Abriendo Caminos: Engaging Latinx Communities Through Culturally Responsive Peer Delivered Motivational Interviewing

计划摘要/摘要 患有严重精神疾病(SMI；精神病和严重情感障碍)的人经历了 与没有这些疾病的相似年龄段的人相比，发病率更高。在这片广阔的土地上 在人口中，最脆弱的是患有重度精神分裂症的拉丁裔人，他们没有从事治疗。更进一步，精神创伤 在患有SMI的人中，总体上是普通公众的四到五倍，发病率最高 在拉丁裔中，与其他种族和民族相比。尽管有有效的心理治疗 健康治疗干预，大约47%患有SMI的拉丁裔成年人没有从事治疗。 那些参与治疗的人的治疗依从率、保留率和满意率明显低于 白人。拉丁裔患者参与治疗的障碍包括缺乏双语和双文化临床 在拉丁语中，提供者缺乏响应文化的干预措施，无法获得专门服务 影响心理健康认知的邻里关系、自立态度和文化差异 担忧。一些证据表明，针对拉丁裔进行文化调整的干预措施可能会改善治疗 订婚。熟练运用以证据为基础、以人为中心的动机访谈 治疗方法，已被证明可以预测行为变化，如治疗参与度，更大 药物依从性和酒精消耗量的减少，以及拉丁裔患者的额外结果。 然而，到目前为止，还没有研究考察MI精神的文化适应或完整的方法。充分地 整合拉丁裔文化价值观和MI，我们不仅需要关注干预，还需要关注 提供服务的方式。Latinx同行可能处于通过SMI向Latinx提供MI的最佳位置，给定 他们在文化和疾病中的生活经历。中关于Latinx对等点的可用研究的 从SMI中恢复，有证据表明Latinx对等导航器似乎提高了服务参与度， 恢复，以及拉美裔人从SMI中恢复的生活质量。因此，这一职业的总体目标是 发展建议是在文化上适应MI，以整合拉美裔文化、关系价值观和创伤信息 照顾SMI康复中的同龄人的分娩，让拉丁裔与SMI一起接受精神健康治疗。 具体地说，这项拟议的研究将1)确定有助于心理健康的社会和文化因素 患有精神分裂症的拉丁裔患者的治疗犹豫不决和参与度；2)文化适应心梗治疗 为患有SMI的拉美裔人提供创伤信息和同伴提供的参与干预；以及3)提供 与以下方面相关的目标机制的可行性、可接受性和参与性的证据 干预。我的导师，结合耶鲁大学世界级的培训环境，将指导 我朝着我的目标前进，成为一名独立的双文化和双语多层次影响的调查者 关于精神健康不平等问题，具有设计和进行严谨、务实的研究的专门知识，旨在 改善拉丁裔和其他种族和民族社区的参与度、护理和临床结果。

Program Summary/Abstract People with serious mental illness (SMI; psychotic and major affective disorders) experience significantly higher rates of morbidity compared with individuals of similar ages without these conditions. Among this broad population, the most vulnerable are Latinxs living with SMI who are not engaged in treatment. Further, trauma among people with SMI, in general, is four to five times higher than for the general public, with highest rates among Latinxs in comparison to other racial and ethnic groups. Despite the availability of effective mental health treatment interventions, approximately 47% of Latinx adults with SMI are not engaged in treatment. Those who are engaged have significantly lower rates of treatment adherence, retention, and satisfaction than White people. Barriers to treatment engagement for Latinxs include lack of bilingual and bicultural clinical providers, the absence of culturally responsive interventions, lack of access to specialty services in Latinx neighborhood, self-reliant attitudes, and cultural differences that impact the recognition of mental health concerns. Some evidence suggests that culturally tailoring interventions to Latinxs may improve treatment engagement. The proficient use of Motivational Interviewing (MI), an evidence-based and person-centered treatment approach, has been shown to predict behavior change, such as treatment engagement, greater medication adherence and reductions in alcohol consumption, and additional outcomes among Latinxs. However, no research to date has examined the cultural adaptation of the MI spirit or the full approach. To fully integrate Latinx cultural values and MI, we need to pay attention not just to the intervention, but also to the method of service delivery. Latinx peers may be in the best position to deliver MI to Latinxs with SMI, given their lived experience with both the culture and the illness. Of the available research on Latinx peers in recovery from SMI, evidence suggests that Latinx peer navigators appear to enhance service engagement, recovery, and quality of life for Latinxs in recovery from a SMI. Therefore, the overall objective of this career development proposal is to culturally adapt MI to integrate Latinx cultural relational values and trauma informed care for delivery by peers in recovery from SMI to engage Latinxs with SMI in mental health treatment. Specifically, the proposed research will 1) identify social and cultural factors that contribute to mental health treatment hesitancy and engagement among Latinxs with SMI; 2) culturally adapt an MI treatment engagement intervention that is trauma informed and peer delivered for Latinxs with SMI; and 3) provide evidence of the feasibility, acceptability, and engagement of target mechanisms associated with the intervention. My mentors, in combination with a world-class training environment at Yale University, will guide me towards my goal of becoming an independent bicultural and bilingual investigator of multi-level influences on mental health inequities, with expertise in designing and conducting rigorous, pragmatic research aimed at improving engagement, care, and clinical outcomes for Latinxs and other racial and ethnic communities.