Reaching Optimal Implementation and Mental Health Outcomes for Underserved and Rural Communities in Foster and Kinship Care: Adaptation and Evaluation of the KEEP Model

在寄养和亲属照护方面为服务不足和农村社区实现最佳实施和心理健康结果：KEEP 模型的调整和评估

• 批准号: 10576530
• 负责人: Rohanna Buchanan
• 金额: $ 68.26万
• 依托单位: OREGON SOCIAL LEARNING CENTER, INC.
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-16 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10576530
• 关键词: Address; Adherence; Affinity; African American; Anxiety; Black race; Caring; Characteristics; Child; Child Rearing; Child Welfare; Clinical; Contracts; Data; Data Pooling; Denmark; Educational Curriculum; Educational Intervention; England; Evaluation; Evidence based intervention; Family; Fostering; Funding; Future; Goals; Health Services Accessibility; Hispanic; Home; Human; International; Internet; Intervention; Knowledge; Latino; Matched Group; Mediating; Mental Depression; Mental Health; Mental disorders; Minority Groups; Modeling; Oregon; Outcome; Parents; Participant; Population; Post-Traumatic Stress Disorders; Prevalence; Quality of Care; Quasi-experiment; Randomized Controlled Trials; Recording of previous events; Reporting; Risk; Role; Rural; Rural Community; Rural Minority; Rural Population; Selection Bias; Services; Sexual and Gender Minorities; Sexual and Gender Minority Youth; Stress; Suicide; Symptoms; System; Techniques; Time; Training; Training Programs; Training Support; Underserved Population; United States National Institutes of Health; Ursidae Family; Youth; child services; comparison group; data harmonization; design; dosage; evidence base; externalizing behavior; follow-up; foster parent; gender minority group; health disparity; health equity; high risk; high risk population; implementation outcomes; improved; innovation; interest; minority children; native youth; peer; post intervention; racial and ethnic; rural dwellers; rural underserved; scale up; service delivery; skills; symposium; underserved community; underserved minority; uptake; vulnerable community

PROJECT SUMMARY There are alarming disparities in the prevalence of mental health (MH) disorders and suicide between youth with a history of child welfare system (CWS) and their non-CWS-involved peers. Yet few services are designed for these high-risk youth, and even fewer focus on racial and ethnic, and sexual and gender minority (SGM) populations, which bear a disproportionate proportion of the burden of MH disorders and are overrepresented in the CWS. Also underserved in the CWS are rural populations for which few services exist. “Keeping Foster and Kinship Parents Supported and Trained” (KEEP) is an evidence-based intervention that focuses on optimizing the role of foster/kin parents as the agents of positive change for children and youth. The proposed application capitalizes on a current contract with the Oregon Department of Human Services Child Welfare to implement KEEP state wide in Oregon with a focus on increasing access to services for rural and minority youth populations. To help the CWS meet their goal of achieving health equity, adaptations to the KEEP curriculum have been made for minority groups, and KEEP is being delivered in “affinity groups”. Affinity KEEP (A-KEEP) groups are tailored to meet a specific population’s needs and are comprised of parents who all share a common interest, purpose, or key characteristic. To date, A-KEEP groups are being offered for foster/kin parents of populations defined by SGM youth and Native youth, and for Spanish-speaking parents. The curriculum is currently being revised for transracial foster/kin placements where Black/African American youth are placed in homes with one or more White parents. KEEP groups are also offered via web conference for rural foster/kin parents. The current proposal seeks to study N = 500 new families (53% rural and 15% A- KEEP), as part of the ongoing Oregon KEEP implementation, and aggregate existing data from four KEEP studies (N = 2,397) to use propensity score matching to reduce selection bias and strengthen causal inferences that can be drawn from the potential benefits of providing KEEP to underserved rural and minority populations. By leveraging two decades worth of data on the KEEP intervention and using state-of-the-art data harmonization techniques and a quasi-experimental design, this study affords a rigorous evaluation of whether tailoring the KEEP curriculum to minority populations’ specific needs, and providing KEEP to rural foster/kin parents, improves youth MH outcomes (i.e., depression/anxiety, PTSD symptoms, suicidality, and externalizing behaviors) (Aim 1), maximizes uptake and dosage, and improves parenting factors (Aim 2). Further, whether such improvements are mechanisms of action explaining the positive impacts of the intervention on youth MH will be examined (Aim 3), as well as the optimal dosage necessary to improve youth MH outcomes (Aim 4). The proposed study could have a wide reach, impacting our understanding of how to improve and inform equitable delivery of services to youth and families involved in the CWS, and effectively address youth MH disorders and improve care quality and long-term outcomes for a high-risk, underserved population of youth.

项目摘要 青少年之间精神健康障碍和自杀的流行率存在惊人的差异 有儿童福利系统（CWS）的历史和他们的非CWS参与的同龄人。然而，很少有服务被设计为 对于这些高危青年，更少关注种族和民族，性和性别少数群体（SGM） 人口，他们承担了不成比例的MH疾病负担， 在CWS。农村人口在社区福利服务中也得不到充分的服务，他们几乎得不到服务。“留住福斯特 支持和培训”（KEEP）是一项以证据为基础的干预措施，重点是 优化养父母/亲属作为儿童和青年积极变革推动者的作用。拟议 应用程序利用与俄勒冈州人类服务儿童福利部的现行合同， 在俄勒冈州全州范围内实施KEEP，重点是增加农村和少数民族获得服务机会 青年人口。为了帮助CWS实现其实现健康公平的目标， 为少数群体编制了课程，并在“亲密群体”中提供“保持教育和就业”方案。Affinity KEEP （A-KEEP）小组是为满足特定人群的需要而量身定制的，由父母组成，他们都分享 共同的兴趣、目的或主要特征。到目前为止，A-KEEP小组正在为寄养/亲属提供服务， 由SGM青年和土著青年定义的人口的父母，以及讲西班牙语的父母。的 目前正在修订跨种族寄养/亲属安置课程， 被安置在有一个或多个白色父母的家庭。KEEP小组还通过网络会议提供， 农村养父母/亲属。目前的提案旨在研究N = 500个新家庭（53%为农村家庭，15%为A- KEEP），作为正在进行的俄勒冈州KEEP实施的一部分，并汇总来自四个KEEP的现有数据 研究（N = 2，397）使用倾向评分匹配来减少选择偏倚并加强因果关系 从向服务不足的农村和少数民族提供KEEP的潜在好处中可以得出的推论 人口。通过利用20年来关于KEEP干预措施的数据和使用最先进的数据， 协调技术和准实验设计，这项研究提供了一个严格的评估是否 根据少数群体的具体需求定制KEEP课程，并向农村寄养/亲属提供KEEP 父母，改善青年MH结果（即，抑郁/焦虑、PTSD症状、自杀倾向和外化 行为）（目标1），最大限度地提高摄入量和剂量，并改善养育因素（目标2）。此外，无论 这些改进是解释干预对青年心理健康产生积极影响的行动机制 将检查（目标3），以及改善青年MH结果所需的最佳剂量（目标4）。 拟议的研究可能具有广泛的影响力，影响我们对如何改进和告知 公平地向参与社区服务的青年和家庭提供服务，并有效地解决青年心理健康问题; 我们的目标是，为高风险、得不到充分服务的青年群体提供更好的医疗服务，并提高护理质量和长期成果。