Designing Deaf-MET: A Deaf-Accessible Pre-Treatment for Alcohol Use Disorder

项目总结/摘要 美国聋人社区-超过500，000名听力损失者使用 美国手语（ASL）-与美国手语相比， 普通民众。然而，目前还没有经过正式验证的循证治疗方法来治疗 问题饮酒或酒精使用障碍（AUD）的聋人客户。 可用的AUD治疗无法满足聋人客户独特的语言和文化需求。聋人的中位数 英语阅读水平福尔斯下降到四年级，许多人表现出低健康素养。因此，书面处理 材料需要纯文本修订，直接的美国手语翻译，或美国手语叙事讲故事。同样重要的是， 需要纳入聋人的价值观和社会规范，承认聋人的压迫历史， 尊重聋人作为一个文化群体而不是残疾群体的身份。认识和资源有限 导致许多听力临床医生将聋人视为“残疾”或“受损”， 合作的工作关系，并排除聋人从重要的决定，他们自己的照顾。 为了解决这些障碍，拟议的K23研究将利用社区参与的干预发展 方法来设计，试点，并完善文化和语言上可访问的动机适应 增强治疗（MET）为聋人客户与AUD（聋人MET）。MET是一种简短的预处理， 结合动机访谈和改变阶段，以增加客户的积极性， 参与复苏。有强有力的证据表明MET的疗效和广泛的循证客户选择 在与听力客户一起使用时，MET无法满足聋人的语言和文化需求。 在ENGAGED for CHANGE模型的指导下，这是一个多步骤的社区参与过程， 干预措施，以减少健康差距，候选人将设计，试点，并完善聋人MET：（1） 评估聋人社区的需求，优先事项和资产，通过一系列的四个全国性的重点小组与聋人 具有AUD现场经验的人和其他关键利益相关者;（2）与聋人参与的合作 干预开发小组，开发聋人MET治疗师手册原型和聋人无障碍MET 处理材料（例如，视觉讲义，ASL翻译，ASL叙述和/或MET改编 脚本）;以及（3）与24名聋人成年人进行三个聋人MET试点测试周期，分析 可行性（例如，招募、保留、满意度）和初步功效。 每个试点测试周期后的结果将用于在下一个周期之前改进Deaf-MET原型。 总体研究结果将为耳聋-MET的全面RCT设计提供信息，并有助于开发 第一个聋人可获得的AUD预处理。此外，拟议的目标将为候选人提供 在社区参与的研究和干预发展的实践经验，成为一个必要的 独立的临床研究人员，为聋人客户调整，开发和评估AUD治疗。

PROJECT SUMMARY/ABSTRACT The U.S. Deaf community – more than 500,000 individuals with hearing loss who communicate using American Sign Language (ASL) – experiences nearly triple the rate of lifetime problem drinking compared to the general population. Yet, there are no evidence-based treatments that have been formally validated to treat problem drinking or alcohol use disorder (AUD) among Deaf clients. Available AUD treatments fail to meet Deaf clients’ unique linguistic and cultural needs. Deaf people’s median English reading level falls at the fourth grade and many exhibit low health literacy. Therefore, written treatment materials require plain text revisions, direct ASL translations, or ASL narrative storytelling. Equally critical is the need to incorporate Deaf values and social norms, acknowledge Deaf people’s history of oppression, and respect Deaf people’s identification as a cultural– not a disability – group. Limited awareness and resources lead many hearing clinicians to perceive Deaf people as “disabled” or “impaired,” struggle to develop a collaborative working relationship, and exclude Deaf people from important decisions about their own care. To address these barriers, the proposed K23 study will leverage community-engaged intervention development methods to design, pilot, and refine a culturally- and linguistically-accessible adaptation of Motivational Enhancement Therapy (MET) for Deaf clients with AUD (Deaf-MET). MET is a brief pre-treatment that combines Motivational Interviewing and the stages of change to increase a client’s motivation for actively engaging in recovery. There is strong evidence of MET’s efficacy and a wide selection of evidence-based client tools when used with hearing clients; however, MET fails to meet Deaf people’s linguistic and cultural needs. Guided by the ENGAGED for CHANGE model, a multistep community-engaged process for developing interventions to reduce health disparities, the candidate will design, pilot, and refine Deaf-MET by: (1) assessing Deaf community needs, priorities, and assets via a series of four nationwide focus groups with Deaf people with lived AUD experience and other key stakeholders; (2) in collaboration with a Deaf-engaged intervention development team, developing a prototype Deaf-MET therapist manual and Deaf-accessible MET treatment materials (e.g., visual handouts, ASL translations, ASL narratives, and/or adaptations to the MET script); and, (3) conducting three pilot testing cycles of Deaf-MET with 24 Deaf adults, analyzing key aspects of feasibility (e.g., recruitment, retention, satisfaction) and preliminary efficacy. Results after each pilot testing cycle will be used to refine the Deaf-MET prototype prior to the next cycle. Overall study findings will inform the design of a full-scale RCT of Deaf-MET and contribute to the development of the first Deaf-accessible AUD pre-treatment. Additionally, the proposed aims will provide the candidate with hands-on experience in community-engaged research and intervention development necessary to become an independent clinical researcher who adapts, develops, and evaluates AUD treatments for Deaf clients.