Development of a Training Intervention to Improve Mental Health Treatment for Gender Minority Youth

项目摘要/摘要 背景：少数性别青年(GMY；性别认同不同于 与顺性青年相比，他们面临严重心理健康问题的风险高得不成比例 (其性别认同与出生分配的性别一致)。这些心理健康不平等因以下原因而加剧 治疗利用障碍，包括缺乏受过性别肯定护理培训的精神卫生服务提供者(即做法 解决了性别少数群体的独特经历和心理健康需求)。美国国立卫生研究院和众多学者 呼吁加大努力制定和部署干预措施，以改善获得、参与和提高精神卫生服务的质量 针对性别少数群体的卫生干预措施。研究：拟议的研究将开发和试行培训 采取干预措施，增加精神卫生服务提供者对性别肯定做法的使用。干预设计(目标1)将利用 社区参与和以用户为中心的设计方法，以及关键利益相关者的系统参与：GMY、他们的 照顾者，以及在促进性别平等护理方面有专长和没有专长的提供者。使用经验性支持的 制定行为干预框架，将干预设计为影响三种机制 假设导致提供者的行为改变(即，更多地使用性别肯定做法)：知识， 态度和自我效能感。将通过整合mHealth来强调干预的可扩展性 技术干预改进(目标2)将涉及以用户为中心的设计可用性测试的两个阶段：(1)基于实验室 与供应商的焦点小组进行测试，以及(2)3家供应商治疗GMY消费者3个月的案例系列研究。 可用性测试的反馈将用于反复改进干预措施，并确保干预措施为 试行测试。试点测试(AIM 3)将在一家多诊所的精神健康机构进行公开试验，旨在检查 开展未来区域临床试验的可行性和可接受性。来自两个提供商的有效性和实施数据(N= 44)和消费者(即GMY及其照顾者；N=50 GMY)将被收集和分析。候选人的职业生涯 发展、目标和环境：以患者为导向的研究事业发展奖 (K23)将为普莱斯博士提供启动独立研究计划所需的高级培训和技能 通过制定和评估培训，重点减少受羞辱的青年和家庭的心理健康不平等现象 干预措施，重点是转基因作物。(T1)机制驱动干预中的正式培训和指导 开发和测试，(T2)以用户为中心的设计，(T3)社区参与的研究，和(T4)实施科学 将支持主要研究目标的成功执行和普莱斯博士的职业发展。无边无际 波士顿学院现有的资源，再加上普莱斯博士的导师和顾问团队成员的丰富专业知识， 将进一步确保研究和培训目标的成功，并为未来的培训RCT铺平道路 干预。

PROJECT SUMMARY/ABSTRACT Background: Gender minority youth (GMY; children, adolescents, and young adults whose gender identity differs from their birth-assigned sex) face a disproportionately high risk for serious mental health problems relative to cisgender youth (whose gender identity is congruent with their birth-assigned sex). These mental health inequities are exacerbated by treatment utilization barriers, including the dearth of mental health providers trained in gender-affirming care (i.e., practices that address the distinct experiences and mental health needs of gender minorities). The NIH and numerous scholars have called for increased efforts to develop and deploy interventions that improve access to, engagement in, and quality of, mental health interventions for gender minorities. Research: The proposed research will develop and pilot test a training intervention to increase mental health providers’ use of gender-affirming practices. Intervention design (Aim 1) will utilize community-engaged and user-centered design methods, with systematic engagement from key stakeholders: GMY, their caregivers, as well as providers with and without expertise in gender-affirming care. Using an empirically-supported framework for behavioral intervention development, the intervention will be designed to affect three mechanisms hypothesized to result in behavioral change in providers (i.e., increased use of gender-affirming practices): knowledge, attitudes, and self-efficacy. Scalability of the intervention will be emphasized through the integration of mHealth technology. Intervention refinement (Aim 2) will involve two phases of user-centered design usability testing: (1) lab-based testing with focus groups of providers and (2) a case series study with 3 providers treating GMY consumers for 3 months. Feedback from usability testing will be used to iteratively refine the intervention and ensure the intervention’s readiness for pilot testing. The pilot test (Aim 3) will be an open trial in a multi-clinic mental health agency, aimed at examining the feasibility and acceptability of conducting a future RCT. Effectiveness and implementation data from both providers (N = 44) and consumers (i.e., GMY and their caregivers; N = 50 GMY) will be collected and analyzed. Candidate’s Career Development, Goals, and Environment: The proposed Mentored Patient-Oriented Research Career Development Award (K23) will provide Dr. Price with the advanced training and skills necessary to launch an independent research program focused on reducing mental health inequities for stigmatized youth and families through developing and evaluating training interventions, with an emphasis on GMY. Formal training and mentorship in (T1) mechanism-driven intervention development and testing, (T2) user-centered design, (T3) community-engaged research, and (T4) implementation science will support the successful execution of the primary research aims and Dr. Price’s career development. The immense resources available at Boston College, coupled with the vast expertise of Dr. Price’s mentorship and advisory team members, will further ensure the success of the research and training aims, and pave the way for a future RCT of the training intervention.