Family Spirit Strengths: A home visiting strategy to support parents and caregivers with mental distress and substance misuse

项目摘要/摘要 精神健康和滥用药物对美国人的健康和福祉构成了一些最大的风险 印第安人和阿拉斯加土著(AI/AN)社区，并导致代际发病率和死亡率。这些 风险是历史创伤、持续的歧视和精神健康长期资金不足的遗留问题 物质使用护理，造成巨大的护理和治疗缺口。同时，许多人工智能/人工智能社区 强调以家庭和社区为中心的整体幸福观，更倾向于上游 预防性和以家庭为基础的干预措施，有可能扰乱创伤和 逆境。我们的土著和盟国研究人员团队与参与社区密切合作，以 设计并试行家庭精神力量(FSS)干预，旨在提供跨诊断技能- 为心理健康风险较高的母亲和主要照顾者制定预防策略 物质使用障碍。我们提出了一种混合类型I有效性实施设计，其中主要 目标是测试FSS在减少抑郁、焦虑和药物使用症状方面的有效性，其中N= 188名主要照顾者，涉及三个不同的部落环境和背景。参与者将被随机分配到 接受FSS或受益对照，这是一种名为家庭精神的循证营养支持计划 养育。主要结果将在注册后6个月进行评估。我们还将寻求将 通过分别探索调节因子和调节因子，引导FSS效应的异质性和机制 西方和本土的行动理论。作为我们混合方法的一部分，我们将估计FSS 成本、成本效益和预算影响。最后，我们将与国家利益攸关方共同开展一个进程，以 了解在全国范围内实施FSS的障碍和促进者，包括共同设计 实施战略，以在不同的AI/AN社区中大规模支持FSS。这项研究是有反应的 计划公告PAR-20-238，重点关注感兴趣的关键领域，包括证据测试- 以社区实践为基础(MH-22-170)和扩大围产期心理健康干预(MH- 21-215，MH-21-270)。我们的总体目标是严格测试设计的二级预防性干预 被纳入家访计划，这样我们就可以扩大心理和行为健康的范围 在全国各地的AI/AN社区提供服务。

PROJECT SUMMARY/ABSTRACT Mental health and substance misuse pose some of the greatest risks to the health and wellbeing of American Indian and Alaska Native (AI/AN) communities and result in intergenerational morbidity and mortality. These risks are the legacy of historical trauma, ongoing discrimination, and chronic underfunding of mental health and substance use care, resulting in massive care and treatment gaps. Simultaneously, many AI/AN communities emphasize a holistic view of wellbeing centered around family and community, and prefer upstream preventative and family-based interventions with potential to disrupt intergenerational cycles of trauma and adversity. Our team of Indigenous and allied researchers has worked closely with participating communities to design and pilot the Family Spirit Strengths (FSS) intervention, designed to provide transdiagnostic skills- based preventive strategies to mothers and primary caregivers at elevated risk for mental health and substance use disorders. We propose a Hybrid Type I Effectiveness-Implementation design with the primary goal of testing FSS effectiveness at reducing symptoms of depression, anxiety, and substance use, among N = 188 primary caregivers across three diverse Tribal settings and contexts. Participants will be randomized to receive FSS or a beneficial control, which is an evidence-based nutritional support program called Family Spirit Nurture. Primary outcomes will be measured at 6 months post-enrollment. We will also seek to characterize heterogeneity in and mechanisms of FSS effects by exploring moderators and mediators, respectively, guided by both Western and Indigenous theories of action. As part of our Hybrid approach, we will estimate FSS costs, cost-effectiveness, and budget impact. Finally, we will undertake a process with National stakeholders to understand barriers to and facilitators of FSS implementation across the country, including co-design of implementation strategies to support FSS at scale across diverse AI/AN communities. This study is responsive to Program Announcement PAR-20-238 and focuses on key areas of interest including the testing of evidence- based practices in community settings (MH-22-170) and expanding perinatal mental health interventions (MH- 21-215, MH-21-270). Our overall objective is to rigorously test a secondary preventative intervention designed to be embedded in home visiting programs so that we can extend the reach of mental and behavioral health services in AI/AN communities across the country.