Implementing sustainable evidence-based mental healthcare in low-resource community settings nationwide to advance mental health equity for sexual and gender minority individuals

项目摘要 背景性和性别少数群体（SGM）的心理健康差距最大， 任何人口，以社会的巨大代价。一个驱动因素是缺乏循证实践（EBP） 解决SGM风险背后的独特机制。10多年来，我们的团队开发了LGBTQ- 肯定认知行为疗法（CBT）作为第一个也是唯一一个专门针对SGM心理健康的EBP， 现在需求量很大。这项建议旨在研究实施这种有效治疗的最佳方法， LGBTQ社区中心在全国范围内推进实施科学和健康公平。初步研究。 我们在50个LGBTQ社区中心的试点数据显示，（1）培训可以提高提供者的LGBTQ- 肯定的CBT技能，（2）LGBTQ中心的主任一致支持这种培训，（3）供应商认为 持续的监督有助于保持执行，但接受学习材料也 无价之宝尽管如此，实施科学的知识差距仍然存在，包括：（1）是否培训培训员 战略可以进一步维持实施，（2）低资源环境的特征（例如，工作人员频繁 营业额）预测最佳实施策略，（3）EBP培训的目标机制 影响执行和客户成果。拟议的研究将回答这些问题。法 利用我们与美国LGBTQ社区中心协调中心的长期合作关系， 3型混合试验，我们将随机选择90个中心，接受实施LGBTQ的三种策略之一， 积极的CBT比较其有效性（目标1），确定执行的中心级主持人 成功（目标2），并通过理论研究三种策略对客户心理健康的影响- 知情的组织和提供者机制（目标3）。借鉴社会学习理论，心理健康 研究在低资源设置，我们的试点数据，我们将比较三种实施策略：（1） 一套数字学习材料（仅限材料）;（2）这些材料加上每周的网络研讨会培训， 12周（直接培训条件）;或（3）以上加上当地主管的1年监督，该主管将 接受培训员培训形式的专家咨询（当地监督条件）。执行成果 将包括客观编码的提供者忠诚度在LGBTQ肯定CBT和混合方法评估， 它在各中心的覆盖、采用和维护。有效性结果将包括客户抑郁症 症状假设。我们假设这三种附加训练策略将预测各自的 培训后2年内，实施成功率逐步提高。我们假设中心水平 实施研究综合框架中的实施成功的决定因素。我们 假设组织和供应商因素，将调解更强烈的影响， 关于执行成功和客户心理健康的培训战略。传播。我们将分发 基于爱达荷州的建议和预算影响，以鼓励美国LGBTQ中心的维护。

PROJECT SUMMARY Background. Sexual and gender minorities (SGM) experience among the largest mental health disparities of any population, at substantial cost to society. One driver has been the lack of evidence-based practice (EBP) addressing the distinct mechanisms underlying SGM's risk. For 10+ years, our team has developed LGBTQ- affirmative cognitive-behavioral therapy (CBT) as the first and only EBP specifically for SGM mental health, now in high demand. This proposal seeks to study optimal means of implementing this effective treatment at LGBTQ community centers nationwide to advance implementation science and health equity. Pilot Studies. Our pilot data across 50 LGBTQ community centers shows that (1) training can improve providers' LGBTQ- affirmative CBT skills, (2) directors of LGBTQ centers unanimously support this training, (3) providers perceive that ongoing supervision can help maintain implementation but that receiving learning materials is also invaluable. Still, knowledge gaps remain for implementation science, including: (1) whether train-the-trainer strategies can further sustain implementation, (2) whether features of low-resource settings (e.g., high staff turnover) predict optimal implementation strategies, and (3) the target mechanisms through which EBP training impacts implementation and client outcomes. The proposed research will answer these questions. Method. Drawing on our long-standing partnership with the US's coordinating hub of LGBTQ community centers, in this type 3 hybrid trial we will randomize 90 centers to receive one of three strategies for implementing LGBTQ- affirmative CBT to compare their effectiveness (Aim 1), identify center-level moderators of implementation success (Aim 2), and examine the impact of the three strategies on client mental health through theory- informed organizational and provider mechanisms (Aim 3). Drawing on social learning theory, mental health research in low-resource settings, and our pilot data, we will compare three implementation strategies: (1) a suite of digital learning materials (materials only condition); (2) these materials plus weekly webinar training for 12 weeks (direct training condition); or (3) the above plus 1-year of supervision from a local supervisor who will receive expert consultation in a train-the-trainer format (local supervision condition). Implementation outcomes will include objectively coded provider fidelity in LGBTQ-affirmative CBT and mixed methods assessments of its reach, adoption, and maintenance across centers. Effectiveness outcomes will include client depression symptoms. Hypotheses. We hypothesize that the three additive training strategies will predict respective graduated increases in implementation success up to 2 years post-training. We hypothesize center-level determinants of implementation success from the Consolidated Framework for Implementation Research. We hypothesize organizational and provider factors that will mediate the stronger impact of the more intensive training strategies on implementation success and client mental health. Dissemination. We will distribute scenario-based recommendations and budget impact to encourage maintenance across US LGBTQ centers.