International Latino Research Partnership (ILRP)

Through a grant funded by the National Institute on Drug Abuse (NIDA) the Center for Multicultural Mental Health Research at Cambridge Health Alliance is testing a screening and intervention project designed to improve the quality of care for Latino patients with comorbid mental health and substance use problems. We will first test a screening of comorbid problems with patients identified in mental health as well as primary health care. Building on that work, we will test the feasibility, acceptability and efficacy of the "Integrated Intervention for Dual Problems and Early Action" (IIDEA) intervention addressing mental health, substance use, and prevention of HIV, as well as a smoking cessation supplement. The project is being conducted in Massachusetts as well as at two sites in Spain. As such, the proposed ILRP multi-site international project is a critical step towards developing models of integrated care for the large and diverse Latino migrant population and more broadly towards understanding how best to integrate evidence-based assessment and treatments for co-occurring substance and mental health problems and HIV risks.

Study Overview

• Status: Completed
• Conditions: Substance Use (Drugs, Alcohol)
• Intervention / Treatment: Behavioral: Integrated Intervention for Dual Problems and Early Action

Detailed Description

Our study aims to conduct behavioral health services research focused on rapid screening and referral; as well as testing the feasibility, acceptability and efficacy of integrated behavioral health services in primary care clinics for migrant Latinos with co-occurring substance use and mental health problems, and increased risk of HIV.

A key activity for the first phase, the screening project, is administering a screener to at least 450 Latino migrant patients across the 3 sites (n=150 each in Boston, Madrid, and Barcelona) from primary care and behavioral health (substance abuse and mental health) services. We intend to test the referral process for screened participants in need of treatment to identify barriers and streamline the process. We will analyze data to optimize the screening battery and protocol to use in Phase 2, the IIDEA intervention.

In Phase 2, we intend to enroll, randomize and collect data on 360 total patients across the 3 sites - 180 in the intervention condition and 180 in the control condition (120 in each site, 60 in the intervention condition and 60 in the control condition). The 10 session IIDEA intervention will be offered to Latino patients by trained clinicians with at least a Masters level of training. The intervention is designed to help patients to address and prevent mental health and substance use problems and will be culturally adapted to Latino populations in Boston, Madrid and Barcelona. Usual care - the control group - receives treatment as usual, for patients in primary care identified with a mental health or substance use problem. 5 Research interviews will be conducted to assess outcomes, for patients in both the intervention and usual care arms.

• Study Type: Interventional
• Enrollment (Anticipated): 360
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Spain
  • Madrid, Spain
    • Universidad Autonoma de Madrid Medical School
  • Catalonia
    • Barcelona, Catalonia, Spain
      • Vall d'Hebron University Hospital
• United States
  • Massachusetts
    • Somerville, Massachusetts, United States, 02143
      • Cambridge Health Alliance

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 70 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Latino migrants
• Must speak English or Spanish
• 18-70 years of age
• Screen positive to at least one substance use and one mental health problem

Exclusion Criteria:

• Current or recent (last 3 months) substance use treatment (more than 1 visit with a provider at a behavioral health clinic)
• Planning to receive behavioral health services (i.e., have an appointment scheduled in the next 2 months)
• Evidence that the patient lacks capacity to consent to the study
• Evidence of current suicidal risk or harm to others (affirmative responses to questions 4 and/or 5 on Paykel suicide questionnaire)- patient can be rescreened in 30 days

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: IIDEA; Patients in the Integrated Intervention for Dual Problems and Early Action (IIDEA) arm will receive the 10 session intervention administered in person and via telephone.	Behavioral: Integrated Intervention for Dual Problems and Early Action; Integrated Intervention for Dual Problems and Early Action (IIDEA) includes psycho-education, Cognitive Behavioral Therapy and mindfulness; identifies triggers and challenging thoughts; provides motivational techniques for reducing substance use and/or smoking cravings; incorporates cognitive restructuring to identify and correct negative thinking patterns influenced by depression, anxiety and/or trauma; and includes self-monitoring of thoughts and risk behaviors that contribute to substance use, smoking and increased HIV risk.
No Intervention: Usual Care; Patients in this arm receive usual care for dual-diagnosis symptoms of mental health and substance use. They receive 5 check-in calls from a care manager to assess safety.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Addiction Severity Index (ASI) - Alcohol (change)	The ASI is a semi-structured interview designed to address seven potential problem areas in substance-abusing patients; this outcome measure refers to the Alcohol problem area.	Baseline, 2 months, 4 months, 6 months, 12 months
Addiction Severity Index (ASI) - Drugs (change)	The ASI is a semi-structured interview designed to address seven potential problem areas in substance-abusing patients; this outcome measure refers to the Drug problem area.	Baseline, 2 months, 4 months, 6 months, 12 months
Change on Urine Drug Test (change)	Technical analysis of a biological specimen (urine) to determine the presence or absence of specified parent drugs or their metabolites.	Baseline, 2 months, 4 months, 6 months, 12 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Generalized Anxiety Disorder 7-item (GAD-7) Scale (change)	The GAD-7 is a questionnaire for screening and severity measuring of generalized anxiety disorder (GAD).	Baseline, 2 months, 4 months, 6 months, 12 months
PTSD Checklist for DSM-V (PCL-5)	The PCL-5 is is a 20-item self-report measure that assesses the 20 DSM-5 symptoms of PTSD.	Baseline, 2 months, 4 months, 6 months, 12 months
Patient Health Questionnaire (PHQ-9) (change)	The PHQ-9 is a 9-item screening questionnaire to determine level of depressive disorder.	Baseline, 2 months, 4 months, 6 months, 12 months
Hopkins Symptom Checklist-20	The HSCL-20 is a symptom inventory for depression that indicates severity of psychological distress.	Baseline, 2 months, 4 months, 6 months, 12 months

Collaborators and Investigators

• Sponsor: Massachusetts General Hospital
• Collaborators: National Institute on Drug Abuse (NIDA); Universidad Autonoma de Madrid; Hospital Vall d'Hebron
• Investigators: Principal Investigator: Margarita Alegria, Ph.D., CMMHR, Cambridge Health Alliance and Harvard Medical School; Principal Investigator: Enrique Baca-Garcia, Ph.D., Universidad Autonoma de Madrid; Principal Investigator: Francisco Collazos, MD, Vall d'Hebron University Hospital

Publications and helpful links

General Publications

• Levison JH, Alegria M, Wang Y, Markle SL, Fuentes L, Mejia DL, Tarbox A, Albarracin Garcia L, Cellerino L, El-Bassel N. High HIV/STI Test Acceptance Through a Behavioral Health Encounter in Latino Immigrants with Substance Use and Mental Health Problems. AIDS Behav. 2019 Apr;23(4):835-846. doi: 10.1007/s10461-019-02413-y.
• Alegria M, Falgas-Bague I, Collazos F, Carmona Camacho R, Lapatin Markle S, Wang Y, Baca-Garcia E, Le Cook B, Chavez LM, Fortuna L, Herrera L, Qureshi A, Ramos Z, Gonzalez C, Aroca P, Albarracin Garcia L, Cellerino L, Villar A, Ali N, Mueser KT, Shrout PE. Evaluation of the Integrated Intervention for Dual Problems and Early Action Among Latino Immigrants With Co-occurring Mental Health and Substance Misuse Symptoms: A Randomized Clinical Trial. JAMA Netw Open. 2019 Jan 4;2(1):e186927. doi: 10.1001/jamanetworkopen.2018.6927.

Helpful Links

• Project Website

Study record dates

Study Major Dates

• Study Start: April 1, 2014
• Primary Completion (Actual): February 28, 2017
• Study Completion (Actual): February 28, 2017

Study Registration Dates

• First Submitted: January 14, 2014
• First Submitted That Met QC Criteria: January 15, 2014
• First Posted (Estimate): January 17, 2014

Study Record Updates

• Last Update Posted (Actual): May 1, 2017
• Last Update Submitted That Met QC Criteria: April 27, 2017
• Last Verified: April 1, 2017

More Information

Terms related to this study

• Keywords: Mental health; Substance use; Latino; HIV risk; Dual-diagnosis
• Additional Relevant MeSH Terms: Mental Disorders; Chemically-Induced Disorders; Substance-Related Disorders
• Other Study ID Numbers: CHA-IRB-0910/06/12; R01DA034952-01A1 (U.S. NIH Grant/Contract)