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

项目总结/摘要 由于精神卫生服务利用率低至40%，种族和少数民族的年轻人， 严重精神疾病患者脱离精神卫生服务的风险很高。他们经历 未满足的需求增加，长期健康差距、贫困、监禁和早期 mortality.治疗参与方面的差异往往是由于缺乏考虑到 影响年轻人持续参与的独特发展需求和相关文化因素 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， 希望从心理健康提供者那里获得更多的知识、欣赏和支持他们的文化身份。 然而，很少有基于证据的治疗参与计划，为年轻的成年人与SMI，没有 明确针对那些种族和民族的发展和文化偏好， 少数群体这个职业发展奖提出了一个全面的道路，成为一个 独立的临床研究者调整和优化基于证据的干预措施，以适应目标文化 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的少数种族和少数民族年轻人合作 （n=15），提供者（n=9）和专家导师，以适应简短的，以证据为基础的年轻成人治疗 参与干预包括三个新的以人为本，以文化身份为重点的组成部分。的 然后将在混合方法试点优化试验中评估适应性干预的可行性， 可接受性，以及对城市公共资助的成人精神病治疗参与的初步影响 康复计划。试验包括多阶段优化策略的准备阶段 （MOST），在此期间，年轻人（n=80）将被分配到八个条件之一，以测试新的组件 一个有效的析因实验。干预后进行的深入访谈将结合具体情况， 澄清调查结果。为了进一步实现她成为一名独立临床研究者的长期职业目标， 在向成年过渡期间，为服务不足的青少年改善心理健康服务，PI将继续 （1）为老年人制定以实践为导向的参与干预措施， （2）调整干预措施，使之在文化上与服务不足、 人口，（3）使用MOST，和（4）赠款写作。本研究的产品将是一个大规模的R 01 优化试验，旨在测试干预成分的疗效和靶向机制的变化， 治疗参与。总的来说，这个奖项将确保PI成功过渡到独立的 具有既定研究计划的研究人员，专注于干预措施的开发，适应， 优化解决少数群体青少年和年轻人心理健康差距的工作。

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.