Mental Health Skills for Latino Assistants in Primary Care

描述（由申请人提供）：尽管精神障碍的患病率与白人相似，但与三分之一的白色成年人相比，只有十一分之一的拉丁美洲精神障碍成年人接受服务。即使考虑到健康状况和社会经济地位的中介作用，拉丁裔使用心理健康服务的差异仍然存在。拉丁美洲人报告开放接受精神卫生服务，特别是从初级保健提供者，但面临的障碍与语言，期望，以及患者与医生沟通风格的差异。社区卫生工作者和患者激活模型已被应用于初级保健中的这些障碍，但不适用于孕产妇和儿童心理健康问题。目标和具体目的：该项目将制定和评估一项干预措施，以改善拉丁美洲母亲和儿童在初级保健中的心理健康服务。干预措施将培训母语为西班牙语的拉丁美洲准专业人员，以帮助母亲和儿童（1）在访问前与医生讨论心理健康问题;（2）制定访问议程;（3）克服心理健康治疗后续工作的障碍。辅助专业人员还将帮助初级保健提供者了解母亲和儿童可能表达与心理健康有关的关切的特定文化方式。这一干预发展建议的具体目标是确定是否是可行的培训辅助人员的技能，促进使用心理健康服务，如果培训被认为是从事辅助人员和有用的医生，他们支持，如果干预改变治疗的相互作用和中间结果预测其基础理论模型。方法：这项研究发生在一个独立的社区中心，为低收入的拉丁美洲母亲和儿童提供初级保健服务。它将招募375对父母-子女（3-16岁的儿童），采用事前事后设计来评估辅助专业人员培训的影响。培训中的技能来自以患者为中心的互动，以解决方案为中心的认知疗法和动机增强的文献;培训是基于一个类似的模型成功地与初级保健提供者自己。培训具有高度互动性，可以将准专业人员的文化知识与调查人员传授的沟通/启动技能相结合。三波数据收集将首先建立检测和讨论心理健康问题的基线，然后查看培训的影响，然后在6个月后评估培训效果的持续性。公共卫生相关性：辅助专业人员通常受雇于诊所环境和多元文化社区，以促进有效的护理。提高他们促进有效讨论心理健康问题的能力，可能是减少拉丁美洲人和其他族裔群体心理保健文化障碍的一种有效和可复制的方法。

DESCRIPTION (provided by applicant): Despite a similar prevalence of mental disorders as whites, only 1 in 11 Latino adults with a mental disorder receive services compared to 1 in 3 white adults. Differences in Latino's use of mental health services persist even after accounting for health status and the mediating effect of socioeconomic status. Latinos report openness to receipt of mental health services in general and from primary care providers in particular, but face barriers related to language, expectations, and differences in styles of patient-doctor communication. Community health worker and patient activation models have been applied to these sorts of barriers in primary care, but not for maternal and child mental health problems. Goals and specific aims: This project will develop and evaluate an intervention to improve the delivery of mental health services to Latino mothers and children in primary care. The intervention will train native Spanish-speaking Latino paraprofessionals to help mothers and children (1) articulate mental health concerns for discussion with their doctor prior to the visit; (2) formulate an agenda for the visit; and (3) overcome barriers to follow-through with mental health treatment. The paraprofessionals will also help primary care providers understand culturally-specific ways in which mothers and children may express concerns related to mental health. The specific aims of this intervention development proposal are to determine if it is feasible to train paraprofessionals in skills that promote use of mental health services, if the training is perceived as engaging to the paraprofessionals and useful to the physicians they support, and if the intervention alters therapeutic interactions and intermediate outcomes as predicted by its underlying theoretical model. Methods: The study takes place in a free-standing community center providing primary care services to low- income Latino mothers and children. It will enroll 375 parent-child pairs (children ages 3-16), using a pre-post design to evaluate the impact of paraprofessionals' training. Skills in the training come from the literature on patient-centered interaction, solution-focused cognitive therapy, and motivational enhancement; the training is based on a similar model successfully employed with primary care providers themselves. The training is highly interactive, allowing for combining the culturally specific knowledge of the paraprofessionals with the communication/activation skills taught by the investigators. Three waves of data collection will first establish a baseline for detection and discussion of mental health issues, then look at the impact of the training, and then assess persistence of training effects 6 months later. PUBLIC HEALTH RELEVANCE: Paraprofessionals are commonly employed to promote efficient care in clinic settings and in multicultural communities. Improving their ability to promote the effective discussion of mental health concerns could be an efficient and replicable method for reducing cultural barriers to mental health care among Latinos and other ethnic groups.