Multilevel Community-Based Mental Health Intervention to Address Structural Inequities and Adverse Disparate Consequences of COVID-19 Pandemic on Latinx Immigrants and African Refugees

项目摘要 这项研究的目的是测试一种多层次的方法，以减少COVID-19的不良后果。 通过观察和实施对拉丁裔和黑人移民和难民产生不同影响的流行病 三个嵌套层次的干预：1）有效的6个月同伴倡导和相互学习模式 （难民和移民福利项目）; 2）与社区组织接触 （CBO）;以及3）为应对大流行而预计将颁布的结构性政策变化，例如国家 为混合身份的拉丁裔家庭提供救灾建议，并扩大全州范围的医疗保险覆盖面。 这项以社区为基础的参与式研究（CBPR）建立在与五个 以社区为基础的组织（CBO），专注于心理健康、教育、法律的问题和系统 改变努力，以改善拉丁美洲移民和非洲难民的福祉。包括240名拉丁裔 移民和60名非洲难民从CBO合作伙伴那里招募，他们被随机分配到 通常CBO参与或RIWP干预和300名拉丁美洲人的随机样本对照组 移民，本研究采用混合方法纵向候补对照组设计，共7个时间点， 几个月将检验RIWP干预和与社区组织接触的有效性， 心理困扰、日常压力源和经济不稳定性，并增加保护因素（社会支持， 对资源的批判意识/获取，英语能力，文化联系和心理健康 服务使用）。这项研究还将测试RIWP干预和与社区组织接触的能力， 增加拉丁美洲人获得结构性干预措施（地方/州救济相关政策）的直接利益的机会 黑人移民和难民。将通过测试探索干预有效性的机制 调节主要结果和保护因素之间的关系。我们还将跟踪地方/州政策 变化，并获得这些结构性干预措施的影响的初步量化估计， 心理困扰，压力源，和经济不稳定性使用倾向评分匹配。定性 来自参与者和CBO工作人员的有目的子样本的访谈数据将使更多的探索成为可能， 变化机制，政策干预对个人的影响，社区组织如何有助于制定 政策和帮助人们从中受益，以及在每个地点实施RIWP的背景。这 研究具有创新性和重要性，因为它采用了最先进的研究设计和干预措施 推进多层次心理健康干预科学的战略，旨在了解和解决 已经强调的潜在的结构性不平等和由此产生的心理健康差距， 大流行加剧了这种情况。因此，这项研究不仅有助于减少不同的不利因素， 心理健康，行为和社会经济后果的COVID-19大流行病，但也对我们的能力 消除拉丁裔和黑人人口之间的心理健康差距。

PROJECT SUMMARY The goal of this study is to test a multilevel approach to reduce adverse consequences of the COVID-19 pandemic with disparate impacts on Latinx and Black immigrants and refugees by observing and implementing three nested levels of intervention: 1) an efficacious 6-month peer advocacy and mutual learning model (Refugee and Immigrant Well-being Project, RIWP); 2) engagement with community-based organizations (CBOs); and 3) structural policy changes expected to be enacted in response to the pandemic, such as a state disaster relief proposal for mixed status Latinx families and expanded statewide health insurance coverage. This community-based participatory research (CBPR) study builds on a long-standing collaboration with five community-based organizations (CBOs) that focus on mental health, education, legal issues, and system change efforts to improve the well-being of Latinx immigrants and African refugees. By including 240 Latinx immigrants and 60 African refugees recruited from CBO partners who are randomly assigned to treatment-as- usual CBO involvement or the RIWP intervention and a random sample comparison group of 300 Latinx immigrants, this mixed methods longitudinal waitlist control group design study with seven time points over 36 months will test the effectiveness of the RIWP intervention and engagement with CBOs to reduce psychological distress, daily stressors, and economic precarity and increase protective factors (social support, critical awareness of/access to resources, English proficiency, cultural connectedness, and mental health service use). This study will also test the ability of the RIWP intervention and engagement with CBOs to increase access to the direct benefits of structural interventions (local/state relief-related policies) for Latinx and Black immigrants and refugees. Mechanisms of intervention effectiveness will be explored by testing mediating relationships between primary outcomes and protective factors. We will also track local/state policy changes and obtain preliminary quantitative estimates of effects of these structural interventions on psychological distress, stressors, and economic precarity using propensity score matching. Qualitative interview data from a purposive subsample of participants and CBO staff will enable additional exploration of mechanisms of change, the effects of policy interventions on individuals, how CBOs contribute to enacting policies and helping people benefit from them, and the context of RIWP implementation at each site. This research is innovative and significant because it employs cutting-edge research design and intervention strategies to advance the science of multilevel mental health interventions that aim to understand and address underlying structural inequities and resulting mental health disparities that have been highlighted and exacerbated by the pandemic. Thus, this study will contribute not only to reducing the disparate adverse mental health, behavioral, and socioeconomic consequences of the COVID-19 pandemic but also to our ability to eliminate mental health disparities among Latinx and Black populations.