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

项目概要/摘要 患有严重精神疾病（SMI;精神病和主要情感障碍）的人 与没有这些条件的类似年龄的个体相比，发病率较高。在这广阔的 在这一人群中，最脆弱的是没有接受治疗的患有重度精神分裂症的拉丁裔人。此外，创伤 一般来说，重度精神障碍患者的发病率是普通公众的四到五倍， 与其他种族和族裔群体相比，拉丁美洲人的比例更高。尽管有效的心理治疗 健康治疗干预，大约47%的患有SMI的拉丁裔成年人没有参与治疗。 那些参与的人在治疗依从性、保留率和满意度方面明显低于那些参与的人。 白色人。拉丁裔参与治疗的障碍包括缺乏双语和双文化临床 提供者，缺乏文化上敏感的干预措施，缺乏拉丁语专业服务 邻里，自力更生的态度和文化差异，影响心理健康的认识 性问题一些证据表明，针对拉丁美洲人的文化定制干预措施可能会改善治疗 订婚动机性访谈（MI）是一种以证据为基础，以人为本的方法。 治疗方法，已被证明可以预测行为变化，如治疗参与，更大 药物依从性和酒精消费的减少，以及拉丁美洲人的其他结果。 然而，迄今为止还没有研究探讨多元智能精神的文化适应或全面的方法。充分 整合拉丁文化价值观和多元智能，我们不仅需要注意干预，而且需要注意 服务交付方式。考虑到以下因素，Latinx同行可能处于最佳位置，可以通过SMI向Latinx提供MI 他们对文化和疾病的生活经历。关于拉丁美洲同行的现有研究， 从重度精神分裂症中恢复后，有证据表明拉丁裔同行导航员似乎增强了服务参与度， 恢复，以及从SMI中恢复的拉丁人的生活质量。因此，这个职业的总体目标 发展建议是在文化上适应MI，以整合拉丁文化关系价值观和创伤信息 护理从重度精神病患者中恢复过来的同龄人的分娩，让患有重度精神病患者的拉丁裔参与精神健康治疗。 具体来说，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SMI的拉丁裔患者的治疗犹豫和参与; 2）在文化上适应MI治疗 参与干预，这是创伤知情和同伴交付的拉丁裔与SMI;和3）提供 相关目标机制的可行性、可接受性和参与性的证据 干预我的导师，结合耶鲁大学世界一流的培训环境，将指导 我朝着我的目标，成为一个独立的双文化和多层次的影响双语调查 心理健康不公平，在设计和进行严谨，务实的研究，旨在 改善拉丁裔和其他种族和民族社区的参与，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.