Adapting and Testing A Mental Health Services Engagement Program for Racial and Ethnic Minority Young Adults

项目摘要/摘要 精神卫生服务使用率低至40%，少数民族青年 严重精神疾病(SMI)是脱离精神卫生服务的高风险人群。他们经历了 更大的未得到满足的需求和长期健康差距、贫困、监禁和早熟的风险增加 死亡率。治疗参与度的差异往往是由于缺乏考虑到 影响青少年持续参与的独特发展需求及相关文化因素 在治疗中。PI在种族和少数民族年轻人中的初步调查结果表明，他们 希望从心理健康提供者那里获得更多关于他们的文化身份的知识、欣赏和支持。 然而，很少有针对患有SMI的年轻人的循证治疗参与计划，而且还没有 明确针对那些种族和民族的发展和文化偏好 少数族裔。这一职业发展奖提出了一条全面的道路，以成为一名 独立临床医生调查员调整和优化循证干预措施，以针对文化 健康的决定因素，并减少青少年和年轻人之间的心理健康差距。这项建议 使用参与式Adapt-IT框架与患有SMI的种族和少数民族青年合作 (n=15)、提供者(n=9)和专家导师，以适应简短、循证的青少年治疗 参与度干预包括三个新的以个人为中心、以文化认同为重点的组成部分。这个 然后将在混合方法的试点优化试验中评估适应干预的可行性， 可接受性，以及对城市、公共资助的成人精神病院治疗参与度的初步影响 康复计划。试点包括多阶段优化策略的准备阶段 (大多数)，在此期间，年轻人(n=80)将被分配到八种条件之一来测试新组件 在一个有效的析因实验中。干预后进行的深入访谈将结合实际情况和 澄清调查结果。为了进一步实现她的长期职业目标，成为一名专注于 在向成年过渡期间为服务不足的青少年改善精神健康服务方面，少年警务处将继续 以下四个领域的培训：(1)为老年人制定经验驱动的参与干预措施 青少年和青壮年；(2)调整干预措施，使之与服务不足、小型化的文化相关 人口，(3)使用最多，和(4)赠款书写。这项研究的产品将是大规模的R01 优化试验支持测试干预组件的有效性和靶向机制的变化 治疗约定。总体而言，这一奖项将确保PI成功过渡到独立的 具有既定研究计划的调查员，专注于干预措施的开发、适应和 针对小规模青少年和青壮年心理健康差距的优化。

PROJECT SUMMARY/ABSTRACT With rates of mental health service utilization as low as 40%, racial and ethnic minority young adults with serious mental illnesses (SMI) are at high risk for disengaging from mental health services. They experience greater unmet need and increased risk for long-term health disparities, poverty, incarceration, and early mortality. Disparities in treatment engagement are often driven by the lack of services that take into account the unique developmental needs and relevant cultural factors that impact young adults’ on-going participation in treatment. The PI’s preliminary findings among racial and ethnic minority young adults indicate that they desired greater knowledge, appreciation, and support of their cultural identities from mental health providers. However, there are few evidence-based treatment engagement programs for young adults with SMI, and none that explicitly target both the developmental and cultural preferences of those who are racial and ethnic minorities. This Career Development Award proposes a comprehensive path towards becoming an independent clinician investigator adapting and optimizing evidence-based interventions to target cultural determinants of health and reduce mental health disparities among adolescents and young adults. This proposal uses the participatory ADAPT-IT framework to partner with racial and ethnic minority young adults with SMI (n=15), providers (n=9), and expert mentors to adapt a brief, evidence-based young adult treatment engagement intervention to include three new person-centered, cultural identity-focused components. The adapted intervention will then be evaluated in a mixed-methods pilot optimization trial for feasibility, acceptability, and preliminary impact on treatment engagement at an urban, publicly-funded, adult psychiatric rehabilitation program. The pilot comprises the preparation stage of the multiphase optimization strategy (MOST), during which young adults (n=80) will be assigned to one of eight conditions to test new components in an efficient factorial experiment. In-depth interviews administered post-intervention will contextualize and clarify findings. To further her long-term career goal of becoming an independent clinician investigator focused on improving mental health services for underserved youth during the transition to adulthood, the PI will pursue training in the following four areas: (1) developing empirically-driven engagement interventions for older adolescents and young adults, (2) adapting interventions to be culturally relevant to underserved, minoritized populations, (3) using MOST, and (4) grant writing. The product of this study will be an R01 of a large-scale optimization trial powered to test intervention components for efficacy and change in targeted mechanisms of treatment engagement. Overall, this award will ensure the PI’s successful transition to an independent investigator with an established program of research focused on intervention development, adaptation, and optimization for addressing mental health disparities in minoritized adolescents and young adults.