Optimizing implementation of evidence-based mental health interventions to promote reach and retention among migrants in transit in humanitarian emergencies

项目摘要/摘要 与全球平均水平相比，人道主义环境中精神障碍的患病率高出三倍。 在复杂的紧急情况下实施精神卫生服务的挑战放大了困难人群的健康差距 覆盖人群。过境到目的地国的移民是最难到达和留住的人之一 考虑到他们的机动性和与现有卫生系统的外围连接，他们正在接受护理。创新战略 需要改善过境移民获得精神卫生服务的机会。这位K01导师的目标是 研究科学家发展奖是为独立研究生涯做准备的候选人 致力于改善最难以接触的人群获得循证精神卫生服务的机会 在人道主义紧急情况下。通过此K01奖项，候选人将利用培训资源 可通过哥伦比亚大学和她的指导团队获得系统所需的技能 科学和以人为本的设计，以开发和测试战略，以提高覆盖和保留 在可扩展的心理干预中对过境移民进行干预。这项K01研究的目标是优化 实施问题管理+(PM+)，这是一种可扩展的心理干预措施，以提高覆盖范围 以及滞留通过哥伦比亚过境的委内瑞拉移民。这项研究建立在一项正在进行的 哥伦比亚大学与人道主义非政府组织HIAS之间的研究伙伴关系 在哥伦比亚。具体目标是：1)描述个人、社区和系统级别的关系 这影响了在哥伦比亚过境的委内瑞拉移民在心理健康服务方面的可及性和保留性 使用小组建模；2)设计和优化实施计划，以提高覆盖率和保留率 在PM+中，通过以人为中心的设计在哥伦比亚过境的委内瑞拉移民；以及3) 使用当地设计的实施计划与PM+相比，比较PM+中的覆盖范围和保留率 在哥伦比亚过境的委内瑞拉移民执行情况照常进行，但相对中断 时间序列分析。这项研究是严格的培训和职业发展不可或缺的组成部分 涉及系统科学、以人为本的设计、适应方面的强化培训和指导的计划 实施战略，了解获得护理的结构、文化和社会决定因素 在拉丁美洲过境的移民中。这项研究将是第一次优化精神的实施 为过境移民提供卫生服务，并将提供关键的初步数据，为R01申请提供参考 在规模上测试有希望的实现方法。这项研究与NIMH的战略目标一致 开发创新的服务提供模式，以改善不同社区和人口的心理健康， 以及NIMH全球心理健康和人类流动性研究计划的优先事项。

PROJECT SUMMARY/ABSTRACT The prevalence of mental disorder is three times greater in humanitarian settings relative to global averages. Challenges to implementing mental health services in complex emergencies amplify health disparities for hard- to-reach populations. Migrants transiting to a destination country are among those hardest to reach and retain in care given their mobility and peripheral connections with established health systems. Innovative strategies are needed to improve access to mental health services for migrants in transit. The goal of this K01 Mentored Research Scientist Development Award is to prepare the candidate for an independent research career dedicated to improving access to evidence-based mental health services for the hardest-to-reach populations in humanitarian emergencies. Through this K01 award, the candidate will leverage the training resources available through Columbia University and her mentorship team to acquire the skills needed in systems science and human-centered design to develop and test strategies for improving reach and retention of migrants in transit in scalable psychological interventions. The goal of this K01 research is to optimize implementation of Problem Management Plus (PM+), a scalable psychological intervention, to improve reach and retention of Venezuelan migrants transiting through Colombia. This research builds on an ongoing research partnership between Columbia University and HIAS, a humanitarian non-governmental organization in Colombia. The specific aims are: 1) To describe the individual-, community-, and systems-level relationships that influence reach and retention in mental health services among Venezuelan migrants in transit in Colombia using group model building; 2) To design and optimize an implementation plan to improve reach and retention in PM+ among Venezuelan migrants in transit in Colombia through human-centered design; and 3) To compare reach and retention in PM+ using the locally designed implementation plan relative to PM+ implementation-as-usual among Venezuelan migrants in transit in Colombia with a comparative interrupted time series analysis. This research is an integral component of a rigorous training and career development plan involving intensive training and mentorship in systems science, human-centered design, adapting implementation strategies, and understanding structural, cultural, and social determinants of access to care among migrants in transit in Latin America. This study will be the first to optimize implementation of mental health services for migrants in transit and will provide critical preliminary data to inform an R01 application to test promising implementation approaches at scale. This research aligns with NIMH’s strategic objective to develop innovative service delivery models to improve mental health in diverse communities and populations, as well as the priorities of the NIMH Global Mental Health and Human Mobility Research Program.