A Multimodal Parent-focused Intervention for Vulnerable Populations in the Bronx

项目总结/摘要 针对PAR-20-237，“社区干预措施，以应对COVID-19大流行的后果 在健康差距和弱势群体中，”我们建议研究一种以父母为中心的心理化 在布朗克斯的弱势群体中使用智能手机健康平台进行干预。布朗克斯区--最穷的 纽约市的一个自治市，84%的人口是少数民族， 受到COVID-19疫情的影响。对于布朗克斯的护理人员来说， 前所未有的心理困扰;除了打击健康的社会决定因素（SDOH），这些 家庭现在面临更大的财政不安全和与学龄儿童有关的挑战。此外，委员会认为， 布朗克斯家庭的社交距离要求和有限的远程医疗资源构成了更大的障碍 to healthcare医疗.这种父母的痛苦有助于提高跨代心理周期的风险， 压力创伤和虐待为了应对这些挑战，我们提出了一项多模式研究， 父母的脆弱性和医疗保健的获取。a）针对父母的脆弱性，我们建议在我们的 12-会话治疗护理计划，利用基于心理化的治疗，专为父母 在我们的卫生系统的社区精神病诊所接受治疗的儿童。多项随机对照试验 （RCT）的依恋为基础的育儿干预，包括从我们的小组在弱势群体， 布朗克斯。B）针对医疗保健服务，我们建议使用符合HIPAA标准和IRB批准的瓦莱拉 健康智能手机应用程序（“应用程序”），这已经在我们的卫生系统在选定的队列研究， 导致了更多的医疗服务。基于我们的工作和临床基础设施，我们假设， CARE计划和瓦莱拉应用程序都将减轻COVID-19的心理影响， 在布朗克斯享受医疗保健。该研究将在Montefiore医学中心（MMC）进行，该中心是世界上最大的 布朗克斯的卫生系统，主要为种族和少数民族的个人从服务不足 家庭我们将重点关注三个高度脆弱的群体：a）患有精神疾病的儿童的照顾者 （N=130）; B）自身免疫性疾病儿童的照顾者（N=130），以及; c）一线照顾者 MMC的医护人员（N=100）;均表现为中度压力。4组RCT（2 x 2设计）将 检验我们假设：a）单独的CARE计划; B）CARE计划+瓦莱拉应用程序; c）单独的家长教育（PE）; d）PE +瓦莱拉应用程序。将根据需要提供智能手机和连接。研究入组时的调查，6-， 12-24周将评估父母的压力，心智能力（反射功能），获得医疗保健， 情绪和焦虑以及其他父母和儿童临床测量。机器学习方法将探索 作为结果预测因素的复杂模式，包括COVID-19疾病/死亡、医疗并发症、住房， 贫困、精神病理学、年龄、家庭功能和创伤。冲击这项多模式研究解决了 减轻COVID-19对弱势群体心理和健康影响的战略。

PROJECT SUMMARY / ABSTRACT In response to PAR-20-237, “community interventions to address the consequences of the COVID-19 pandemic among health disparity and vulnerable populations,” we propose to study a parent-focused mentalizing intervention with a smartphone health platform in vulnerable populations in the Bronx. The Bronx—the poorest borough in New York City (NYC) with 84% of its population comprised of minorities—has been hit disproportionally by the COVID-19 pandemic. For caregivers in the Bronx, the pandemic has caused unprecedented psychological distress; in addition to combating social determinants of health (SDOH), these families now face greater financial insecurity and challenges related to their school-aged children. Furthermore, social distancing requirements and limited telehealth resources for Bronx families have posed greater barriers to healthcare. Such parental distress contributes to heightened risk of transgenerational cycles of psychological stress, trauma and maltreatment. Addressing these challenges, we propose a multimodal study tackling both parental vulnerability and healthcare access. a) Targeting parental vulnerability, we propose to build upon our 12-session therapeutic CARE program, which utilizes Mentalization Based Therapy and designed for parents of children in treatment in a community psychiatry clinic in our health system. Multiple randomized controlled trials (RCTs) of attachment-based parenting interventions, including from our group in disadvantaged cohorts from the Bronx. b) Targeting healthcare access, we propose to utilize the HIPAA-compliant and IRB-approved Valera Health smartphone application (“app”), which has been studied in our health system in selected cohorts and resulted in greater access to healthcare. Building upon our work and clinical infrastructure, we hypothesize that both the CARE program and the Valera app will mitigate the psychological effects of COVID-19 while enhancing access to healthcare in the Bronx. The study will take place at Montefiore Medical Center (MMC), the largest health system in the Bronx, which serves predominantly racial and ethnic minority individuals from underserved families. We will focus on three highly vulnerable cohorts: a) caregivers of children with psychiatric conditions (N=130); b) caregivers of children with autoimmune illnesses (N=130), and; c) caregivers who are frontline healthcare workers at MMC (N=100); all presenting with moderate stress. A RCT with 4 arms (2 x 2 design) will test our hypothesis: a) CARE program alone; b) CARE program + Valera app; c) Parent Education (PE) alone; d) PE + Valera app. Smartphones and connectivity will be provided as needed. Surveys at study enrollment, 6-, 12- and 24-weeks will assess parental stress, mentalizing capacity (reflective functioning), access to healthcare, mood and anxiety and additional parent and child clinical measures. Machine learning approaches will explore complex patterns as predictors of outcome including COVID-19 illness/deaths, medical comorbidity, housing, poverty, psychopathology, age, family functioning, and trauma. Impact. This multimodal study addresses key strategies to mitigate the psychological and health impact of COVID-19 in vulnerable populations.