Multilevel Community-Based Mental Health Intervention to Address Structural Inequities and Adverse Disparate Consequences of COVID-19 Pandemic on Latinx Immigrants and African Refugees

项目总结 这项研究的目标是测试一种多层次的方法来减少新冠肺炎的不良后果 通过观察和实施对拉丁裔和黑人移民和难民产生不同影响的流行病 三个嵌套的干预水平：1)有效的6个月同行倡导和相互学习模式 (难民和移民福利项目)；2)与社区组织接触 (CBOS)；和3)预计将为应对大流行而颁布的结构性政策变化，例如一个国家 针对混血拉丁裔家庭的救灾提案，并扩大全州医疗保险覆盖面。 这项基于社区的参与性研究(CBPR)建立在与五个国家长期合作的基础上 以社区为基础的组织(CBO)，关注心理健康、教育、法律问题和制度 改变改善拉丁裔移民和非洲难民福祉的努力。通过包含240个Latinx 从CBO伙伴招募的移民和60名非洲难民，他们被随机分配到被视为- 常规CBO参与或RIWP干预和300名拉丁裔随机样本对照组 移民，本研究采用纵向轮候对照设计方法，共7个时间点36个以上 几个月将测试RIWP干预和与CBO接触的有效性，以减少 心理困扰、日常压力源和经济早熟，并增加保护因素(社会支持， 对资源的批判性认识/获取、英语熟练程度、文化联系和心理健康 服务使用)。这项研究还将测试RIWP干预和与CBO接触的能力 增加拉丁裔获得结构性干预(与地方/州救济有关的政策)直接惠益的机会 以及黑人移民和难民。将通过测试来探索干预效果的机制 调节主要结局和保护性因素之间的关系。我们还将跟踪地方/州政策 并获得对这些结构性干预措施的影响的初步量化估计 心理困扰、压力源和经济倾向使用倾向得分匹配。定性的 来自有目的的参与者和国会预算办公室工作人员的访谈数据将有助于进一步探索 变化机制、政策干预对个人的影响、社区组织如何促进颁布 政策和帮助人们从中受益，以及在每个地点实施RIWP的背景。这 研究具有创新性和重要意义，因为它采用了尖端的研究设计和干预 促进多层次心理健康干预科学的战略，目的是了解和解决 强调了根本的结构性不平等和由此产生的精神健康差距，并 大流行加剧了这一现象。因此，这项研究不仅将有助于减少不同的不利因素 新冠肺炎大流行的心理健康、行为和社会经济后果，但也与我们的能力有关 消除拉丁裔和黑人人群之间的心理健康差距。

PROJECT SUMMARY The goal of this study is to test a multilevel approach to reduce adverse consequences of the COVID-19 pandemic with disparate impacts on Latinx and Black immigrants and refugees by observing and implementing three nested levels of intervention: 1) an efficacious 6-month peer advocacy and mutual learning model (Refugee and Immigrant Well-being Project, RIWP); 2) engagement with community-based organizations (CBOs); and 3) structural policy changes expected to be enacted in response to the pandemic, such as a state disaster relief proposal for mixed status Latinx families and expanded statewide health insurance coverage. This community-based participatory research (CBPR) study builds on a long-standing collaboration with five community-based organizations (CBOs) that focus on mental health, education, legal issues, and system change efforts to improve the well-being of Latinx immigrants and African refugees. By including 240 Latinx immigrants and 60 African refugees recruited from CBO partners who are randomly assigned to treatment-as- usual CBO involvement or the RIWP intervention and a random sample comparison group of 300 Latinx immigrants, this mixed methods longitudinal waitlist control group design study with seven time points over 36 months will test the effectiveness of the RIWP intervention and engagement with CBOs to reduce psychological distress, daily stressors, and economic precarity and increase protective factors (social support, critical awareness of/access to resources, English proficiency, cultural connectedness, and mental health service use). This study will also test the ability of the RIWP intervention and engagement with CBOs to increase access to the direct benefits of structural interventions (local/state relief-related policies) for Latinx and Black immigrants and refugees. Mechanisms of intervention effectiveness will be explored by testing mediating relationships between primary outcomes and protective factors. We will also track local/state policy changes and obtain preliminary quantitative estimates of effects of these structural interventions on psychological distress, stressors, and economic precarity using propensity score matching. Qualitative interview data from a purposive subsample of participants and CBO staff will enable additional exploration of mechanisms of change, the effects of policy interventions on individuals, how CBOs contribute to enacting policies and helping people benefit from them, and the context of RIWP implementation at each site. This research is innovative and significant because it employs cutting-edge research design and intervention strategies to advance the science of multilevel mental health interventions that aim to understand and address underlying structural inequities and resulting mental health disparities that have been highlighted and exacerbated by the pandemic. Thus, this study will contribute not only to reducing the disparate adverse mental health, behavioral, and socioeconomic consequences of the COVID-19 pandemic but also to our ability to eliminate mental health disparities among Latinx and Black populations.