Developing a piot intervention to increase child mental health service utilizatio

尽管除抑郁症外，所有儿童严重和持续性精神疾病的患病率相似，但仍有 在使用精神卫生服务方面存在明显的种族差异。与种族主义和种族歧视有关的各种因素 耻辱、家庭和疾病特征以及服务系统属性可能是造成这些问题的原因 但以前对再生障碍性贫血儿童的研究在这些领域是有限的。我们希望将领域从简单的 列举和描述这些与提供文化敏感帮助方式的干预措施之间的差异 非裔美国人家庭能够及时、适当地照顾患有这些疾病的儿童。我们 已经参考了现有的证据，我们小组最初进行的焦点小组的结果，以及我们的 与AA家庭一起处理早发性精神分裂症、严重情感障碍的广泛临床工作 和自闭症，为干预设计的初始阶段提供信息。我们建议制定一项干预措施，以 增强寻求及时和适当护理的知识和动力以及导航技术 通过以下具体目标提供服务：(1)通过以下方式完善拟议干预措施的内容 确定再生障碍性贫血家庭认为影响或促进其使用精神健康服务的因素 对于患有SPMI的儿童，使用焦点小组方法；通过确定相对人群患病率 使用对AA家庭(N=300)的大样本调查和这些因素的影响；并通过评估 参与者对干预后所涉及的主题和所用材料的满意度 评估。(2)根据中期调查结果，完善拟议干预措施的结构； 以及(3)对拟议的干预措施进行小规模随机试点试验，以估计关键参数 通过从以下方面评估其可行性来设计一项足够强大的严谨疗效研究 征聘、完成率和参加会议的比例；通过确定最适当和 来自可能的措施的敏感结果衡量，包括精神卫生保健的数量和/或类型 接受，关于疾病的知识，关于精神卫生保健系统的知识，感知的力量 心理健康护理是有益和可取的，自我效能感评级和照顾者压力； 与控制条件和相关置信度相比，估计干预的效果大小 关键成果的限度。我们认为这个独立的研究项目是一个漫长的 学期研究议程集中在再生障碍性贫血家庭和精神健康服务上。紧接着的下一步 与该项目相关的是提交R01申请，以测试 家庭心理社会干预是本研究的试点。我们相信我们有远见，有研究能力，而且 致力于制定一项可持续的研究计划，重点是缩小心理健康方面的差距 AA家庭及其子女的服务使用情况。

Despite similar prevalence of all childhood severe and persistent mental illness except depression, there are pronounced racial disparities in use of mental health services. A variety of factors related to racism and stigma, family and illness characteristics, and service system attributes are likely to account for these disparities, but prior research on AA children is limited in these areas. We want to shift the field from simple enumeration and description of these disparities to interventions that offer culturally-sensitive ways of helping African-American families to access timely and appropriate care for their children with these illnesses. We have drawn on available evidence, results from initial focus groups conducted by our group, and our extensive clinical work with AA families dealing with early onset schizophrenia, severe affective disorders and autism to inform the initial stage of intervention design. We propose to develop an intervention to enhance knowledge and motivation to seek timely and appropriate care as well as the know-how to navigate services by means of the following specific aims: (1) To refine the'content of the proposed intervention by identifying factors that AA families feel have compromised or facilitated their use of mental health services for their children with SPMI using focus group methods; by determining the relative population prevalence and impact of these factors using a large sample survey of AA families (N= 300); and by assessing participant satisfaction with topics covered and materials employed in this intervention using postintervention evaluations. (2) To refine the structure of the proposed intervention based on interim findings, and (3) To conduct a small randomized pilot trial of the proposed intervention to estimate key parameters for the design of an adequately powered rigorous efficacy study by assessing its feasibility in terms of recruitment, completion rates, and proportion of sessions attended; by determining the most appropriate and sensitive outcome measures from possible measures including amount and/or type of mental health care received, knowledge about illnesses, knowledge about the mental health care system, strength of perception that mental health care is beneficial and desirable, self-efficacy ratings, and caregiver stress; and by estimating the effect size of the intervention compared to the control condition and associated confidence limits of key outcomes. We see this independent research project as the foundational component of a long term research agenda focused upon AA families and mental health services. The immediate next step associated with this project would be the submission of an R01 application to test the cost-efficacy of the family psychosocial intervention piloted in this study. We believe we have the vision, research capacity, and commitment to develop a sustainable research program focused on lessening disparities in mental health service use by AA families and their children.