A Multimodal Parent-focused Intervention for Vulnerable Populations in the Bronx

针对布朗克斯弱势群体的以家长为中心的多模式干预

• 批准号: 10414991
• 负责人: JONATHAN Edward ALPERT
• 金额: $ 84万
• 依托单位: ALBERT EINSTEIN COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-06-01 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10414991
• 关键词: Address; Adherence; Age; Anxiety; Autoimmune; COVID-19; COVID-19 impact; COVID-19 pandemic; COVID-19 pandemic effects; Caregivers; Caring; Case Manager; Cellular Phone; Cessation of life; Child; Child Rearing; Clinic; Clinical; Community Psychiatry; Complex; Data; Disadvantaged; Distress; Education; Effectiveness; Emotional; Enrollment; Face; Family; Family health status; Food; Generations; Health; Health Insurance Portability and Accountability Act; Health Personnel; Health system; Housing; Infrastructure; Institutional Review Boards; Intervention; Machine Learning; Measures; Mediating; Medical; Medical center; Mental Health; Minority; Modeling; Moods; Mothers; New York City; Outcome; Outcome Measure; Parents; Participant; Patients; Pattern; Pilot Projects; Population; Poverty; Procedures; Psyche structure; Psychological Stress; Psychopathology; Randomized Controlled Trials; Research; Resources; Risk; Sample Size; School-Age Population; Schools; Social Distance; Stress; Surveys; Technology; Testing; Therapeutic; Trauma; United States National Institutes of Health; Vulnerable Populations; Work; anxiety symptoms; arm; barrier to care; base; clinical infrastructure; cohort; community intervention; comorbidity; dashboard; design; digital; efficacy evaluation; ethnic minority population; evidence base; experience; follow-up; health care availability; health disparity; improved; innovation; maltreatment; member; mood symptom; multimodality; online care; outcome prediction; pandemic disease; pandemic stress; perceived stress; primary caregiver; programs; prospective; psychologic; psychological distress; racial minority; relative effectiveness; response; smartphone Application; social health determinants; substance use treatment; telehealth; therapy design; vulnerable community

PROJECT SUMMARY / ABSTRACT In response to PAR-20-237, “community interventions to address the consequences of the COVID-19 pandemic among health disparity and vulnerable populations,” we propose to study a parent-focused mentalizing intervention with a smartphone health platform in vulnerable populations in the Bronx. The Bronx—the poorest borough in New York City (NYC) with 84% of its population comprised of minorities—has been hit disproportionally by the COVID-19 pandemic. For caregivers in the Bronx, the pandemic has caused unprecedented psychological distress; in addition to combating social determinants of health (SDOH), these families now face greater financial insecurity and challenges related to their school-aged children. Furthermore, social distancing requirements and limited telehealth resources for Bronx families have posed greater barriers to healthcare. Such parental distress contributes to heightened risk of transgenerational cycles of psychological stress, trauma and maltreatment. Addressing these challenges, we propose a multimodal study tackling both parental vulnerability and healthcare access. a) Targeting parental vulnerability, we propose to build upon our 12-session therapeutic CARE program, which utilizes Mentalization Based Therapy and designed for parents of children in treatment in a community psychiatry clinic in our health system. Multiple randomized controlled trials (RCTs) of attachment-based parenting interventions, including from our group in disadvantaged cohorts from the Bronx. b) Targeting healthcare access, we propose to utilize the HIPAA-compliant and IRB-approved Valera Health smartphone application (“app”), which has been studied in our health system in selected cohorts and resulted in greater access to healthcare. Building upon our work and clinical infrastructure, we hypothesize that both the CARE program and the Valera app will mitigate the psychological effects of COVID-19 while enhancing access to healthcare in the Bronx. The study will take place at Montefiore Medical Center (MMC), the largest health system in the Bronx, which serves predominantly racial and ethnic minority individuals from underserved families. We will focus on three highly vulnerable cohorts: a) caregivers of children with psychiatric conditions (N=130); b) caregivers of children with autoimmune illnesses (N=130), and; c) caregivers who are frontline healthcare workers at MMC (N=100); all presenting with moderate stress. A RCT with 4 arms (2 x 2 design) will test our hypothesis: a) CARE program alone; b) CARE program + Valera app; c) Parent Education (PE) alone; d) PE + Valera app. Smartphones and connectivity will be provided as needed. Surveys at study enrollment, 6-, 12- and 24-weeks will assess parental stress, mentalizing capacity (reflective functioning), access to healthcare, mood and anxiety and additional parent and child clinical measures. Machine learning approaches will explore complex patterns as predictors of outcome including COVID-19 illness/deaths, medical comorbidity, housing, poverty, psychopathology, age, family functioning, and trauma. Impact. This multimodal study addresses key strategies to mitigate the psychological and health impact of COVID-19 in vulnerable populations.

项目摘要/摘要