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

项目摘要/摘要 针对PAR-20-237，“应对新冠肺炎大流行后果的社区干预措施” 在健康差距和弱势人群中，我们建议研究以父母为中心的心理化 利用智能手机健康平台对布朗克斯脆弱人群进行干预。布朗克斯--最贫穷的地区 纽约市(NYC)84%的人口由少数族裔组成的行政区-已经受到打击 不成比例地受到新冠肺炎大流行的影响。对于布朗克斯的照顾者来说，大流行已经导致 前所未有的心理痛苦；除了与健康的社会决定因素(SDOH)作斗争外，这些 家庭现在面临着更大的经济不安全和与其学龄儿童相关的挑战。此外， 对于布朗克斯家庭来说，社交距离要求和有限的远程医疗资源构成了更大的障碍 为了医疗保健。这种父母的痛苦增加了跨代心理循环的风险 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，既要解决这两个问题 父母的脆弱性和医疗保健的可获得性。A)针对父母的脆弱性，我们建议在我们的 12个疗程的治疗护理计划，利用基于精神化的治疗，专为 在我们卫生系统的社区精神科诊所接受治疗的儿童。多个随机对照试验 (RCT)基于依恋的育儿干预措施，包括来自我们弱势群体的 布朗克斯。B)针对医疗保健准入，我们建议使用符合HIPAA和IRB批准的Valera 健康智能手机应用程序(APP)，它已经在我们的健康系统中进行了选定的队列和 结果是更容易获得医疗保健。根据我们的工作和临床基础设施，我们假设 CARE计划和Valera应用程序都将缓解新冠肺炎的心理影响，同时增强 在布朗克斯区获得医疗服务。这项研究将在蒙特菲奥里医疗中心(MMC)进行，这是世界上最大的医疗中心 布朗克斯区的卫生系统，主要为服务不足的种族和少数民族提供服务 家人。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)患有自身免疫性疾病的儿童的照顾者(N=130)；以及；c)第一线的照顾者 MMC的医护人员(N=100)；所有人都有中等压力。4臂RCT(2 x 2设计)将 检验我们的假设：a)单独的CARE计划；b)CARE计划+Valera应用程序；c)单独的家长教育(PE)； D)PE+Valera APP。将根据需要提供智能手机和连接。研究登记时的调查，6-， 12周和24周将评估父母的压力、意念能力(反思能力)、获得医疗保健的机会、 情绪和焦虑以及其他亲子临床措施。机器学习方法将探索 预测结果的复杂模式，包括新冠肺炎疾病/死亡、医疗合并症、住房、 贫穷、精神病、年龄、家庭功能和创伤。冲击力。这项多模式研究解决了关键问题 缓解新冠肺炎对弱势人群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.