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

项目概要/摘要 精神健康和药物滥用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原住民（AI/AN）社区，并导致代际发病率和死亡率。这些 风险是历史创伤的遗留问题，持续的歧视，以及心理健康的长期资金不足， 药物使用护理，造成巨大的护理和治疗差距。同时，许多AI/AN社区 强调以家庭和社区为中心的整体幸福观， 预防性和以家庭为基础的干预措施，有可能打破代际创伤循环， 逆境我们的土著和相关研究人员团队与参与社区密切合作， 设计和试点家庭精神优势（FSS）干预，旨在提供transdiagnosis技能- 为精神健康风险高的母亲和主要照顾者提供基于预防战略的服务， 物质使用障碍我们提出了一个混合I型容错实现设计与主要的 测试FSS在减少抑郁、焦虑和物质使用症状方面的有效性的目标，N = 188名主要照顾者，来自三个不同的部落环境和背景。受试者将被随机分配至 接受FSS或有益控制，这是一个基于证据的营养支持计划，称为家庭精神 教养将在入组后6个月测量主要结局。我们还将努力描述 通过探索调节剂和介质，分别引导FSS效应的异质性和机制， 西方和本土的行为理论。作为混合方法的一部分，我们将估算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开展一个进程， 了解在全国范围内实施FSS的障碍和促进因素，包括共同设计 实施战略，在不同的AI/AN社区中大规模支持FSS。这项研究是响应 计划公告PAR-20-238，重点关注关键领域，包括证据测试- 在社区环境中的基于实践的做法（MH-22-170）和扩大围产期心理健康干预措施（MH-22-170） 21-215，MH-21-270）。我们的总体目标是严格测试二级预防干预措施， 将其纳入家访项目，这样我们就可以扩大精神和行为健康的覆盖面， 全国各地的AI/AN社区服务。

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.