Increasing provider competence for treating stress-related mental health conditions in low resource settings

提高医疗服务提供者在资源匮乏的环境中治疗与压力相关的心理健康状况的能力

• 批准号: 9340890
• 负责人: Corina Lelutiu-Weinberger
• 金额: $ 21.72万
• 依托单位: RBHS-SCHOOL OF NURSING
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-01 至 2019-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9340890
• 关键词: AIDS prevention; Address; Alcohol abuse; Alcohol consumption; Anal Sex; Anxiety; Attitude; Bisexual; Caring; Case Study; Client; Clinical; Clinical Skills; Companions; Competence; Consultations; Continuing Education; Counseling; Country; Coupled; Dangerousness; Data Collection; Disclosure; Discrimination; Educational Curriculum; Enrollment; Ensure; Europe; European; Feedback; Fright; Gays; General Population; Group Meetings; HIV; HIV risk; HIV/STD; Health; Health Communication; Health Personnel; Health Professional; Health Services; Health Surveys; Healthcare; Healthcare Systems; Heterosexuals; Homophobia; Homosexuality; Hour; Incidence; Individual; International; Intervention; Interview; Knowledge; LGBT Health; Lesbian; Lesbian Gay Bisexual Transgender; Medical; Mental Depression; Mental Health; Methodology; Modeling; Monitor; Morbidity - disease rate; Motivation; Names; Participant; Persons; Prevalence; Professional counselor; Provider; Psyche structure; Psychiatrist; Psychologist; Public Health; Randomized Controlled Trials; Reporting; Research; Research Infrastructure; Resources; Risk; Risk Behaviors; Romania; Science; Seeds; Self Efficacy; Services; Sexual Health; Sexuality; Stress; Structure; Suicide; Sum; Supervision; Techniques; Testing; Therapeutic; Training; Training Programs; Translating; United States National Institutes of Health; Universities; alcohol risk; base; clinical practice; condoms; cost effective; cost effectiveness; drinking; efficacy testing; evidence base; health care availability; health care service utilization; health disparity; health training; implementation science; improved; mHealth; meetings; men who have sex with men; mental training; multidisciplinary; peer; personalized medicine; physical conditioning; post intervention; programs; sex; skills; social stigma; stressor; tool; transgender; treatment planning; trial comparing; virtual

Project Summary Lesbian, gay, bisexual and transgender individuals (LGBTI) present increased morbidity compared to the general population, which is attributed to healthcare discrimination and lack of LGBT-specific expertise, especially in high-stigma countries. Motivated by fear, Romanian LGBTI conceal their identities and report significantly more barriers to healthcare access than heterosexuals. Poor mental health, specifically anxiety and depression, is elevated for Romanian LGBTI, and associated with poor physical health (e.g., HIV risk, alcohol abuse.) However, LGBT-competent mental health professionals (MHPs) are nearly non-existent in Romania, and thus the negative impact of homophobia on mental health cannot be ameliorated. Neither universities nor continuing education include LGBT identity and health curricula, to the contrary, the dominant discourse promotes homosexuality as a dangerous anomaly in need of eradication. Given that a pilot of our in- person LGBT-affirmative MHP training we tested recently in Romania showed significant receptivity and increased competence among MHPs, this training is now ripe for testing its feasibility and efficacy in creating significant change via mobile delivery, in a randomized controlled trial (RCT). Proving the efficacy of this first mobile training and supervision model has high potential for cost-effective and expeditious boundless dissemination. In Aim 1, we will test the relative feasibility and efficacy of our mHealth MHP training by conducting an RCT comparing a mobile training (MT) of our MHP LGBT-competency program (n=60) to the equivalent in-person training (IPT) (n=60) we recently piloted. Both programs' content and structure will be identical (3-day trainings and two boosters 6 months apart). At baseline, 4, 8, and 12 months, we will assess, in a mobile fashion, all MHPs' LGBT-related attitudes, knowledge of LGBT health needs and clinical practice, and LGBT caseload. In Aim 2, we will test the efficacy of a companion mHealth supervision and consultation program in maintaining LGBT competency and enhancing LGBT-friendly practice. Half of the MHPs in each group will receive our mHealth supervision and expert consultation program, consisting of monthly 2-hour virtual group meetings to discuss case studies, in order to determine the added benefit of mobile supervision. After the training, 10 MHPs will provide interview-based program feedback. In Aim 3, we will build mHealth research capacity among MHPs by demonstrating how to integrate mobile data collection tools in clinical practice to monitor client progress for personalized treatment plans. We have chosen four types of partners to maximize the project's sustainability and benefit from the power of their multidisciplinarity: academics, direct service agencies supporting LGBTI, practicing MHPs, and a technical developer. This first RCT testing of an mHealth training in LGBT-competent mental healthcare in Romania affords us an unparalleled opportunity to introduce much needed expertize and mHealth methodologies in universities and clinical practice, and create a seed infrastructure for an implementation science R01 of national and global public health significance.

项目摘要 女同性恋、男同性恋、双性恋和变性人(LGBTI)的发病率比 一般人口，这归因于医疗保健歧视和缺乏针对LGBT的专门知识， 特别是在耻辱程度高的国家。在恐惧的驱使下，罗马尼亚LGBTI隐瞒身份并报告 与异性恋者相比，获得医疗保健的障碍要多得多。心理健康状况不佳，特别是焦虑 和抑郁，罗马尼亚LGBTI的发病率较高，并与较差的身体健康相关(例如，艾滋病毒风险， 酗酒。)然而，具有LGBT能力的精神卫生专业人员(MHP)在中国几乎不存在 因此，仇视同性恋对心理健康的负面影响是无法改善的。都不是 大学也不包括LGBT身份和健康课程，相反，占主导地位的 话语将同性恋宣传为一种危险的反常现象，需要根除。鉴于我们的一名飞行员- 我们最近在罗马尼亚测试的个人LGBT-肯定MHP培训显示出显著的接受性和 提高了MHP的能力，这种培训现在已经成熟，可以测试其在创建 在一项随机对照试验(RCT)中，通过移动交付实现了显著变化。首先证明了这一点的有效性 移动培训和监督模式具有高性价比和快速无界的潜力 传播。在目标1中，我们将通过以下方式测试我们的mHealth MHP培训的相对可行性和有效性 对我们的MHP LGBT能力计划(n=60)的移动培训(MT)与 我们最近试行了相当于面对面培训(IPT)(n=60)。这两个节目的内容和结构都将是 完全相同(为期3天的培训和两次相隔6个月的强化训练)。在基线、4个月、8个月和12个月时，我们将评估 以一种流动的方式，所有MHPS的LGBT相关态度，LGBT健康需求和临床实践的知识， 还有LGBT的案件数量。在目标2中，我们将测试与之配套的移动健康监督和咨询的效果 保持LGBT能力和加强LGBT友好实践的计划。每个MHPS中的一半 小组将接受我们的移动健康监督和专家咨询计划，每月2小时 召开虚拟小组会议，讨论案例研究，以确定移动监管的额外好处。 培训结束后，10名MHPS将提供基于面试的计划反馈。在目标3中，我们将构建mHealth 通过演示如何将移动数据收集工具集成到临床来展示MHP的研究能力 针对个性化治疗计划监控患者进展的做法。我们选择了四种类型的合作伙伴来 最大限度地提高项目的可持续性，并从其多学科的力量中受益：学者，直接 支持LGBTI的服务机构，实践MHPS，以及技术开发人员。这是第一次对 在罗马尼亚接受LGBT-胜任精神卫生保健的MHealth培训为我们提供了一个无与伦比的机会 在大学和临床实践中引入急需的专家和移动健康方法，并创建 具有国家和全球公共卫生意义的实施科学R01的种子基础设施。