Addressing Mental Health Disparities in Refugee ChildrenL A CBPR Collaboration

解决难民儿童的心理健康差异L A CBPR 合作

• 批准号: 8655907
• 负责人: Theresa Stichick Betancourt
• 金额: $ 33.05万
• 依托单位: HARVARD SCHOOL OF PUBLIC HEALTH
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-05-01 至 2016-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8655907
• 关键词: Address; Adolescent; Adverse effects; Affect; African; Age; Asians; Attention; Attitude; Behavior; Bhutan; Boston; Caregivers; Caring; Child; Child Mental Health; Clinical Treatment; Collaborations; Communication; Communities; Conflict (Psychology); Data; Data Collection; Decision Making; Depressive disorder; Development; Disadvantaged; Discrimination; Ecology; Emotional; Employment; Enrollment; Exposure to; Face; Family; Family dynamics; Feasibility Studies; Functional disorder; Healed; Health Services Accessibility; Healthcare; Housing; Improve Access; Incidence; Instruction; Intervention; Knowledge; Language; Leadership; Learning; Life; Linguistics; Massachusetts; Measures; Mental Health; Mental Health Services; Mental disorders; Methods; Modeling; Needs Assessment; Outcome; Parent-Child Relations; Parents; Pilot Projects; Population; Post-Traumatic Stress Disorders; Poverty; Prevention; Preventive; Preventive Intervention; Principal Investigator; Problem behavior; Process; Provider; Psychosocial Assessment and Care; Public Housing; Qualitative Methods; Qualitative Research; Randomized; Recruitment Activity; Refugees; Research; Research Methodology; Research Project Grants; Risk; Role; School-Age Population; Schools; Science; Self Efficacy; Services; Social Network; Social Work; Somalia; Source; Stress; Supervision; Symptoms; Testing; Training; Trauma; Unemployment; United States; Universities; Violence; War; Work; base; behavioral health; community based participatory research; demographics; design; experience; flexibility; gang; healing; health disparity; help-seeking behavior; high risk; improved; innovation; member; parent-child communication; preference; psychoeducation; psychosocial; racism; resilience; school health; skills; social; socioeconomics; stressor; therapy design

DESCRIPTION (provided by applicant): In the US, refugee children and families face dramatic disparities in the incidence and treatment of mental health disorders. Resettlement stressors (poverty, limited access to care) and acculturative challenges (differences in cultural norms, discrimination) often exacerbate risks due to war-related trauma exposure. Commonly, refugee mental health services are limited-usually with a narrow focus on clinical treatment of PTSD-and rarely respond to the holistic needs of refugee communities; few interventions are designed to be used across cultures and refugee groups, despite rapidly evolving refugee demographics in the US. The cross-cultural application of community-based participatory research (CBPR) methods can increase understanding of risk and protective factors in refugee communities and contribute to development of flexible mental health interventions to address disparities. This CBPR project builds on an existing collaborative research relationships with the Somali Bantu refugee community in Greater Boston. Preliminary research has identified numerous cultural and community strengths as well as ongoing problems of family conflict, poor parent-child communication which interact with ongoing stressors to increase risks for child emotional and behavioral problems. Family-based intervention models adapted via local input and delivered by trained members of the community hold great promise for use among these and other refugee groups in the US. This study will use CBPR mixed methods (qualitative and quantitative data collection) to conduct needs assessments and design and evaluate a core family-based intervention. Project activities will emphasize capacity building in two refugee communities resettled in Greater Boston-the Somali Bantu and the Bhutanese-actively engaging refugee community members, community advisory boards, services providers, and other stakeholders. Specific Aims are to: (1) deepen partnerships with the Somali Bantu and Bhutanese communities through co-leadership, capacity-building, and knowledge sharing; (2) collect and apply qualitative data to (a) prepare a needs assessment of mental health in children and adolescents, barriers to care, and services preferences with each target refugee group; (b) develop mental health/psychosocial assessments for refugee caregivers and children; (c) adapt the core components of a family-based strengthening intervention for use with refugees; and (3) conduct an 80-family pilot study to examine acceptability and sustainability of the intervention. Key outcomes will be improvements in caregiver-child relationships, mental health services access, increased functioning, and reduced mental health symptoms in children and adolescents. RELEVANCE (See instructions): The proposed study will employ cross-cultural CBPR methods to develop a family-based intervention grounded in needs assessments on contributors to mental health disparities among refugee children and families. The mixed methods research approach to selecting, adapting and implementing culturally-informed assessments and intervention models has the potential to contribute to feasible, acceptable and sustainable intervention models of mental health services for diverse groups of refugee children and families.

描述（由申请人提供）：在美国，难民儿童和家庭在精神健康障碍的发病率和治疗方面面临着巨大的差异。重新安置压力（贫困、获得护理的机会有限）和文化适应挑战（文化规范差异、歧视）往往会加剧战争相关创伤造成的风险。通常，难民心理健康服务是有限的——通常只关注创伤后应激障碍的临床治疗——并且很少满足难民社区的整体需求；尽管美国难民人口结构迅速变化，但很少有干预措施是针对不同文化和难民群体而设计的。基于社区的参与性研究（CBPR）方法的跨文化应用可以增加对难民社区风险和保护因素的了解，并有助于制定灵活的心理健康干预措施以解决差异。该 CBPR 项目建立在与大波士顿索马里班图难民社区现有的合作研究关系的基础上。初步研究发现，许多文化和社区优势以及家庭冲突、亲子沟通不良等持续存在的问题，与持续存在的压力源相互作用，增加了儿童情绪和行为问题的风险。基于家庭的干预模式通过当地的投入进行调整，并由经过培训的社区成员提供，对于在这些和美国的其他难民群体中使用具有很大的前景。本研究将使用 CBPR 混合方法（定性和定量数据收集）来进行需求评估，并设计和评估基于家庭的核心干预措施。项目活动将强调在大波士顿重新安置的两个难民社区（索马里班图人和不丹人）的能力建设，并积极吸引难民社区成员、社区咨询委员会、服务提供商和其他利益相关者的参与。具体目标是： (1) 通过共同领导、能力建设和知识共享，深化与索马里班图和不丹社区的伙伴关系； (2) 收集并应用定性数据，以 (a) 准备对每个目标难民群体的儿童和青少年心理健康、护理障碍和服务偏好的需求评估； (b) 对难民照顾者和儿童进行心理健康/心理社会评估； (c) 调整以家庭为基础的强化干预措施的核心组成部分，以供难民使用； (3) 开展一项 80 个家庭的试点研究，以检验干预措施的可接受性和可持续性。主要成果将是改善看护者与儿童的关系、改善儿童和青少年的心理健康服务、增强功能并减少心理健康症状。 相关性（参见说明）：拟议的研究将采用跨文化 CBPR 方法来制定基于家庭的干预措施，该干预措施基于对难民儿童和家庭心理健康差异影响因素的需求评估。选择、调整和实施基于文化的评估和干预模型的混合方法研究方法有可能为不同群体的难民儿童和家庭提供可行、可接受和可持续的心理健康服务干预模型。