有素的同行倡导者作为对这种情况的创造性反应。这些倡导者将在农村地区发挥几项重要职能：减少与少数群体压力相关的社会背景因素，这些因素可能对男女同性恋、双性恋和变性者的福祉和服务利用产生不利影响;与专业提供者和其他人进行外联;培养男女同性恋、双性恋和变性者的社会支持。倡导者的日常工作将通过一项赋权议定书进行 具体说明了他们将参与的以社区为基础的活动的一般范围，以向农村LGBT寻求帮助者提供援助。为了获得有效执行本议定书所需的知识和技能，同行倡导者将参加教学和互动培训活动，这些活动将在本研究过程中进行评估和完善。 这项研究有三个目的：（1）制定赋权议定书、指导手册和同侪倡导支持系统;（2）设计和实施培训课程，使个人做好担任同侪倡导者的准备;（3）对赋权议定书进行试点测试，以产生关于可行性、可接受性以及对男女同性恋、双性恋和变性者寻求帮助者获得治疗和利用以及社会支持的影响的初步定性和定量数据。在追求所有三个目标，我们将评估程序，以招募和留住同行的倡导者和LGBT寻求帮助的人都是一个广泛分散的成员，农村人口的干预研究。本多方法研究生成的数据也将用于提高方案的实用性并完善培训课程。最重要的是，这些基本数据将为更广泛的规模有效性试验奠定基础，为服务不足和研究不足的人群提供有希望的干预措施。据我们所知，没有专门针对农村性少数群体和性别少数群体的类似干预措施，尽管这些人面临着巨大的心理健康差距。

DESCRIPTION (provided by applicant): A decade of studies confirm that lesbian, gay, bisexual, and transgender (LGBT) people suffer disproportionately from mental health and substance use problems in comparison to their heterosexual counterparts. The higher prevalence of disorders within this population is most reasonably explained by minority stress, referring here to stigma, prejudice, discrimination, and violence toward socially disadvantaged groups. Our previous formative research in the rural and multi-ethnic state of New Mexico suggests that professional providers frequently fail to recognize how the experience of minority stress affects rural LGBT people and are often ill-prepared to provide quality services to this population. Rural LGBT people, particularly those who are isolated from supportive social networks, have few LGBT-specific resources to draw from when in need of assistance for mental health and substance use problems. We propose the use of well-trained peer advocates as a creative response to this situation. The advocates will perform several vital functions in rural areas: reduction of social contextual factors associated with minority stress that can adversely affect wellbeing and service utilization among LGBT people; outreach to professional providers and others; and cultivation of LGBT social support. The day-to-day work of the advocates will be informed by an empowerment protocol that specifies the general range of community-based activities they will engage in to provide assistance to rural LGBT help seekers. To obtain the knowledge and skills needed to effectively implement this protocol, peer advocates will take part in didactic and interactive training exercises that are to be evaluated and refined in the course of this research. This study has three aims: (1) Develop the empowerment protocol, coaching manual, and peer advocate support system; (2) Design and implement a training curriculum to prepare individuals to serve as peer advocates; (3) Conduct a pilot test of the empowerment protocol that will yield preliminary qualitative and quantitative data on feasibility, acceptability, and impacts on treatment access and utilization and social support for LGBT help seekers. In pursuit of all three aims, we will evaluate procedures to recruit and retain peer advocates and LGBT help seekers both members of a widely dispersed, rural population in intervention research. Data generated from this multi-method study will also be used to improve utility of the protocol and refine the training curriculum. Most importantly, these essential data will comprise the groundwork for a broader scale effectiveness trial of a promising intervention for an underserved and understudied population. To our knowledge, there are no similar interventions tailored for rural sexual and gender minorities, even though such individuals face significant mental health disparities.