SUPERA: Supporting Peer Interactions to Expand Access to Digital Cognitive Behavioral Therapy for Spanish-speaking Safety-Net Patients in Primary Care

项目摘要 英语水平有限（LEP）的拉丁裔经历更长时间的未经治疗的心理健康 紊乱在抑郁和焦虑的情况下，拉丁裔接受高质量教育的可能性是白人的一半， 循证护理，尽管初级保健提供者建议以同等费率治疗。有 患有抑郁和焦虑的LEP Latinx患者的已知障碍，特别是在医疗保健水平。 因为这些患者更有可能在公共医疗机构接受治疗， 对于接受医疗补助或没有保险的患者，通常会有语言和文化上一致的护理 在这些系统中的模型，但西班牙语的行为/心理健康临床医生的整体不足。在 此外，这些资源不足的医疗保健系统也不太可能成为实施 这些创新可能会增加其人口获得精神卫生保健的机会。 数字干预，即，那些利用互联网和移动的技术，可以提供有效的 克服这些障碍的方法。在许多国家，数字治疗是精神疾病的一线治疗。 健康问题，如抑郁和焦虑，创造一个标准的护理，可以克服差距， 促进卫生公平。在美国，很少有患者能够获得基于证据的数字治疗， 即使有，吸收和参与也往往很低。 该提案旨在实施和评估一种基于证据的数字认知行为疗法 在安全网初级保健诊所对患有抑郁和/或焦虑的LEP Latinx患者进行干预。初级 护理是治疗抑郁症等常见心理健康问题的实际治疗环境 焦虑和拉丁裔患者倾向于留在初级保健治疗，而不是被转介到 其他专业心理健康服务。我们将进行有效性-实施混合试验（类型2） 提供者和患者水平的随机化设计。这将产生有关数字化有效性的数据， 同伴支持LEP Latinx患者的心理健康结果，同时生成严格的数据 在今后的工作中传播机会最大的执行战略。在提供者一级 我们将比较外展（使用我们的诊所患者登记处）与内展（传统的提供者转诊），在 在患者层面，我们将比较dCBT平台的两种交付模式（同行支持与不支持）。 这项研究的长期目标是帮助实施数字心理健康干预措施 可在资源匮乏的环境中可持续地实施，同时减少对专业人员的依赖， 克服劳动力短缺，增加对不同人群的相关性。这些干预措施可以是 大规模提供，解决常见精神障碍造成的巨大疾病负担， 使那些传统上得不到我们卫生系统服务的人能够获得更多的资源。

Project Summary Limited English Proficiency (LEP) Latinxs experience longer duration of untreated mental health disorders. In the case of depression and anxiety, Latinxs are half as likely as whites to receive quality, evidence-based care despite primary care providers recommending treatment at equivalent rates. There are known barriers for LEP Latinx patients with depression and anxiety, especially at the healthcare setting level. Because these patients are more likely to receive care in public healthcare settings which disproportionately care for patients on Medicaid or who are uninsured, there are often language and culturally concordant care models in these systems yet an overall deficiency of Spanish-speaking behavioral/mental health clinicians. In addition, these under-resourced healthcare systems also are less likely to be the site for implementation of innovations that might increase access to mental health care for their population. Digital interventions, i.e., those that leverage Internet and mobile technologies, can provide an effective option for overcoming these barriers. In many countries, digital treatments are frontline treatments for mental health issues such as depression and anxiety, creating a standard of care that can overcome disparities and promote health equity. In the United States, few patients have access to evidence-based digital treatments, and even when available, uptake and engagement is often low. This proposal aims to implement and evaluate an evidence-based digital cognitive-behavioral therapy intervention in safety-net primary care clinics for LEP Latinx patients with depression and/or anxiety. Primary care is the de facto treatment setting for the treatment of common mental health problems such as depression and anxiety and Latinx patients tend to prefer to remain treated in primary care rather than being referred to other specialty mental health services. We will conduct an effectiveness-implementation hybrid trial (Type 2) design with both provider- and patient-level randomization. This will generate data on effectiveness of digital peer support for mental health outcomes for LEP Latinx patients while simultaneously generating rigorous data on the implementation strategies with the highest chance of dissemination in future work. At the provider-level we will compare outreach (using our clinic patient registry) with inreach (traditional provider referral), at the patient-level we will compare two modes of delivery of the dCBT platform (peer-supported vs. unsupported). The long-term goal of this research is to aid in the implementation of digital mental health interventions that can be sustainable implemented in low-resourced settings, while reducing the reliance on professionals, overcoming workforce deficits, and increasing relevance for diverse populations. Such interventions could be provided at scale and address the substantial burden of disease resulting from common mental disorders while making resources more available to those traditionally underserved by our health system.