CRISOL Mente: A Multilevel Community Intervention to Reduce Mental Health Disparities Among Latinos

CRISOL Mente：减少拉丁裔心理健康差异的多层次社区干预

• 批准号: 10597875
• 负责人: Mariana Lazo Elizondo
• 金额: $ 111.96万
• 依托单位: DREXEL UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-19 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10597875
• 关键词: Acute; Address; Adherence; Advocacy; Awareness; COVID-19 pandemic; Caring; Client; Clinic; Clinical Data; Communication; Communities; Community Outreach; Community Surveys; Complex; Coupled; Data; Development; Discrimination; Economics; Education; Education and Outreach; Educational Background; Effectiveness; Evaluation; Evidence based treatment; Fright; Health; Health Insurance; Health Resources; Health Services Accessibility; Healthcare; Immigrant; Intervention; Interview; Language; Latina; Latino; Latino Population; Legal; Limited English Proficiency; Linguistics; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Methods; Modeling; Newsletter; Not Hispanic or Latino; Occupations; Outcome; Patients; Phase; Philadelphia; Population; Poverty; Provider; Public Health; Radio; Reach Effectiveness Adoption Implementation and Maintenance; Reduce health disparities; Reporting; Research; Resource-limited setting; Resources; Respondent; Rest; Risk; Sampling; Services; Site; Social Conditions; Social Work; Stress; Supervision; Surveys; Symptoms; Syndrome; Testing; Time; Training; Woman; barrier to care; base; bilingualism; clinical anxiety; cohort; community engaged research; community intervention; community setting; cost; cost effective; cultural competence; design; disparity reduction; effectiveness testing; experience; follow-up; health care availability; health disparity; improve minority health; improved; informant; member; men; novel; outreach; peer; post-COVID-19; post-traumatic stress; programs; psychological distress; racism; recruit; screening; social stigma; syndemic

Latinos in the U.S. experience significant disparities in access to mental health services due to lack of health insurance, cost of services, limited awareness of mental health resources, mental health stigma, and fear of deportation. Limited English proficiency coupled with an acute lack of bilingual and culturally competent providers further impede Latinos’ adequate access to quality mental health services. The COVID-19 pandemic has only amplified the need for mental health care and exacerbated mental health disparities for Latino communities, making it urgent to identify low-cost, effective strategies to reduce these gaps. This 5-year project seeks to develop and test a multi-level, community intervention to improve mental health outcomes and promote access to culturally appropriate mental health treatment for Latino communities in Philadelphia. CRISOL Mente will include components at various levels of the socio-ecological model: a clinic-based, stepped-care program relying on Latino lay health workers (LHW) for the delivery of mental health services (Aim 1), outreach and education activities to reduce mental health stigma in the community (Aim 2), and efforts to strengthen Latino-serving organizations’ capacity to address mental health and other syndemic conditions contributing to untreated mental health among Latinos (Aim 3). To improve mental health symptoms and engagement in care, we will recruit, train and supervise a cohort of Latino LHW who will be embedded into two Latino-serving clinics, extending the reach and effectiveness of the clinics’ mental health services. We will compare the impact of three different levels of LHW involvement: a) community outreach/navigation (i.e. screening and referral of community members); b) auxiliary care (i.e. screening, referral, and help overcoming barriers to better mental health); and c) task shifting (i.e. screening, referral, assistance, and supervised delivery of basic mental health treatment). The LHWs will also conduct outreach/education activities in the community (e.g. radio talks, info sessions, tables in community venues) to reduce mental health stigma. Our experienced and largely Latino community-academic research team will also engage in capacity building activities (i.e. monthly town halls, annual retreats, weekly newsletters, provision of trainings and technical support) with the Latino Health Collective, a coalition of Latino-serving organizations. Using mixed-methods and the RE-AIM framework, CRISOL Mente’s impact will be evaluated with clinical data, baseline and 6-month patient survey data (N=200 from each level of LHW involvement), and qualitative interviews with community members (N=30) referred to mental health services by the LHW (Aim 1); pre/post mental health stigma data from two respondent driven sampling (RDS) surveys of Latinos (N=400 each) conducted in 2022 (preliminary study) and in 2027 (Aim 2); community capacity indicators from three surveys of Latino-serving organizations conducted in 2019, 2021 (preliminary studies) and 2027, and key informant interviews (KII) with Latino-serving providers (N=30) in 2019 (preliminary study) and 2027 (Aim 3).

在美国的拉丁美洲人在获得心理健康服务方面存在显着差异， 健康保险，服务成本，对精神卫生资源的认识有限，精神卫生耻辱，以及 害怕被驱逐出境。有限的英语能力加上严重缺乏双语和文化能力 提供者进一步阻碍拉丁美洲人充分获得高质量的心理健康服务。COVID-19疫情 这只会扩大对心理健康护理的需求，加剧拉丁美洲人的心理健康差距， 社区，迫切需要确定低成本，有效的战略，以减少这些差距。本5年 该项目旨在开发和测试一种多层次的社区干预措施，以改善心理健康 结果，并促进获得文化上适当的心理健康治疗拉丁美洲人 费城的社区。CRISOL Mente将包括社会生态各个层面的组成部分， 模式：一个以诊所为基础的阶梯式护理计划，依靠拉丁美洲非专业卫生工作者（LHW）提供 精神健康服务（目标1）、外展和教育活动，以减少 社区（目标2），并努力加强拉丁美洲服务组织的能力，以解决心理健康 以及其他导致拉丁美洲人心理健康得不到治疗的综合症（目标3）。提高 心理健康症状和参与护理，我们将招募，培训和监督一批拉丁裔LHW 他们将被嵌入两个拉丁裔服务诊所，扩大诊所的覆盖范围和有效性， 心理健康服务。我们将比较三个不同层次的LHW参与的影响： 社区外展/导航（即社区成员的筛选和转介）; B）辅助护理（即 筛查、转诊，并帮助克服障碍以改善心理健康）;以及c）任务转移（即筛查， 转诊、援助和监督下的基本精神卫生治疗）。LHWs还将进行 社区外展/教育活动（例如电台讲座、资讯讲座、在社区场地举行的座谈会） 减少心理健康的耻辱感。我们经验丰富，主要是拉丁裔社区学术研究团队将 还参与能力建设活动（即每月市政霍尔斯，年度务虚会，每周通讯， 提供培训和技术支持）与拉丁美洲健康集体，一个联盟的拉丁美洲服务 组织的使用混合方法和RE-AIM框架，将评估CRISOL Mente的影响 临床数据、基线和6个月患者调查数据（N=200，来自每个LHW受累水平），以及 与由LHW（目标1）转介到精神健康服务的社区成员（N=30）进行定性访谈; 来自两项对拉丁美洲人（N=400）进行的应答者驱动抽样（RDS）调查的前/后心理健康污名数据 在2022年（初步研究）和2027年（目标2）进行;三个社区能力指标 在2019年，2021年（初步研究）和2027年进行的拉丁美洲服务组织的调查，以及关键 在2019年（初步研究）和2027年（目标3）与拉丁美洲服务提供者（N=30）进行的线人访谈（KII）。