CRISOL Mente: A Multilevel Community Intervention to Reduce Mental Health Disparities Among Latinos

由于缺乏心理健康服务，美国的拉美裔美国人在获得心理健康服务方面存在显著差异 医疗保险、服务成本、对精神卫生资源的有限认识、精神健康污名以及 害怕被驱逐出境。英语水平有限，再加上严重缺乏双语和文化能力 医疗服务提供者进一步阻碍了拉美裔人充分获得高质量的心理健康服务。新冠肺炎大流行 只会扩大对心理健康护理的需求，并加剧拉美裔的心理健康差距 因此，迫切需要找到低成本、有效的战略来缩小这些差距。本5年期 该项目旨在开发和测试多层次的社区干预措施，以改善心理健康 结果并促进拉丁裔获得文化上合适的心理健康治疗 费城的社区。Crisol Mente将包括社会生态的各个层面的组成部分。 模式：依赖拉丁裔非专业卫生工作者(LHW)提供以诊所为基础的分级护理计划 心理健康服务(目标1)、外展和教育活动，以减少心理健康方面的污名 社区(目标2)，以及努力加强拉丁裔服务组织解决心理健康问题的能力 以及导致拉丁裔心理健康得不到治疗的其他共同疾病(目标3)。为了提高 精神健康症状和参与护理，我们将招募、培训和监督一批拉丁裔LHW 世卫组织将被嵌入两个拉丁裔服务诊所，扩大诊所的覆盖范围和有效性 心理健康服务。我们将比较三种不同级别的LHW参与的影响：a) 社区外展/导航(即社区成员的筛查和转介)；b)辅助护理(即 筛查、转介和帮助克服更好的心理健康障碍)；以及c)任务转移(即筛查， 转介、协助和监督提供基本精神健康治疗)。LHW还将进行 社区外展/教育活动(例如电台讲座、信息会议、社区场所的餐桌) 以减少心理健康方面的污名。我们经验丰富且以拉丁裔为主的社区学术研究团队将 还参与能力建设活动(如每月市政厅、年度务虚会、每周通讯、 提供培训和技术支持)与拉丁裔服务联盟--拉丁裔健康集体 组织。使用混合方法和RE-AIM框架，将评估Crisol Mente的影响 临床数据、基线和6个月的患者调查数据(每个LHW受累级别N=200)，以及 对社区成员的定性访谈(N=30)涉及LHW提供的精神卫生服务(目标1)； 来自两个拉美裔受访者驱动抽样(RDS)调查(N=400)的心理健康污名前后数据 每个)在2022年(初步研究)和2027年(目标2)进行；社区能力指标 2019年、2021年(初步研究)和2027年对拉丁裔服务组织的调查，以及主要 2019年(初步研究)和2027年(目标3)对拉丁裔服务提供者(N=30)的线人访谈(Kii)。

Latinos in the U.S. experience significant disparities in access to mental health services due to lack of health insurance, cost of services, limited awareness of mental health resources, mental health stigma, and fear of deportation. Limited English proficiency coupled with an acute lack of bilingual and culturally competent providers further impede Latinos’ adequate access to quality mental health services. The COVID-19 pandemic has only amplified the need for mental health care and exacerbated mental health disparities for Latino communities, making it urgent to identify low-cost, effective strategies to reduce these gaps. This 5-year project seeks to develop and test a multi-level, community intervention to improve mental health outcomes and promote access to culturally appropriate mental health treatment for Latino communities in Philadelphia. CRISOL Mente will include components at various levels of the socio-ecological model: a clinic-based, stepped-care program relying on Latino lay health workers (LHW) for the delivery of mental health services (Aim 1), outreach and education activities to reduce mental health stigma in the community (Aim 2), and efforts to strengthen Latino-serving organizations’ capacity to address mental health and other syndemic conditions contributing to untreated mental health among Latinos (Aim 3). To improve mental health symptoms and engagement in care, we will recruit, train and supervise a cohort of Latino LHW who will be embedded into two Latino-serving clinics, extending the reach and effectiveness of the clinics’ mental health services. We will compare the impact of three different levels of LHW involvement: a) community outreach/navigation (i.e. screening and referral of community members); b) auxiliary care (i.e. screening, referral, and help overcoming barriers to better mental health); and c) task shifting (i.e. screening, referral, assistance, and supervised delivery of basic mental health treatment). The LHWs will also conduct outreach/education activities in the community (e.g. radio talks, info sessions, tables in community venues) to reduce mental health stigma. Our experienced and largely Latino community-academic research team will also engage in capacity building activities (i.e. monthly town halls, annual retreats, weekly newsletters, provision of trainings and technical support) with the Latino Health Collective, a coalition of Latino-serving organizations. Using mixed-methods and the RE-AIM framework, CRISOL Mente’s impact will be evaluated with clinical data, baseline and 6-month patient survey data (N=200 from each level of LHW involvement), and qualitative interviews with community members (N=30) referred to mental health services by the LHW (Aim 1); pre/post mental health stigma data from two respondent driven sampling (RDS) surveys of Latinos (N=400 each) conducted in 2022 (preliminary study) and in 2027 (Aim 2); community capacity indicators from three surveys of Latino-serving organizations conducted in 2019, 2021 (preliminary studies) and 2027, and key informant interviews (KII) with Latino-serving providers (N=30) in 2019 (preliminary study) and 2027 (Aim 3).