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 创伤性脑损伤是一种常见的、代价高昂的、有时甚至是毁灭性的与认知相关的疾病。 损害，对美国种族/族裔少数群体和中低收入个人的影响不成比例 国家。寻求庇护者和难民是一个特别脆弱的群体，由于以下原因，他们的创伤发生率很高 战争、酷刑和人际暴力等经历。现有的有针对性的认知康复干预 颅脑损伤后的认知症状提供了一种有效的循证方法来解决脑外伤后的认知后遗症 在这一人群中存在脑外伤；但它们需要适应和评估。这项研究提案的中心目标是 优化和评估首个适应文化、了解创伤的认知康复干预(“SMART-Plus”) 由社区卫生工作者(CHWS)使用基于视频的远程医疗提供。这种方法解决了几个问题 个人和系统层面的挑战，如语言障碍、文化观念差异以及周围的耻辱 创伤性脑损伤、高创伤暴露、医疗保健不信任、缺乏受过专业培训的临床医生以及交通障碍 这使得面对面干预变得不太可行。鉴于该人群中脑膜炎的流行病学情况，并减少样本 在早期干预适应的异质性阶段，该项目将重点关注那些有人际暴力的人 相关的轻度脑外伤。三个具体目标是：(1)为寻求庇护者和难民开发SMART-Plus 与人际关系相关的轻度TBI使用寻求庇护者和难民的投入来定制内容，纳入干预 交付偏好，并确定接洽的决定因素；(2)通过以下方式进行Smart-Plus的公开试点 使用远程医疗对CHW进行培训，并进一步完善干预、研究程序和结果目标；以及(3) 进行SMART-Plus与等待名单对照的试点可行性随机试验，以改善脑震荡后和 认知障碍症状。这些目标与代表IA阶段(目标1)的NIH阶段模型一致 和2)和阶段1B(目标3)研究，以及巴雷拉的涉及信息的文化适应阶段模型 收集(目标1)；初步适应设计和测试(目标2)；全面适应设计和测试(目标3)。这个 该项目的发现将填补高影响力研究领域的现有空白，该领域将为日益增长的和 弱势群体。同时，它为文化和创伤信息适应提供了一个翻译模型 其他健康差距经历认知障碍和类似护理障碍的人群，在国内和 全球范围内。私家侦探萨阿迪博士是一名职业生涯早期的临床医生研究员和神经科医生，他将利用这一职业发展 获奖以提高她在干预适应、认知康复治疗和治疗的混合方法研究方面的技能 神经精神病学结果，以公平为中心的基于技术的方法，以及涉及弱势群体的随机对照试验设计。 她将利用这次培训，在可扩展、技术增强的社区-- 参与促进大脑健康公平的干预措施。在整个颁奖期间，萨阿迪博士将与一位 专家、承诺和多学科的指导和咨询团队，以实现她既定的职业目标和 明确的目标。