Telemedicine for Mental Health Services for the Linguistically Isolated: A Pilot

描述(由申请人提供)：缺乏文化和语言上合适的精神卫生专业人员是当前精神卫生系统的一个严重限制。对于居住在语言偏僻地区、英语水平有限的种族/少数民族来说，这一限制变得更加成问题。作为增加获得心理健康服务的一种手段，我们建议使用属于远程医疗类别的技术。远程医疗已被证明是实施身心健康干预措施的有效工具。通常用于在农村地区提供护理，通过视频会议技术进行远程咨询非常适合具有语言或文化障碍的少数民族人口获得适当心理健康护理的机会有限或无法获得的情况，无论他们住在哪里。远程咨询也可能是有效的，允许客户避免向同一紧密社区的临床医生透露问题的尴尬。为了进一步减少在少数族裔中经常出现的心理健康治疗的耻辱，我们建议在大学环境中设立一个远程咨询中心。这项拟议的试点研究针对的是一个对心理健康服务的需求增加但获得机会有限的群体：佛罗里达州的韩裔美国人。然而，结果将成为改善任何语言孤立人口获得精神卫生保健的机会的典范。这项研究的总体目标是开发和评估远程销售计划。该项目将由南佛罗里达大学(USF)的一个研究小组与纽约的韩裔美国人行为健康协会(Kabha)合作进行。卡巴的三名双语成员将担任顾问，他们的实践基于认知行为疗法(CBT)。该咨询将提供给居住在坦帕湾地区的韩裔美国成年人，他们可能患有抑郁症(PHQ-9的e-10分)。我们预计有24名参与者(每个辅导员8名客户)。每个参与者都将在位于美国联邦的远程咨询接待中心接受咨询。采用混合方法，将对客户和顾问进行调查和深入访谈，以评估该计划。评估标准包括该计划的可行性(即依从性、可接受性、满意度)和有效性(即抑郁症状的变化)。该项目将提供一个模式，使那些需要文化和语言上适当服务的人能够获得服务。鉴于韩裔美国人只是遭受语言孤立的许多种族/少数民族群体之一，因此无法获得文化和语言上适当的服务，我们的方法将广泛适用于其他服务不足的人群，创造一种可复制的量身定制的治疗系统。 公共卫生相关性：针对改善英语水平有限的少数民族获得精神卫生服务的需要，该项目提议利用远程医疗作为提供服务的一种手段。该项目旨在开发和评估一个远程销售计划，将需要服务的韩裔美国人与在文化和语言上有能力的提供者联系起来，这些提供者在其他地方已经建立并随时可以获得。该项目对许多其他语言上与世隔绝的人群的服务提供具有影响。

DESCRIPTION (provided by applicant): The lack of culturally and linguistically appropriate mental health professionals is a serious limitation of the current mental health system. The limitation becomes even more problematic for racial/ethnic minorities with limited English proficiency who live in linguistically isolated areas. As a means of increasing accessibility to mental health services, we propose the use of technologies that fall into the category of telemedicine. Telemedicine has proven effectiveness as a vehicle for implementing both physical and mental health interventions. Commonly used to provide care in rural areas, remote counseling via videoconferencing technology is admirably suited for situations in which ethnic minority populations with language or cultural barriers have limited or no access to appropriate mental health care, regardless of where they live. Remote counseling may also be effective in allowing the client to avoid the discomfit of disclosing problems to clinicians who are members of the same close-knit community. In order to further reduce the stigma of mental health treatments often found among racial/ethnic minorities, we propose to position a telecounseling center in a university setting. The proposed pilot study targets one group with a heightened need for mental health services but limited access: Korean Americans in Florida. Results, however, will serve as a model for improving access to mental health care for any linguistically isolated population. The overall goal of the study is to develop and evaluate a telecounseling program. The project will be conducted by a research team at the University of South Florida (USF) in collaboration with the Korean American Behavioral Health Association (KABHA) in New York. Three bilingual members of KABHA whose practice is based on cognitive-behavioral therapy (CBT) will serve as counselors. The counseling will be available to Korean American adults with probable depression (score e 10 on the PHQ-9) who live in the Tampa Bay area. We anticipate 24 participants (eight clients per counselor). Each participant will receive counseling at a telecounseling reception center to be located at the USF. Using a mixed methods approach, both survey and in-depth interviews with clients and counselors will be conducted to evaluate the program. Evaluation criteria include feasibility (i.e., adherence, acceptability, satisfaction) and efficacy (i.e., changes in depressive symptoms) of the program. The project will provide a model for making services accessible to those in need of culturally and linguistically appropriate services. Given that Korean Americans are just one of many racial/ethnic minority groups that suffer from linguistic isolation and a consequent lack of access to culturally and linguistically appropriate services, our approach will have wide applicability to other underserved populations, creating a system of tailored treatment that can be replicated. PUBLIC HEALTH RELEVANCE: Responding to the need to improve access to mental health services for ethnic minorities with limited English proficiency, this project proposes to utilize telemedicine as a vehicle for service provision. The project is designed to develop and evaluate a telecounseling program that links Korean Americans in need of services with culturally and linguistically competent providers who are established and readily available elsewhere. This project holds implications for service delivery for many other linguistically isolated populations.