International Latino Research Partnership (ILRP)

描述(由申请人提供)：未经治疗的物质使用障碍与过早死亡、生产力丧失、高伤残率和艾滋病毒风险增加有关。物质使用还会使吸毒者面临抑郁症状加剧和高度焦虑的风险。反过来，有心理健康问题会从根本上增加吸毒、吸烟、酗酒和间歇性酗酒的可能性。尽管有大量证据证明双重诊断患者的高患病率，但很少有严格的干预措施来治疗同时患有药物使用和精神健康障碍的个人。在全球范围内，大多数有药物使用和/或精神健康问题的人得不到治疗。拟议的国际拉丁裔研究伙伴关系(ILRP)直接回应了文献中的这一空白。ILRP将波士顿、马德里和巴塞罗那的研究机构及其合作社区诊所聚集在一起，以加强国际合作伙伴关系，并开发必要的研究证据，以应对拉美裔移民的行为健康服务需求。我们将重点转向拉丁裔移民，因为经济机遇将空前数量的拉美移民转移到西班牙和美国等东道国。西班牙的拉美裔移民数量仅次于美国，位居世界第二，美国的大多数移民都是拉美裔。拉美裔移民在行为健康方面面临巨大障碍。在适应宿主文化的过程中，移民被证明喝了更多的酒，使用了更多的药物，给卫生保健系统和公共安全带来了压力，并增加了他们感染艾滋病毒的风险。我们提出了三个目标：1)发展国际伙伴关系和研究合作，以支持能够改善初级保健诊所中存在共生药物使用、精神健康问题和/或艾滋病毒风险的拉丁裔移民的综合行为健康服务的可获得性、质量和结果的研究；2)协调各研究地点的数据；以及3)开展行为健康服务研究，重点是针对初级保健诊所中存在共生药物使用、精神健康问题和艾滋病毒风险的拉美裔移民人群进行快速筛查、转诊和综合行为健康服务研究。对于目标3，我们遵循筛查、短暂干预和转诊到治疗(SBIRT)模式，在该模式中，我们首先测试针对西班牙语人群的简短行为健康筛查的有效性。在这项工作的基础上，我们测试了针对药物使用、吸烟和精神健康障碍的“双重问题和早期行动综合干预”(IIDEA)干预的可行性、可接受性和有效性。因此，拟议的ILRP多地点国际项目是朝着为大量和多样化的拉丁裔移民人口制定综合护理模式迈出的关键一步，也是朝着更广泛地了解如何最好地整合对共存的物质和精神健康问题以及艾滋病毒风险的循证评估和治疗迈出的关键一步。

DESCRIPTION (provided by applicant): Untreated substance use disorders are associated with premature mortality, productivity loss, high rates of disability, and increased risk for HIV. Substance use also places users at risk for elevated depression symptoms and high levels of anxiety. In reciprocal fashion, having mental health problems radically increases the likelihood of augmented drug use, smoking, binge drinking and heavy episodic drinking. Despite a substantial body of evidence documenting the high prevalence of dual-diagnosis patients, few rigorous interventions have been conducted to treat individuals with comorbid substance use and mental health disorders. Globally, most people with substance use and/or mental health problems receive no treatment. The proposed International Latino Research Partnership (ILRP) directly responds to this gap in the literature. The ILRP brings together research institutions an their partnering community clinics in Boston, Madrid and Barcelona to enhance a collaborative international partnership and to develop the research evidence necessary to respond to Latino migrants' behavioral health service needs. We turn our focus to Latino migrants because economic opportunities have moved unprecedented numbers of migrants from Latin America to host countries like Spain and the US. Spain has the second largest number of Latino migrants in the world behind only the US, where most immigrants are Latino. Migrant Latinos confront colossal barriers to behavioral health. During the process of acculturation to the host culture, migrants have been shown to drink more alcohol and use more drugs straining the health care system, public safety, and increasing their risk for HIV. We propose three aims: 1) Develop an international partnership and research collaboration to support research that can improve accessibility, quality and outcomes of integrated behavioral health services for migrant Latinos with co-occurring substance use, mental health problems and/or HIV risk in primary care clinics; 2) Harmonize data across research sites; and 3) Conduct behavioral health services research focused on rapid screening, referral, and integrated behavioral health services research for migrant Latino populations with co-occurring substance use, mental health problems, and HIV risk in primary care clinics. For Aim 3, we follow a Screening, Brief Intervention and Referral to Treatment (SBIRT) model, where we first test the validity of a brief behavioral health screener for Spanish-Speaking populations. Building on that work, we test the feasibility, acceptability and efficacy of the "Integrated Intervention for Dual Problems and Early Action" (IIDEA) intervention addressing substance use, smoking and mental health disorders. As such, the proposed ILRP multi-site international project is a critical step towards developing models of integrated care for the large and diverse Latino migrant population and more broadly towards understanding how best to integrate evidence- based assessment and treatments for co-occurring substance and mental health problems and HIV risks.