Designing Deaf-MET: A Deaf-Accessible Pre-Treatment for Alcohol Use Disorder

项目摘要/摘要 美国聋人社区-超过500,000名听力损失患者使用 美国手语(ASL)-与美国手语(ASL)相比，终生饮酒问题的发生率几乎是 普通民众。然而，目前还没有经过正式验证的循证治疗方法。 聋人客户中存在饮酒或酒精使用障碍(AUD)问题。 现有的AUD治疗方法不能满足聋人客户独特的语言和文化需求。聋人中位数 英语阅读水平下降到四年级，许多学生的健康素养较低。因此，书面治疗 材料需要纯文本修改、直接ASL翻译或ASL叙述性故事讲述。同样重要的是 需要纳入聋人的价值观和社会规范，承认聋人的压迫历史，以及 尊重聋人作为文化群体的认同，而不是残疾群体。认识和资源有限 导致许多听力临床医生将聋人视为“残障”或“受损”，努力发展出一种 合作工作关系，并将聋人排除在有关他们自己护理的重要决策之外。 为了解决这些障碍，拟议的K23研究将利用社区参与的干预发展 设计、试行和提炼一种在文化和语言上都可接受的动机适应方法 为患有AUD的聋人患者提供增强疗法(MET)。MET是一个简短的前处理程序， 将激励性面试和变化阶段相结合，以增加客户积极的动机 从事恢复工作。有强有力的证据表明MET的有效性，并有广泛的循证客户选择 当与听力受试者一起使用时，MET无法满足聋人的语言和文化需求。 在参与变革模式的指导下，一个多步骤的社区参与开发过程 为了减少健康差距，候选人将通过以下方式设计、试点和完善聋人-Meet：(1) 通过四个全国性的聋人焦点小组评估聋人社区的需求、优先事项和资产 具有现场AUD经验的人和其他关键利益相关者；(2)与聋人合作 干预开发团队，开发原型聋人治疗师手册和聋人可访问的MET 治疗材料(例如，视觉讲义、ASL翻译、ASL叙述和/或对MET的改编 脚本)；以及，(3)对24名聋人进行了三个试点测试周期，分析了 可行性(例如，招聘、保留、满意度)和初步效力。 每个试点测试周期后的结果将用于在下一个周期之前改进聋人-MET原型。 总体研究结果将为聋哑人RCT的设计提供参考，并有助于开发 的第一个聋人无障碍的AUD前治疗。此外，拟议的AIMS将为候选人提供 在社区参与研究和干预开发方面的实践经验是成为 为聋人客户调整、开发和评估AUD治疗的独立临床研究人员。

PROJECT SUMMARY/ABSTRACT The U.S. Deaf community – more than 500,000 individuals with hearing loss who communicate using American Sign Language (ASL) – experiences nearly triple the rate of lifetime problem drinking compared to the general population. Yet, there are no evidence-based treatments that have been formally validated to treat problem drinking or alcohol use disorder (AUD) among Deaf clients. Available AUD treatments fail to meet Deaf clients’ unique linguistic and cultural needs. Deaf people’s median English reading level falls at the fourth grade and many exhibit low health literacy. Therefore, written treatment materials require plain text revisions, direct ASL translations, or ASL narrative storytelling. Equally critical is the need to incorporate Deaf values and social norms, acknowledge Deaf people’s history of oppression, and respect Deaf people’s identification as a cultural– not a disability – group. Limited awareness and resources lead many hearing clinicians to perceive Deaf people as “disabled” or “impaired,” struggle to develop a collaborative working relationship, and exclude Deaf people from important decisions about their own care. To address these barriers, the proposed K23 study will leverage community-engaged intervention development methods to design, pilot, and refine a culturally- and linguistically-accessible adaptation of Motivational Enhancement Therapy (MET) for Deaf clients with AUD (Deaf-MET). MET is a brief pre-treatment that combines Motivational Interviewing and the stages of change to increase a client’s motivation for actively engaging in recovery. There is strong evidence of MET’s efficacy and a wide selection of evidence-based client tools when used with hearing clients; however, MET fails to meet Deaf people’s linguistic and cultural needs. Guided by the ENGAGED for CHANGE model, a multistep community-engaged process for developing interventions to reduce health disparities, the candidate will design, pilot, and refine Deaf-MET by: (1) assessing Deaf community needs, priorities, and assets via a series of four nationwide focus groups with Deaf people with lived AUD experience and other key stakeholders; (2) in collaboration with a Deaf-engaged intervention development team, developing a prototype Deaf-MET therapist manual and Deaf-accessible MET treatment materials (e.g., visual handouts, ASL translations, ASL narratives, and/or adaptations to the MET script); and, (3) conducting three pilot testing cycles of Deaf-MET with 24 Deaf adults, analyzing key aspects of feasibility (e.g., recruitment, retention, satisfaction) and preliminary efficacy. Results after each pilot testing cycle will be used to refine the Deaf-MET prototype prior to the next cycle. Overall study findings will inform the design of a full-scale RCT of Deaf-MET and contribute to the development of the first Deaf-accessible AUD pre-treatment. Additionally, the proposed aims will provide the candidate with hands-on experience in community-engaged research and intervention development necessary to become an independent clinical researcher who adapts, develops, and evaluates AUD treatments for Deaf clients.