Developing a Peer Advocate Intervention for Rural LGBT Populations

描述(由申请人提供)：十年的研究证实，与异性恋同龄人相比，女同性恋者、男同性恋者、双性恋者和变性人(LGBT)在精神健康和药物使用方面的问题不成比例。少数群体压力最合理地解释了这一群体中较高的疾病流行率，这里指的是对社会弱势群体的污名、偏见、歧视和暴力。我们之前在新墨西哥州农村和多种族州进行的形成性研究表明，专业提供者往往没有认识到少数族裔压力的经历如何影响农村LGBT人群，而且往往没有准备好为这些人群提供优质服务。农村LGBT人群，特别是那些与支持性社会网络隔绝的人，在需要心理健康和药物使用问题的援助时，几乎没有LGBT特有的资源可供利用。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回应。倡导者将在农村地区履行几项重要职能：减少与少数群体压力有关的社会背景因素，这些因素可能对LGBT人群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接触；以及培养LGBT社会支持。倡导者的日常工作将由一项赋权议定书告知，该议定书规定了他们将参与的一般社区活动范围，以向农村LGBT寻求帮助者提供援助。为了获得有效执行该议定书所需的知识和技能，同伴倡导者将参加授课和互动培训练习，这些练习将在本研究过程中进行评估和完善。这项研究有三个目标：(1)制定授权协议、指导手册和同伴倡导支持系统；(2)设计和实施培训课程，为个人充当同伴倡导者做准备；(3)进行授权协议的试点测试，将产生关于LGBT求助者获得和利用治疗的可行性、可接受性以及对治疗获得和利用以及社会支持的影响的初步定性和定量数据。为了实现这三个目标，我们将评估招募和留住同伴倡导者和LGBT求助者的程序，这两个人都是广泛分散的农村人口中的干预研究成员。这项多方法研究产生的数据还将用于提高议定书的实用性和改进培训课程。最重要的是，这些基本数据将构成对服务不足和研究不足的人群进行有希望的干预的更广泛规模有效性试验的基础。据我们所知，没有为农村性少数群体和性别少数群体量身定做的类似干预措施，尽管这些人面临着严重的心理健康差距。

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.