Addressing Mental Health Disparities in Refugee Children Through Family and Community-based Prevention: A CBPR Collaboration and Hybrid Implementation Effectiveness Trial

 描述（由申请人提供）：在美国重新定居的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。重新安置压力因素（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——并且很少全面响应难民社区的需求或优先事项；尽管难民人口统计数据迅速变化，但很少有干预措施是专为跨不同文化和难民群体而设计的。因此，重新安置的难民人口中心理健康服务的使用率较低。对于具有父母创伤、代际冲突以及其他文化和重新安置压力等风险因素的难民儿童和青少年来说，预防性干预措施前景广阔，但极为罕见。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，并有助于制定反应灵敏、灵活的干预措施，以促进健康的家庭功能和儿童心理健康，并有助于防止心理健康差异。我们提出了一项由 CBPR 驱动的混合实施有效性试验，该试验建立在新英格兰索马里班图和 Lhotshampas 不丹难民社区内正在进行的合作研究和社区意识提高的基础上。对这些群体的初步研究和基于 CBPR 的需求评估发现了许多文化和社区优势，以及亲子互动困难、沟通不畅和家庭冲突等持续存在的问题，这些问题与持续的压力源相互作用，增加了儿童情绪和行为的风险 问题。难民家庭强化干预措施 (FSI-R) 采用 CBPR 方法（一种基于家庭的预防模式），改编自非洲使用的经过测试的模式，旨在由难民社区卫生工作者通过涉及利益相关者协商和当地难民社区咨询委员会投入的流程来实施。 FSI-R 的试点数据显示出很强的可行性和可接受性，但需要进一步的数据来了解有效性以及嵌入难民服务社会服务机构的社区卫生工作者实施的障碍和促进因素。具体目标是 (1) 使用混合型 2 型有效性实施设计（在一项双臂随机对照试验中，有 7-17 岁儿童的家庭）检查基于家庭的预防干预对亲子关系、家庭功能和儿童心理健康结果的影响； (2) 通过在实施干预措施的同时进行过程评估，确定社区卫生工作者实施 FSI-R 的障碍和促进因素； (3) 通过难民社区、服务提供者和学术利益相关者之间的合作伙伴关系，加强基于 CBPR 的变革途径，从而加强社区参与的科学性，以解决健康差异问题。

 DESCRIPTION (provided by applicant): Refugee children and families who are resettled in the United States 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 holistically to the needs or priorities of refugee communities; few interventions are designed for use across diverse cultures and refugee groups, despite rapidly evolving refugee demographics. Consequently, mental health service usage is low in resettled refugee populations. For refugee children and adolescents characterized by risk factors such as parental trauma, intergenerational conflict and other acculturative and resettlement stressors, preventive interventions hold great promise but are exceedingly rare. 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 responsive, flexible, interventions to promote healthy family functioning and child mental health and help prevent mental health disparities. We propose a CBPR-driven hybrid implementation effectiveness trial that builds upon ongoing collaborative research and community awareness-raising within Somali Bantu and Lhotshampas Bhutanese refugee communities in New England. Preliminary research and CBPR-based needs assessments with these groups has identified numerous cultural and community strengths as well as ongoing problems of difficult parent-child interactions, poor communication, and family conflict which interact with ongoing stressors to increase risks for child emotional and behavioral problems. Using a CBPR approach, a family based prevention model, the Family Strengthening Intervention for Refugees (FSI-R) was adapted from a tested model used in Africa and designed for delivery by refugee community health workers with through a process involving stakeholder consultation and local refugee Community Advisory Board input. Pilot data on the FSI-R demonstrates strong feasibility and acceptability, but further data are needed on effectiveness as well as barriers and facilitators to implementation by community health workers embedded in refugee-serving social services agencies. Specific aims are to (1) examine the impact of a family-based preventive intervention on outcomes of parent-child relationships, family functioning, and child mental health using a Hybrid Type 2Effectiveness-Implementation Design (families with children aged 7-17 in a two-arm randomized controlled trial); (2) identify barriers and facilitators to implementation of the FSI-R by community health workers by conducting a process evaluation concurrent with the delivery of the intervention; and (3) strengthen the science of community engagement to address health disparities by fortifying CBPR-based pathways of change via collaborative partnerships between refugee communities, service providers, and academic stakeholders.