SUPERA: Supporting Peer Interactions to Expand Access to Digital Cognitive Behavioral Therapy for Spanish-speaking Safety-Net Patients in Primary Care

项目摘要 英语水平有限(LEP)的拉丁裔经历了更长时间的未经治疗的心理健康 精神错乱。在抑郁和焦虑的情况下，拉丁裔获得高质量的可能性是白人的一半， 循证护理，尽管初级保健提供者建议以同等费率进行治疗。确实有 LEP Latinx患者存在抑郁和焦虑的已知障碍，特别是在医疗保健环境层面。 因为这些患者更有可能在公共医疗机构接受治疗，这一比例不成比例 对于接受医疗补助的患者或没有保险的患者，往往有语言和文化上的协调一致的护理 这些系统中的模式仍然是讲西班牙语的行为/心理健康临床医生的总体不足。在……里面 此外，这些资源不足的医疗系统也不太可能成为实施 创新可能会增加其人口获得精神卫生保健的机会。 数字干预，即利用互联网和移动技术的干预，可以提供有效的 克服这些障碍的选择。在许多国家，数字化治疗是精神疾病的一线治疗。 健康问题，如抑郁症和焦虑症，创造一个可以克服差异和 促进健康公平。在美国，很少有患者能够获得基于证据的数字治疗， 而且，即使有机会，人们的参与度和参与度也往往很低。 本提案旨在实施和评估一种基于证据的数字认知行为疗法。 对患有抑郁和/或焦虑的拉美裔LEP患者进行安全网初级保健诊所的干预。主要 护理是治疗抑郁症等常见心理健康问题的事实上的治疗环境 焦虑症和拉丁裔患者倾向于继续在初级保健中心接受治疗，而不是转诊 其他专门的精神卫生服务。我们将进行有效性-实施混合试验(类型2) 设计时同时采用提供者和患者级别的随机化。这将生成有关数字有效性的数据 为LEP Latinx患者的心理健康结果提供同行支持，同时生成严格的数据 关于在未来工作中传播机会最大的执行战略。在提供者级别 我们将比较外联(使用我们的诊所患者登记)和inReach(传统提供者转介)，请访问 在患者级别，我们将比较dCBT平台的两种交付模式(同行支持和不支持)。 这项研究的长期目标是帮助实施数字心理健康干预措施 这可以在资源匮乏的环境中可持续地实施，同时减少对专业人员的依赖， 克服劳动力短缺，并提高与不同人群的相关性。这样的干预可能是 以规模提供，并解决由常见精神障碍引起的疾病的实质性负担，同时 使资源更多地提供给那些传统上得不到我们卫生系统服务的人。

Project Summary Limited English Proficiency (LEP) Latinxs experience longer duration of untreated mental health disorders. In the case of depression and anxiety, Latinxs are half as likely as whites to receive quality, evidence-based care despite primary care providers recommending treatment at equivalent rates. There are known barriers for LEP Latinx patients with depression and anxiety, especially at the healthcare setting level. Because these patients are more likely to receive care in public healthcare settings which disproportionately care for patients on Medicaid or who are uninsured, there are often language and culturally concordant care models in these systems yet an overall deficiency of Spanish-speaking behavioral/mental health clinicians. In addition, these under-resourced healthcare systems also are less likely to be the site for implementation of innovations that might increase access to mental health care for their population. Digital interventions, i.e., those that leverage Internet and mobile technologies, can provide an effective option for overcoming these barriers. In many countries, digital treatments are frontline treatments for mental health issues such as depression and anxiety, creating a standard of care that can overcome disparities and promote health equity. In the United States, few patients have access to evidence-based digital treatments, and even when available, uptake and engagement is often low. This proposal aims to implement and evaluate an evidence-based digital cognitive-behavioral therapy intervention in safety-net primary care clinics for LEP Latinx patients with depression and/or anxiety. Primary care is the de facto treatment setting for the treatment of common mental health problems such as depression and anxiety and Latinx patients tend to prefer to remain treated in primary care rather than being referred to other specialty mental health services. We will conduct an effectiveness-implementation hybrid trial (Type 2) design with both provider- and patient-level randomization. This will generate data on effectiveness of digital peer support for mental health outcomes for LEP Latinx patients while simultaneously generating rigorous data on the implementation strategies with the highest chance of dissemination in future work. At the provider-level we will compare outreach (using our clinic patient registry) with inreach (traditional provider referral), at the patient-level we will compare two modes of delivery of the dCBT platform (peer-supported vs. unsupported). The long-term goal of this research is to aid in the implementation of digital mental health interventions that can be sustainable implemented in low-resourced settings, while reducing the reliance on professionals, overcoming workforce deficits, and increasing relevance for diverse populations. Such interventions could be provided at scale and address the substantial burden of disease resulting from common mental disorders while making resources more available to those traditionally underserved by our health system.