A Culturally Informed Tele-Intervention for Minority High Risk Youth and Parents

描述（由申请人提供）：本申请涉及广泛的挑战领域（01）行为，行为改变和预防以及特定的挑战主题，06-MD-101* 远程医疗工具的开发，以促进健康并通过低成本，移动的和无线技术将处于风险中的青年与卫生系统联系起来。拟议的研究旨在加强，完善和测试文化知情和灵活/量身定制的高风险少数民族青少年及其父母，主要是通过移动的/无线系统提供的干预。这项研究的重点是高风险的非洲裔美国人和西班牙裔青少年及其父母。艾滋病毒、艾滋病、性传播感染、抑郁症和自杀企图的发生率表明，未经治疗的高风险发展轨迹导致了一些重大的健康差距。拟议的研究汇集了两个团队，他们拥有强大的创新和研究计划，一个团队拥有使用技术提供心理干预的专业知识，另一个团队拥有为高风险少数民族青年开发和测试文化知情治疗的专业知识。这种独特的合作有望加速每个团队的个人轨迹，并为高危青少年提供高度创新的远程干预。这项研究：1）完善和加强了原来的文化知情和灵活的以家庭为基础的青少年治疗（CIFFTA），以满足非洲裔美国人和西班牙裔高危青年的需求，2）完善了创新的无线移动的技术，以多媒体格式提供干预，包括文本，音频，视频和图形，3）对新的干预措施及其实施系统进行试点测试，对10个家庭实施干预措施，并进行焦点小组讨论，以确定改进措施，和4）对80名12-15岁的非洲裔美国人和西班牙裔青少年进行中等规模的随机试验，以测试可行性、可接受性，并获得对关键风险因素的初步效应量估计（行为问题、学业失败、危险性行为、家庭冲突）。最初的CIFFTA旨在以灵活的形式解决少数民族青年面临的独特压力，从而选择最“适合”青年临床需求和文化特征的干预措施。它的目标是：1）减少家庭风险（例如，不良的养育方式，家庭冲突）和日益增加的保护因素（例如，亲子依恋），2）教授青少年和父母的技能，3）提供文化上一致的材料（例如，处理歧视问题），以及4）使用灵活的治疗手册，根据少数群体家庭的独特特点和需要调整治疗方法（Stenbeban & Mena，出版中）。通过修改和加强显示出有希望的初步数据的原始CIFFTA，并将其调整为便于青少年使用的无线和移动的技术，干预措施有可能缓解服务利用不足和无法在青年最需要的时候向他们提供干预措施的问题。干预措施将设法查明青少年生活中的高危人群、时间和地点，以便在最脆弱的时候与青年接触，并采取有针对性的干预措施。非洲裔美国人和西班牙裔青少年中艾滋病毒、艾滋病、性传播感染、抑郁症和自杀企图的发生率表明，未经治疗的高风险发展轨迹可能导致一些重大的健康差距。拟议的研究汇集了两个团队，他们拥有强大的创新和研究计划，其中一个团队拥有使用技术提供心理干预的专业知识，而PI则拥有为高风险少数民族青年开发和测试文化信息和定制治疗的专业知识。拟议的研究旨在通过一项随机试验来增强、完善和测试一项针对高危少数民族青少年及其父母的文化知情和量身定制的干预措施，该干预措施将主要通过移动的/无线系统使用包括文本、音频、视频和图形在内的多媒体格式提供。

DESCRIPTION (provided by applicant): This application addresses broad Challenge Area (01) Behavior, Behavioral Change, and Prevention and specific Challenge Topic, 06-MD-101* Development of Telehealth Tools to Promote Health and Connect At-Risk Youth to the Health System via Low-Cost, Mobile, and Wireless Technologies. The proposed study is designed to enhance, refine, and test a culturally informed and flexible/tailored intervention for high risk minority adolescents and their parents that is delivered primarily via a mobile/wireless system. This study focuses on high risk African American and Hispanic adolescents and their parents. Rates of HIV, AIDS, STIs, depression and suicide attempts, point to some of the major health disparities that result from an untreated high risk developmental trajectory. The proposed research brings together two teams with strong programs of innovation and research, one with expertise in the use of technology to deliver psychosocial interventions and the PI who has expertise in the development and testing of culturally informed treatments for high risk minority youth. This unique collaboration promises to accelerate each team's individual trajectories and converge on a high innovative tele-intervention for high risk youth. The study: 1) refines and enhances the original Culturally Informed and Flexible Family-Based Treatment for Adolescents (CIFFTA) to meet the needs of African American and Hispanic high risk youth, 2) refines an innovative wireless mobile technology to deliver the intervention in a multi-media format that includes text, audio, video and graphics, 3) pilot tests the new intervention and its delivery system by implementing the intervention with 10 families and conducting focus groups to identify refinements, and 4) conducts a medium-sized randomized trial of 80 African American and Hispanic adolescents ages 12-15 to test for feasibility, acceptability, and to obtain preliminary effect size estimates on key risk factors (conduct problems, academic failure, risky sexual behavior, family conflict). The original CIFFTA was designed to address unique stressors faced by minority youth in a flexible format that leads to the selection of interventions that best "fit" the clinical needs and cultural characteristics of the youth. It targets: 1) reducing family risk (e.g., poor parenting practices, family conflict) and increasing protective factors (e.g., Parent-child attachment), 2) teaching adolescent and parents skills, 3) delivering culturally congruent material (e.g., handling discrimination), and 4) using a flexible treatment manual to tailor of the treatment to the unique characteristics and needs of minority families (Santisteban & Mena, in press). By modifying and enhancing the original CIFFTA that has shown promising preliminary data, and adapting it for a wireless and mobile technology that is user friendly for adolescents, the intervention has the potential to mitigate issues of underutilization of services and the inability of interventions to be accessible to youth in the moments they need them most. The intervention will seek to identify the high risk people, times of the day, and locations in the adolescents' lives so that contact is made with youth at those most vulnerable times and interventions can be tailored. Rates of HIV, AIDS, STIs, depression and suicide attempts among African American and Hispanic adolescents, point to some of the major health disparities that can result from an untreated high risk developmental trajectory. The proposed research brings together two teams with strong programs of innovation and research, one with expertise in the use of technology to deliver psychosocial interventions and the PI with expertise in the development and testing of culturally informed and tailored treatments for high risk minority youth. The proposed study is designed to enhance, refine, and test using a randomized trial, a culturally informed and tailored intervention for high risk minority adolescents and their parents that will be delivered primarily via a mobile/wireless system using a multi-media format that includes text, audio, video and graphics.