A Multimodal Parent-focused Intervention for Vulnerable Populations in the Bronx

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.

Grant Number: 5R01MH126821-05
NIH Institute/Center: NIH
Principal Investigator: JONATHAN ALPERT