A Culturally-Adapted, Trauma-Informed Cognitive Rehabilitation Intervention for Asylum-Seekers and Refugees with Traumatic Brain Injury

针对患有创伤性脑损伤的寻求庇护者和难民的文化适应、创伤知情的认知康复干预

• 批准号: 10505811
• 负责人: Altaf Saadi
• 金额: $ 20.09万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-12-01 至 2027-11-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10505811
• 关键词: Address; Advisory Committees; Affect; Agreement; Alzheimer' s Disease; Area; Attention; Award; Behavioral Model; Brain Concussion; Bypass; Caring; Client satisfaction; Clinical; Clinical Research; Clinical Trials Design; Cognitive; Communities; Community Health Aides; Country; Disparity; Economic Burden; Effectiveness; Employment; Enhancement Technology; Epidemiology; Equity; Evaluation; Exercise; Facilities and Administrative Costs; Family; Feedback; Focus Groups; Foundations; Future; Health; Healthcare; Heterogeneity; Home; Immigration; Impaired cognition; Individual; Institute of Medicine (U.S.); Interpersonal Violence; Intervention; Interview; K-Series Research Career Programs; Legal; Linguistics; Memory; Mentorship; Methods; Modeling; Morbidity - disease rate; National Institute of Neurological Disorders and Stroke; Neurobehavioral Manifestations; Neurologist; Outcome; Participant; Patients; Perception; Persons; Population; Post-Concussion Syndrome; Prevalence; Procedures; Questionnaires; Recommendation; Refugees; Rehabilitation therapy; Reporting; Research; Research Methodology; Research Personnel; Research Proposals; Sampling; Societies; Source; Strategic Planning; Surveys; Symptoms; System; Technology; Telemedicine; Testing; Therapeutic Intervention; Therapeutic Studies; Time; Torture; Training; Transportation; Trauma; Traumatic Brain Injury; Trust; Underserved Population; United States National Institutes of Health; Variant; Veterans; Violence; Visual; Vulnerable Populations; Waiting Lists; War; Work; arm; barrier to care; brain health; career; cognitive rehabilitation; cost; court; dementia risk; design; disability; disparity reduction; effectiveness trial; ethnic health disparity; ethnic minority; evidence base; executive function; experience; health care delivery; health care disparity; health disparity; health disparity populations; health equity; health equity promotion; high risk; improved; information gathering; intervention delivery; intervention refinement; low and middle-income countries; marginalized population; medical specialties; mild traumatic brain injury; multidisciplinary; neuropsychiatry; preference; primary outcome; psychoeducation; psychoeducational; racial disparity; racial minority; randomized trial; satisfaction; secondary outcome; skills; social stigma; translational model; trauma exposure

PROJECT SUMMARY Traumatic brain injury (TBI) is a common, costly, and at times devastating condition associated with cognitive impairment, disproportionately affecting U.S. racial/ethnic minorities and individuals in low and middle-income countries. Asylum-seekers and refugees represent one especially vulnerable group that have high rates of TBI due to experiences such as war, torture, and interpersonal violence. Existing cognitive rehabilitation interventions targeting cognitive symptoms following TBI present an effective and evidence-based approach to address the cognitive sequalae of TBI in this population; but they require adaptation and evaluation. The central objective of this research proposal is to optimize and evaluate the first culturally adapted, trauma-informed cognitive rehabilitation intervention (“SMART-Plus”) delivered by community health workers (CHWs) using video-based telemedicine. This approach addresses several individual and system-level challenges such as linguistic barriers, cultural variations in perception of, and stigma around TBI, high trauma exposure, healthcare mistrust, lack of access to specialty-trained clinicians, and transportation barriers that make in-person interventions less feasible. Given the epidemiology of TBI in this population and to reduce sample heterogeneity in the early stages of intervention adaptation, the project will focus on those with interpersonal violence related mild TBI. The three Specific Aims are: (1) To develop SMART-Plus for asylum-seekers and refugees with interpersonal related mild TBI using input from asylum-seekers and refugees to tailor content, incorporate intervention delivery preferences, and identify engagement determinants; (2) To conduct an open pilot of SMART-Plus delivered by trained CHWs using telemedicine and further refine the intervention, study procedures, and outcome targets; and (3) To conduct a pilot feasibility randomized trial of SMART-Plus compared to wait-list control to improve post-concussive and cognitive impairment symptoms. These aims are consistent with the NIH Stage Model, representing a Stage IA (Aim 1 and 2) and Stage 1B (Aim 3) study, as well as Barerra’s stage model for cultural adaptation that involves information gathering (Aim 1); preliminary adaptation design and testing (Aim 2), and full adaptation design and testing (Aim 3). The findings of this project will fill an existing gap in a high impact research area that will inform the care of a growing and vulnerable population. At the same time, it offers a translational model for cultural and trauma-informed adaptation for other health disparities populations experiencing cognitive impairment and similar barriers to care, both domestically and globally. The PI, Dr. Saadi, is an early-career clinician investigator and neurologist, who will use this career development award to enhance her skills in mixed methods research for intervention adaptation, cognitive rehabilitation therapy and neuropsychiatric outcomes, equity-centered technology-based approaches, and RCT design involving vulnerable groups. She will leverage this training to launch an independent research career in scalable, technology-enhanced, community- engaged interventions to promote brain health equity. Throughout the award period, Dr. Saadi will work closely with an expert, committed and multidisciplinary mentorship and advisory team to carry out her stated career objectives and specific aims.

项目总结