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

在全国资源匮乏的社区环境中实施可持续的循证心理保健，以促进性少数群体的心理健康公平

• 批准号: 10706815
• 负责人: John Edward Pachankis
• 金额: $ 87.63万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-01 至 2028-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10706815
• 关键词: Address; Adoption; Budgets; Caring; Characteristics; Client; Climate; Clinical Trials; Code; Cognitive Therapy; Competence; Consolidated Framework for Implementation Research; Consultations; Data; Disparity population; E-learning; Effectiveness; Evidence based intervention; Evidence based practice; Future; Health Personnel; Hybrids; Implementation readiness; Individual; Interview; Knowledge; Lesbian Gay Bisexual Transgender Queer; Maintenance; Measures; Mediating; Mediation; Mental Health; Mental Health Services; Methods; Outcome; Pathway interactions; Pilot Projects; Policies; Population; Provider; Randomized; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recommendation; Research; Resource-limited setting; Risk; Self Efficacy; Series; Sexual and Gender Minorities; Societies; Stress; Supervision; Supportive care; Surveys; Target Populations; Trainers Training; Training; Training Support; Uninsured; Workplace; biological adaptation to stress; budget impact; career; community center; community setting; compare effectiveness; coping; cost; demographics; depressive symptoms; effective therapy; effectiveness outcome; evidence base; experience; gender minority community; gender minority group; health disparity; health disparity populations; health equity; health practice; implementation determinants; implementation outcomes; implementation science; implementation strategy; improved; innovation; learning materials; peer; people of color; provider factors; rural area; skills; social cognitive theory; social stigma; stressor; success; systematic review; theories; transgender; volunteer; webinar

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.

项目摘要 背景。性别和性别少数群体（SGM）经验最大的心理健康差异 任何人口，以巨大的成本向社会付出。一个驾驶员是缺乏循证实践（EBP） 解决SGM风险的不同机制。 10多年来，我们的团队已经开发了LGBTQ- 肯定性认知行为疗法（CBT）是专门用于SGM心理健康的第一个也是唯一的EBP， 现在需求很高。该建议旨在研究在 LGBTQ社区中心在全国范围内推进实施科学和健康公平。试点研究。 我们在50个LGBTQ社区中心的试点数据表明，（1）培训可以改善提供商的LGBTQ- 肯定的CBT技能，（2）LGBTQ中心的董事一致支持此培训，（3）提供者认为 正在进行的监督可以帮助维持实施，但是接受学习材料也是 无价。尽管如此，知识差距仍然用于实施科学，包括：（1）火车培训是否是否 策略可以进一步维持实施，（2）低资源环境的特征（例如，高级员工 营业额）预测最佳实施策略，以及（3）EBP培训的目标机制 影响实施和客户结果。拟议的研究将回答这些问题。方法。 利用我们与美国LGBTQ社区中心协调中心的长期合作伙伴关系， 3型混合试验我们将随机将90个中心随机接收实施LGBTQ-的三种策略之一 肯定的CBT比较其有效性（AIM 1），确定实施的中心级主持人 成功（AIM 2），并通过理论研究三种策略对客户心理健康的影响 - 知情的组织和提供商机制（AIM 3）。利用社会学习理论，心理健康 在低资源设置和我们的试点数据中，我们将比较三种实施策略：（1）A 数字学习材料的套件（仅材料条件）； （2）这些材料以及每周的网络研讨会培训 12周（直接训练条件）；或（3）上述当地主管的1年监督 以火车培训格式（本地监督条件）获得专家咨询。实施结果 将包括客观编码的提供商的保真度在LGBTQ肯定的CBT和混合方法评估中 它的覆盖范围，采用和维护整个中心。有效性结果将包括客户抑郁 症状。假设。我们假设三种添加剂训练策略将预测 培训后长达2年的实施成功增加。我们假设中心级别 实施成功的确定因素是实施研究的合并框架。我们 假设组织和提供者的因素将调解更密集的更强大的影响 培训实施成功和客户心理健康的策略。传播。我们将分发 基于方案的建议和预算影响，以鼓励美国LGBTQ中心维护。