CEREMONY: Culturally Engaged REcovery - MOms connected through Native community

仪式：文化参与式恢复 - MOms 通过原住民社区建立联系

• 批准号: 10748244
• 负责人: Michelle Precourt Debbink
• 金额: $ 56.35万
• 依托单位: UNIVERSITY OF UTAH
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-17 至 2030-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10748244
• 关键词: Address; Adult; Alaska Native; American Indians; Area; Caring; Cessation of life; Cities; Clinic; Clinical; Clinical Services; Clinical effectiveness; Communities; Complement; Contracts; Counseling; County; Data; Dependence; Diné Nation; Education; Enrollment; Evidence based practice; Face; Feedback; Foundations; Goals; Health Personnel; Hybrids; Infant; Intervention; Interview; Knowledge; Length of Stay; Manuals; Maternal Mortality; Measures; Medical Records; Mental Health; Mental Health Services; Modeling; Morbidity - disease rate; Mothers; Native-Born; Navajo; Neonatal; Not Hispanic or Latino; Outcome; Participant; Patient-Focused Outcomes; Perception; Perinatal; Perinatal Care; Persons; Phase; Population; Postpartum Period; Pregnancy; Pregnancy Outcome; Prenatal care; Process Assessment; Production; Protocols documentation; Randomized; Recovery; Research; Reservations; Review Committee; Risk; Risk Reduction; Rural; Services; Social support; Sodium Chloride; Substance Use Disorder; Testing; Toxicology; Training; Trauma; Tribes; Universities; Urine; Utah; Work; addiction; care coordination; clinical center; clinical implementation; cohort; community based participatory research; community engagement; design; disorder risk; effectiveness/implementation study; evidence base; follow-up; high risk; human centered design; hybrid type 1 design; implementation evaluation; implementation process; implementation science; improved; informant; innovation; lens; maternal morbidity; maternal outcome; medication for opioid use disorder; mortality; multidisciplinary; neonatal outcome; novel; patient oriented; peer support; phase 2 testing; postpartum care; pregnant; preventable death; prospective; resilience; simulation; social stigma; substance use; substance use prevention; tribal community; virtual experiments

ABSTRACT: PROJECT 1 CEREMONY Pregnant and postpartum American Indian and Alaska Native people (Native mothers) face a more than two- fold higher risk of maternal mortality compared to non-Hispanic White mothers. Deaths related to substance use (SU) and mental health conditions reflect a leading cause of preventable maternal mortality, including among Native mothers, making these conditions a strong target for reducing maternal mortality and morbidity. The Utah Maternal Mortality Review Committee (MMRC) has identified access to substance use disorder (SUD) treatment including medication for opioid use disorder (MOUD), mental health care, improved social support, decreased stigma against SUD, and care coordination, particularly in the postpartum period (when the majority of deaths occur) as actionable intervention points. The objective of our study, Culturally- Engaged REcovery – MOms connected through Native CommunitY (CEREMONY), is to adapt evidence-based perinatal care models that integrate pregnancy and postpartum care with SU/SUD treatment and care to meet the needs of Native mothers. With our partners at Sacred Circle Clinic, a federal Tribal Contract clinic operated by the Confederated Tribes of the Goshute Reservation, we are uniquely poised to respond to the expressed needs of Native mothers and stakeholders, who identified a lack of culturally-integrated SUD care as a significant gap in perinatal care for Native mothers. We will do this by building upon the strong, evidence- based foundation of our University of Utah integrated perinatal SUD clinic called Substance Use and Pregnancy – Recovery, Addiction, and Dependence (SUPeRAD). The SUPeRAD model directly addresses the actionable intervention points identified by the MMRC to prevent SUD-related maternal deaths, but is not specifically adapted to Native mothers’ needs. The rationale for this study is that there is a critical knowledge gap in the adaptation and implementation of integrated perinatal SUD care specifically for Native mothers. The CEREMONY study will fill this gap by adapting the SUPeRAD clinic model to the needs of Native mothers using the validated ADAPT-ITT adaptation framework, informed by human centered design and community-based participatory research (Aim 1); and then testing the adapted, culturally-integrated perinatal SUD care intervention at Sacred Circle Clinic using a Hybrid Type 1 effectiveness-implementation study (Aim 2a&b). The Hybrid Type 1 design will provide important, reliable data on the clinical effectiveness of culturally adapted perinatal SUD care for Native mothers (Aim 2a) while also producing novel data on the implementation process (Aim 2b). Successful completion of these Aims will provide implementation and training protocols that can be used to guide adaptation and implementation of culturally-adapted perinatal SUD care in other settings across the US. Our study is innovative and significant because it employs strong community engagement principles and a robust implementation science approach to produce novel clinical effectiveness and implementation data that can be rapidly disseminated to dramatically improve the care of Native mothers with SUD and reduce risks for maternal mortality and morbidity.

摘要：项目 1 仪式 怀孕和产后的美洲印第安人和阿拉斯加原住民（原住民母亲）面临着两个以上的问题： 与非西班牙裔白人母亲相比，孕产妇死亡风险更高。与物质有关的死亡 使用（SU）和心理健康状况反映了可预防的孕产妇死亡的主要原因， 包括土著母亲，使这些条件成为降低孕产妇死亡率的有力目标 和发病率。犹他州孕产妇死亡率审查委员会 (MMRC) 已确定药物使用的可及性 障碍 (SUD) 治疗，包括治疗阿片类药物使用障碍 (MOUD) 的药物、心理保健、改善 社会支持、减少对 SUD 的耻辱以及护理协调，特别是在产后时期 （当大多数死亡发生时）作为可行的干预点。我们研究的目标，文化上—— 参与式恢复——通过本地社区（CEREMONY）连接的妈妈们，是为了适应基于证据的 将孕期和产后护理与 SU/SUD 治疗和护理相结合的围产期护理模式，以满足 本土母亲的需求。与我们在 Sacred Circle Clinic 的合作伙伴一起运营，这是一家联邦部落合同诊所 戈舒特保留地的联盟部落，我们以独特的方式准备回应所表达的 土著母亲和利益相关者的需求，他们认为缺乏文化融合的 SUD 护理是一个问题 土著母亲的围产期护理存在巨大差距。我们将通过建立强有力的证据来做到这一点—— 我们犹他大学综合围产期 SUD 诊所的基础名为物质使用和 怀孕 – 恢复、成瘾和依赖 (SUPeRAD)。 SUPeRAD 模型直接解决了 MMRC 确定了预防 SUD 相关孕产妇死亡的可行干预点，但并未 特别适合本土母亲的需求。这项研究的基本原理是存在关键知识 专门针对土著居民的综合围产期 SUD 护理的适应和实施方面的差距 妈妈们。 CEREMONY 研究将通过调整 SUPeRAD 诊所模型以满足以下人群的需求来填补这一空白： 本土母亲使用经过验证的 ADAPT-ITT 适应框架，以人为本的设计 基于社区的参与性研究（目标 1）；然后测试经过调整的、文化整合的 Sacred Circle Clinic 使用混合 1 型有效性实施的围产期 SUD 护理干预 研究（目标 2a 和 b）。混合型 1 型设计将为临床有效性提供重要、可靠的数据。 为土著母亲提供适应文化的围产期 SUD 护理（目标 2a），同时还提供有关 实施过程（目标 2b）。成功完成这些目标将为实施和 可用于指导适应文化的围产期 SUD 的适应和实施的培训协议 美国其他地区的护理。我们的研究具有创新性且意义重大，因为它采用了强大的 社区参与原则和强大的实施科学方法来产生新颖的临床 可以快速传播的有效性和实施数据，以显着改善对患者的护理 患有 SUD 的本土母亲可以降低孕产妇死亡和发病的风险。