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、预防和特定挑战主题，06-MD-101*开发远程医疗工具，通过低成本、移动和无线技术促进健康并将高危青少年连接到医疗系统。这项拟议的研究旨在加强、完善和测试主要通过移动/无线系统为高危少数族裔青少年及其父母提供的文化知识和灵活/量身定制的干预措施。这项研究的重点是高危的非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、抑郁症和自杀未遂的比率表明，未经治疗的高风险发展轨迹导致了一些重大的健康差距。拟议的研究将两个拥有强大创新和研究计划的团队聚集在一起，一个团队拥有利用技术提供心理社会干预的专业知识，而PI拥有为高危少数族裔青年开发和测试了解文化知识的治疗方法的专业知识。这一独特的合作承诺将加快每个团队的个人发展轨迹，并汇聚为高危青年提供高度创新的远程干预。这项研究：1)改进和加强最初的基于文化的灵活的青少年家庭治疗(CIFFTA)，以满足非裔美国人和西班牙裔高危青年的需求；2)改进创新的无线移动技术，以包括文本、音频、视频和图形的多媒体格式提供干预；3)通过对10个家庭实施干预并进行焦点小组以确定改进，对新的干预及其提供系统进行试点测试；以及4)对80名12-15岁的非裔美国人和西班牙裔青少年进行中型随机试验，以测试可行性、可接受性、并获得关键风险因素(品行问题、学业失败、危险性行为、家庭冲突)的初步效应大小估计。最初的CIFFTA旨在以灵活的形式解决少数族裔青年面临的独特压力因素，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(如不良的育儿做法、家庭冲突)和增加保护因素(如亲子依恋)，2)教授青少年和父母技能，3)提供文化契合的材料(如处理歧视)，4)使用灵活的治疗手册，以适应少数群体家庭的独特特点和需要(Santisteban&Mena，正在出版中)。通过修改和加强最初的CIFFTA，显示出有希望的初步数据，并使其适应对青少年用户友好的无线和移动技术，干预措施有可能缓解服务未得到充分利用以及无法在青年最需要的时刻获得干预措施的问题。干预将寻求确定青少年生活中的高危人群、一天中的时间和地点，以便在最脆弱的时候与青少年接触，并根据需要进行干预。非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、抑郁和自杀企图的比率表明，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。拟议的研究将两个拥有强大创新和研究计划的团队聚集在一起，一个团队拥有利用技术提供心理社会干预的专业知识，而PI则拥有为高危少数族裔青年开发和测试了解文化知识的量身定制治疗的专业知识。这项拟议的研究旨在利用随机试验来加强、改进和测试，这是一种针对高危少数族裔青少年及其父母的文化信息和量身定做的干预措施，将主要通过移动/无线系统使用包括文本、音频、视频和图形的多媒体格式提供。

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.