OurChild: A Health IT Solution to Reduce Minority Health Disparities

项目摘要/摘要 心理健康和发育障碍开始于生命的早期，很普遍，损害和预测精神疾病。 儿童后期和成年期间的健康和健康挑战。每九个学龄前儿童中就有一个患有 在精神健康障碍患者中，接受治疗的比例不到15%。在移民社区，差距 心理健康需求和护理之间的关系更大，因为文化和语言的障碍，有限的心理 健康素养，以及减少使用医疗IT解决方案，如电子健康记录(EHR)患者门户网站。 华裔美国移民家庭是一个快速增长的移民群体，他们的童年早期心理尚未得到满足 健康需求。我们计划设计、构建和实施OurChild，这是一个集成的mHealth/EHR解决方案 增加幼儿心理健康知识和心理健康服务的可获得性 日落公园为2-6岁的华裔美国儿童及其父母提供的资源， 布鲁克林。我们的提议使我们与日落华裔社区的长期伙伴关系更加紧密 公园和为其提供服务的安全网诊所，以及我们团队在健康差距方面的临床和科学专业知识， 参与性研究和幼儿心理健康；2)联合国儿童基金会的数字健康/健康信息技术专长 纽约大学朗格尼儿童和青少年精神病学系的数字孵化器WonderLab。我们的目标 是通过明确设计数字解决方案来减少健康差距，该解决方案可促进连接和 跨文化、上下文、语言和环境差异的双向信息交流 儿童早期心理健康知识和获得照顾这些移民人口的主要障碍。我们的 第一个目标是迭代地设计、构建和测试OurChild。为了做到这一点，我们将与我们的家人合作， 临床和社区利益相关者进行儿童早期心理健康背景/需求分析和 参与式设计和发现活动；2)使用这些见解来适应和用户测试迭代原型； 3)在20种方法的混合试验中评估OurChild测试版的可用性和接受性 在日落公园第七大道接受照顾的华裔美国父母和他们2至6岁的孩子 家庭健康中心；以及4)优化设计、功能和性能以创建我们的儿童1.0。我们 第二个目标是评估OurChild 1.0的覆盖面、有效性、采用率和实施情况，其中包括6- 对200名父母/子女进行了一个月纵向实施队列研究。我们将使用混合方法 使用通过OurChild应用程序收集的元数据、来自应用程序的家长报告的数据、EHR数据和 实施后与提供者的焦点小组，以确定使用我们的儿童是否增加了转诊 幼儿心理健康咨询或评估(主要目标)。我们的次要目标将审查 是否使用OurChild 1)提高父母的自我效能感；2)父母-提供者的参与度；以及3)与 社区幼儿资源。OurChild和我们的数字方法都将被设计成可扩展的 并有效地适应了其他健康差距人群。

Project Summary/Abstract Mental health and developmental disorders begin early in life, are prevalent, impairing, and predict mental health and health challenges in later childhood and in adulthood. One in nine preschoolers has an impairing mental health disorder, yet less than 15% receive any treatment. In immigrant communities, the disparity between mental health needs and care is greater because of cultural and language barriers, limited mental health literacy, and decreased use of health IT solutions, like Electronic Health Record (EHR) patient portals. Chinese American immigrant families are a fast-growing immigrant group with unmet early childhood mental health needs. We propose to design, build, and implement OurChild, an integrated mHealth/EHR solution to increase access to early childhood mental health knowledge and mental health services and resources for Chinese American children ages 2-6 years old and their parents in Sunset Park, Brooklyn. Our proposal unites our longstanding partnership with the Chinese American community in Sunset Park and the safety-net clinics serving it with our team's 1) clinical and scientific expertise in health disparities, participatory research and early childhood mental health and 2) the digital health/health IT expertise of the WonderLab, a digital incubator in the NYU Langone Department of Child and Adolescent Psychiatry. Our goal is to reduce health disparities by explicitly designing a digital solution that facilitates connection and bidirectional exchange of information across the cultural, contextual, language, and setting differences that are key barriers to early childhood mental health knowledge and access to care for this immigrant population. Our first aim is to iteratively design, build, and test OurChild. To do this we will 1) collaborate with our family, clinical, and community stakeholders to conduct an early childhood mental health context/needs analysis and participatory design and discovery activities; 2) use these insights to adapt and user-test iterative prototypes; 3) evaluate the usability and acceptability of a beta version of OurChild in a mixed-methods pilot with 20 Chinese American parents and their 2- to 6-year-old children who receive care at the Sunset Park 7th Avenue Family Health Center; and 4) optimize the design, features, and performance to create OurChild 1.0.Our second aim it to evaluate the Reach, Effectiveness, Adoption, and Implementation of OurChild 1.0 with a 6- month longitudinal implementation cohort study with 200 parent/child dyads. We will use a mixed-methods approach using metadata collected with the OurChild app, parent-reported data from the app, EHR data, and post-implementation focus groups with providers to determine whether use of Our Child increases referrals of young children for a mental health consultation or evaluation (Primary Aim). Our secondary aims will examine whether use of OurChild 1) increases parent self-efficacy; 2) parent–provider engagement; and 3) linkage with community early childhood resources. Both OurChild and our digital methodology will be designed to be scaled to other Chinese populations and efficiently adapted for other health disparity populations.