Mental Health Skills for Latino Assistants in Primary Care

描述（由申请人提供）：尽管精神障碍的患病率与白人相似，但只有11名患有精神障碍的拉丁裔成年人中有1人接受服务，而白人成年人中有1人接受服务。即使在考虑了健康状况和社会经济地位的中介效应之后，拉丁裔人使用心理健康服务的差异仍然存在。拉丁美洲人报告说，总的来说，他们对接受精神卫生服务持开放态度，特别是从初级保健提供者那里接受精神卫生服务，但他们面临与语言、期望和医患沟通方式差异有关的障碍。社区卫生工作者和患者激活模式已应用于初级保健中的这类障碍，但不适用于孕产妇和儿童心理健康问题。目标和具体目的：本项目将制定和评估一项干预措施，以改善初级保健中向拉丁裔母亲和儿童提供的心理健康服务。该干预措施将培训母语为西班牙语的拉丁裔辅助专业人员，帮助母亲和儿童(1)在就诊前与医生讨论心理健康问题；（二）制定访问日程；(3)克服心理健康治疗的后续障碍。辅助专业人员还将帮助初级保健提供者了解母亲和儿童可能表达与心理健康有关的关切的特定文化方式。本干预发展建议的具体目标是确定是否可行培训辅助专业人员促进使用精神卫生服务的技能，培训是否被认为对辅助专业人员有吸引力并且对他们支持的医生有用，以及干预是否如其基础理论模型所预测的那样改变了治疗相互作用和中间结果。方法：研究在一个独立的社区中心进行，为低收入的拉丁裔母亲和儿童提供初级保健服务。它将招募375对亲子（3-16岁的孩子），使用岗前设计来评估辅助专业人员培训的影响。培训中的技巧来自于以患者为中心的互动、以解决方案为中心的认知疗法和动机增强；培训基于初级保健提供者自己成功采用的类似模式。培训是高度互动的，可以将辅助专业人员的特定文化知识与调查人员教授的沟通/激活技能结合起来。三波数据收集将首先为发现和讨论心理健康问题建立基线，然后观察训练的影响，然后评估6个月后训练效果的持久性。公共卫生相关性：辅助专业人员通常被雇用来促进诊所环境和多元文化社区的有效护理。提高他们促进有效讨论心理健康问题的能力，可能是减少拉丁裔和其他族裔群体在心理保健方面的文化障碍的一种有效和可复制的方法。

DESCRIPTION (provided by applicant): Despite a similar prevalence of mental disorders as whites, only 1 in 11 Latino adults with a mental disorder receive services compared to 1 in 3 white adults. Differences in Latino's use of mental health services persist even after accounting for health status and the mediating effect of socioeconomic status. Latinos report openness to receipt of mental health services in general and from primary care providers in particular, but face barriers related to language, expectations, and differences in styles of patient-doctor communication. Community health worker and patient activation models have been applied to these sorts of barriers in primary care, but not for maternal and child mental health problems. Goals and specific aims: This project will develop and evaluate an intervention to improve the delivery of mental health services to Latino mothers and children in primary care. The intervention will train native Spanish-speaking Latino paraprofessionals to help mothers and children (1) articulate mental health concerns for discussion with their doctor prior to the visit; (2) formulate an agenda for the visit; and (3) overcome barriers to follow-through with mental health treatment. The paraprofessionals will also help primary care providers understand culturally-specific ways in which mothers and children may express concerns related to mental health. The specific aims of this intervention development proposal are to determine if it is feasible to train paraprofessionals in skills that promote use of mental health services, if the training is perceived as engaging to the paraprofessionals and useful to the physicians they support, and if the intervention alters therapeutic interactions and intermediate outcomes as predicted by its underlying theoretical model. Methods: The study takes place in a free-standing community center providing primary care services to low- income Latino mothers and children. It will enroll 375 parent-child pairs (children ages 3-16), using a pre-post design to evaluate the impact of paraprofessionals' training. Skills in the training come from the literature on patient-centered interaction, solution-focused cognitive therapy, and motivational enhancement; the training is based on a similar model successfully employed with primary care providers themselves. The training is highly interactive, allowing for combining the culturally specific knowledge of the paraprofessionals with the communication/activation skills taught by the investigators. Three waves of data collection will first establish a baseline for detection and discussion of mental health issues, then look at the impact of the training, and then assess persistence of training effects 6 months later. PUBLIC HEALTH RELEVANCE: Paraprofessionals are commonly employed to promote efficient care in clinic settings and in multicultural communities. Improving their ability to promote the effective discussion of mental health concerns could be an efficient and replicable method for reducing cultural barriers to mental health care among Latinos and other ethnic groups.