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Principal Investigator: JONATHAN Edward ALPERT
Organization: ALBERT EINSTEIN COLLEGE OF MEDICINE
Fiscal Year: 2024
Award: $839,995
Funding agency: National Institute of Mental Health
PROJECT SUMMARY / ABSTRACT
In response to PAR-20-237, “community interventions to address the consequences of the COVID-19 pandemic
among health disparity and vulnerable populations,” we propose to study a parent-focused mentalizing
intervention with a smartphone health platform in vulnerable populations in the Bronx. The Bronx—the poorest
borough in New York City (NYC) with 84% of its population comprised of minorities—has been hit
disproportionally by the COVID-19 pandemic. For caregivers in the Bronx, the pandemic has caused
unprecedented psychological distress; in addition to combating social determinants of health (SDOH), these
families now face greater financial insecurity and challenges related to their school-aged children. Furthermore,
social distancing requirements and limited telehealth resources for Bronx families have posed greater barriers
to healthcare. Such parental distress contributes to heightened risk of transgenerational cycles of psychological
stress, trauma and maltreatment. Addressing these challenges, we propose a multimodal study tackling both
parental vulnerability and healthcare access. a) Targeting parental vulnerability, we propose to build upon our
12-session therapeutic CARE program, which utilizes Mentalization Based Therapy and designed for parents of
children in treatment in a community psychiatry clinic in our health system. Multiple randomized controlled trials
(RCTs) of attachment-based parenting interventions, including from our group in disadvantaged cohorts from
the Bronx. b) Targeting healthcare access, we propose to utilize the HIPAA-compliant and IRB-approved Valera
Health smartphone application (“app”), which has been studied in our health system in selected cohorts and
resulted in greater access to healthcare. Building upon our work and clinical infrastructure, we hypothesize that
both the CARE program and the Valera app will mitigate the psychological effects of COVID-19 while enhancing
access to healthcare in the Bronx. The study will take place at Montefiore Medical Center (MMC), the largest
health system in the Bronx, which serves predominantly racial and ethnic minority individuals from underserved
families. We will focus on three highly vulnerable cohorts: a) caregivers of children with psychiatric conditions
(N=130); b) caregivers of children with autoimmune illnesses (N=130), and; c) caregivers who are frontline
healthcare workers at MMC (N=100); all presenting with moderate stress. A RCT with 4 arms (2 x 2 design) will
test our hypothesis: a) CARE program alone; b) CARE program + Valera app; c) Parent Education (PE) alone;
d) PE + Valera app. Smartphones and connectivity will be provided as needed. Surveys at study enrollment, 6-,
12- and 24-weeks will assess parental stress, mentalizing capacity (reflective functioning), access to healthcare,
mood and anxiety and additional parent and child clinical measures. Machine learning approaches will explore
complex patterns as predictors of outcome including COVID-19 illness/deaths, medical comorbidity, housing,
poverty, psychopathology, age, family functioning, and trauma. Impact. This multimodal study addresses key
strategies to mitigate the psychological and health impact of COVID-19 in vulnerable populations.
Terms: <0-11 years old><Active Follow-up><Address><Adherence><Age><Android App><Android Application><Anxiety><Autoimmune><COVID crisis><COVID epidemic><COVID pandemic><COVID-19><COVID-19 affected><COVID-19 consequence><COVID-19 crisis><COVID-19 effect><COVID-19 epidemic><COVID-19 era><COVID-19 global health crisis><COVID-19 global pandemic><COVID-19 health crisis><COVID-19 impact><COVID-19 impacted><COVID-19 pandemic><COVID-19 pandemic affected><COVID-19 pandemic consequence><COVID-19 pandemic effects><COVID-19 pandemic impact><COVID-19 pandemic impacted><COVID-19 period><COVID-19 public health crisis><COVID-19 years><CV-19><Care Givers><Care Manager><Caregivers><Caring><Case Manager><Cell Phone><Cell Phone Application><Cell phone App><Cellular Phone><Cellular Phone App><Cellular Phone Application><Cellular Telephone><Cessation of life><Child><Child Mental Health><Child Youth><Children (0-21)><Clinic><Clinical><Community Psychiatry><Complex><Coronavirus Infectious Disease 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pandemic><SARS-coronavirus-2 epidemic><SARS-coronavirus-2 pandemic><Sample Size><School-Age Population><Schools><Security><Severe Acute Respiratory Syndrome CoV 2 epidemic><Severe Acute Respiratory Syndrome CoV 2 pandemic><Severe acute respiratory syndrome coronavirus 2 epidemic><Severe acute respiratory syndrome coronavirus 2 pandemic><Smart Phone App><Smart Phone Application><Smartphone App><Social Distance><Stress><Substance Use Disorder><Survey Instrument><Surveys><Technology><Testing><Therapeutic><Trauma><Underserved Population><United States Health Insurance Portability and Accountability Act><United States National Institutes of Health><Vulnerable Populations><Work><abnormal psychology><access to health care><access to healthcare><accessibility of health care><accessibility to health care><accessibility to healthcare><active followup><ages><anxiety symptoms><anxious symptom><arm><assess effectiveness><barrier to care><barrier to health care><barrier to healthcare><barrier to 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effectiveness><determine efficacy><digital platform><effectiveness assessment><effectiveness evaluation><effects following the COVID-19 pandemic><efficacy analysis><efficacy assessment><efficacy determination><efficacy evaluation><efficacy examination><enroll><ethnic minority group><ethnic minority individual><ethnic minority people><ethnic minority population><evaluate effectiveness><evaluate efficacy><evidence base><examine effectiveness><examine efficacy><experience><faces><facial><financial adversity><financial burden><financial distress><financial insecurity><financial strain><financial stress><follow up><follow-up><followed up><followup><health care access><health care availability><health care personnel><health care service access><health care service availability><health care worker><health disparity community><health disparity group><health disparity populations><health provider><health workforce><healthcare access><healthcare accessibility><healthcare availability><healthcare personnel><healthcare service access><healthcare service availability><iOS app><iOS application><iPhone><iPhone App><iPhone Application><impact of the SARS-CoV-2 pandemic><improved><innovate><innovation><innovative><interventional strategy><kids><machine based learning><maltreatment><measurable outcome><medical personnel><member><mentalization><mistreatment><mobile phone app><mood symptom><multi-modality><multimodality><obstacle to care><obstacle to healthcare><online care><online health care><online healthcare><outcome measurement><outcome prediction><pandemic><pandemic associated stress><pandemic disease><pandemic induced stress><pandemic related stress><pandemic stress><parent><parenting education intervention><parenting education programs><parenting intervention><parenting program><parenting skill training><parenting training><perceived stress><perception of stress><pilot study><primary care giver><primary caregiver><primary outcome><programs><prospective><psychologic><psychological><psychological distress><racial minority group><racial minority individual><racial minority people><racial minority population><randomized control trial><relative effectiveness><response><school age><self-reported stress><severe acute respiratory syndrome coronavirus 2 global health crisis><severe acute respiratory syndrome coronavirus 2 global pandemic><smart phone><smartphone><smartphone application><smartphone based app><smartphone based application><social health determinants><stress due to pandemic><stress during the pandemic><stress perception><substance use and disorder><substance use treatment><telehealth><treatment provider><under served group><under served individual><under served people><under served population><underserved group><underserved individual><underserved people><vulnerable community><vulnerable group><vulnerable individual><vulnerable people><youngster>