Optimizing a Personalized Health Approach for Virtually Treating High-Risk Caregivers During COVID-19 and Beyond

优化个性化健康方法，以虚拟方式治疗 COVID-19 期间及之后的高风险护理人员

• 批准号: 10709470
• 负责人: Bridgette Lynne Kelleher
• 金额: $ 97.63万
• 依托单位: PURDUE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-23 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10709470
• 关键词: Acceleration; Acute; Address; Algorithms; Award; Behavior; Behavior Therapy; Black race; COVID-19; COVID-19 impact; COVID-19 pandemic; COVID-19 pandemic effects; Caregiver Burden; Caregiver support; Caregivers; Caring; Cellular Phone; Child; Child Care; Child Rearing; Clinic; Clinical; Communication; Communities; Complex; Data; Diagnostic; Distress; Ecological momentary assessment; Education; Effectiveness; Emergency Situation; Epidemic; Evidence based intervention; Evidence based treatment; Face; Family; Financial Hardship; Fright; Frontline worker; Frustration; Future; Geography; Health; Health Services Accessibility; Healthcare; Infrastructure; Intervention; Life; Longitudinal Studies; Medical; Mental Health; Methods; Minority; Modeling; Monitor; Outcome; Participant; Patients; Protocols documentation; Provider; Public Health; Questionnaires; Race; Randomized; Risk; Route; Self Efficacy; Series; Services; Social Distance; Social isolation; Stress; Symptoms; Syndrome; Training; Trauma; Triage; Underserved Population; Vocation; Vulnerable Populations; Work; caregiving; clinically significant; compare effectiveness; cost effective; cost efficient; current pandemic; design; digital assessment; digital delivery; digital health; digital healthcare; digital intervention; digital mental health; digital treatment; efficacy testing; evidence base; experience; feasibility testing; first responder; functional disability; graduate student; health disparity; high risk; high risk population; innovation; meetings; motivational enhancement therapy; neurogenetics; novel; pandemic disease; pandemic impact; peer; peer coaching; personalized medicine; physical conditioning; post-traumatic stress; pre-pandemic; prevent; response; scale up; service intervention; smartphone application; targeted treatment; teacher; telehealth; therapy design; tool; treatment as usual; uptake; vector; virtual

PROJECT SUMMARY/ABSTRACT With the spread of COVID-19, public health precautions have required physical distancing and a variety of shelter-in-place orders, causing rapid and substantial shifts in all aspects of family and community life. Data from COVID-19, supported by evidence from past national emergencies, suggest caregivers are at clear risk for secondary health effects because of the current pandemic. COVID-19 has been described as a “perfect vector for a mental health epidemic” due to the accumulated effects of pandemic-related fear, social isolation, post-traumatic stress, and mental health treatment barriers. These changes to daily life have been especially challenging for families of children with neurogenetic conditions (NGC), who experience high levels of baseline stress, are particularly vulnerable to reductions in targeted therapeutic services, and rely on medical and educational services that have been disrupted by COVID-19 related closures. Specifically, caregivers themselves are vulnerable to stress-related mental and physical health challenges because of the pandemic; they rarely receive treatment for their own mental health needs, and any treatments they do receive are typically disconnected from their child's care plan and are delivered by practitioners with little-to-no expertise in the needs of NGC families. These health care gaps are amplified among Black and other minority families. The proposed study will address the needs of caregivers of children with NGC by examining the feasibility, efficacy, and impact of a novel network for delivering personalized triage and digital treatment. Specifically, we propose to scale up and integrate a series of brief, evidence based digital health interventions to support caregiver mental health, parenting self-efficacy, and stress. Supervised graduate student trainees will implement rigorous, cost-effective, evidence-based interventions via telehealth. A key innovation of this work is that we will develop a personalized health routing algorithm that matches participants with relevant treatments using both clinical inputs and ecological momentary assessment (EMA) data, brief questionnaires “pinged” to caregiver phones via a smartphone app. A second innovation is that we will test the efficacy of peer-to-peer coaching in enhancing treatment uptake and outcomes. Coaching will be delivered by fellow NGC caregivers using an evidence-based motivational interviewing protocol. By the end of the award period, we will have generated a novel, scalable, and cost-effective solution for rapidly meeting acute needs for NGC caregivers through personalized, digital delivery of evidence-based treatments. This model can be rapidly scaled for other high-risk populations during COVID-19 (e.g. first responders, teachers, frontline workers) and future public health crises. Given substantial unmet needs existed among NGC families even prior to COVID- 19, this protocol has potential to fundamentally shift the status-quo for how treatment is selected and accessed in NGC caregivers and other underserved groups, including beyond the COVID-19 pandemic.

项目概要/摘要 随着 COVID-19 的传播，公共卫生预防措施需要保持身体距离并采取各种措施 就地避难令，导致家庭和社区生活的各个方面发生迅速而重大的变化。数据 来自 COVID-19 的数据以及过去国家紧急情况的证据表明，护理人员面临明显的风险 由于当前的大流行而造成的二次健康影响。 COVID-19 被描述为“完美的 由于与流行病相关的恐惧、社会孤立、 创伤后应激和心理健康治疗障碍。这些日常生活的变化尤其明显 对于患有神经遗传疾病 (NGC) 的儿童的家庭来说是一项挑战，他们的基线水平较高 压力大，特别容易受到针对性治疗服务减少的影响，并且依赖医疗和 因与 COVID-19 相关的关闭而中断的教育服务。具体而言，护理人员 由于大流行，他们自己很容易受到与压力有关的精神和身体健康挑战； 他们很少因自己的心理健康需求而接受治疗，而且他们接受的任何治疗都是 通常与孩子的护理计划无关，并且由缺乏专业知识的从业者提供 满足 NGC 家庭的需求。这些医疗保健差距在黑人和其他少数族裔家庭中被放大。 拟议的研究将通过检查可行性来满足 NGC 儿童照顾者的需求， 用于提供个性化分诊和数字治疗的新型网络的功效和影响。具体来说，我们 建议扩大和整合一系列简短的、基于证据的数字健康干预措施，以支持 照顾者的心理健康、育儿自我效能和压力。受监督的研究生实习生将 通过远程医疗实施严格、具有成本效益、循证的干预措施。本工作的一个关键创新点 我们将开发一种个性化的健康路由算法，将参与者与相关的人进行匹配 使用临床输入和生态瞬时评估 (EMA) 数据、简短调查问卷进行治疗 通过智能手机应用程序“ping”到护理人员的电话。第二个创新是我们将测试 同行辅导，以提高治疗的接受度和结果。辅导将由 NGC 同事提供 护理人员使用基于证据的动机访谈协议。在奖励期结束时，我们将 生成了一种新颖、可扩展且经济高效的解决方案，可快速满足 NGC 的迫切需求 通过个性化、数字化的循证治疗向护理人员提供帮助。该模型可以快速 在 COVID-19 期间针对其他高风险人群（例如急救人员、教师、一线工作人员）进行了扩展 未来的公共卫生危机。鉴于甚至在新冠疫情之前，NGC 家庭就存在大量未满足的需求， 19、该方案有可能从根本上改变治疗选择和获取方式的现状 NGC 护理人员和其他服务不足的群体，包括除 COVID-19 大流行之外的群体。