Expanding minority youth access to evidence-based care: A pilot effectiveness trial of a digital mental health intervention

扩大少数族裔青年获得循证护理的机会：数字心理健康干预措施的试点有效性试验

• 批准号: 10647287
• 负责人: ERUM NADEEM
• 金额: $ 27.19万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-01 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10647287
• 关键词: Academy; Address; Adolescent; Adolescent Psychiatry; Adult; Affect; American; Anxiety; Behavioral; Black race; COVID-19; Caring; Child Psychiatry; Clinical; Cognition; Communities; Consent; Coping Skills; Disease; Dose; Economics; Education; Effectiveness; Ethnic Origin; Evidence based intervention; Exhibits; Exposure to; Family; Feedback; Feeling suicidal; Focus Groups; Fright; Health Services Accessibility; Health Technology; Hybrids; Immigrant family; Improve Access; Intervention; Interview; Judgment; Latinx; Low income; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Moods; National Health Services; National Institute of Mental Health; Outcome; Outcome Assessment; Parents; Participant; Pediatrics; Persons; Phase; Population; Prevalence; Privacy; Public Health; Randomized; Randomized, Controlled Trials; Research; School Health Services; Schools; Services; Stress; Students; Suicide attempt; Surgeon; Symptoms; Technology; Testing; Transportation; Youth; acceptability and feasibility; anxiety symptoms; barrier to care; cost; depressive symptoms; digital; digital health; digital healthcare; digital intervention; digital mental health; digital tool; disorder risk; effective intervention; effectiveness trial; effectiveness/implementation trial; emotion regulation; ethnic minority; evidence base; experience; functional improvement; high school; implementation strategy; improved; innovation; minority children; pandemic disease; peer; programs; racial disparity; racial minority; reduce symptoms; school based health center; screening; social stigma; stressor; substance use; suicidal risk; suicide rate; trauma exposure; treatment as usual; university student; vulnerable adolescent

PROJECT ABSTRACT The prevalence of anxiety and depression are high among adolescents. COVID-19-related stressors have increases rates of internalizing disorders and risk for suicide, especially among ethnic minority adolescents who have been disproportionately affected by the pandemic. Although evidence-based interventions are effective, the vast majority ethnic minority adolescents do not access any MH care. School-based MH services can address common barriers to care such as cost and transportation. However, even with access to school- based MH services, capacity can be highly limited in schools, and some adolescents may be reticent to seek services at school due to concerns about privacy, judgment, and academic disruption. Innovative approaches to provide accessible, low-cost, evidence-based MH care to minority youth are urgently needed. Technology creates an opportunity to treat youth in need of MH services and could expand the reach of school health services. Despite the potential impact of digital care, to date there are no studies examining whether digital mental health interventions improve service access for vulnerable youth served by school-based mental health services. Consistent with NIMH Notice of Information MH-18-031 designating digital health technology as a priority, this application proposes to determine the feasibility and acceptability of delivering SilverCloud, a clinician-guided, empirically-supported, app-based, CBT program to vulnerable adolescents through school- based health centers (SBHCs). In contrast to most MH apps, SilverCloud has demonstrated strong engagement and medium-to-large effect sizes. Its features, including personalized feedback, stories from relatable peers, and routine outcome assessment, directly promote engagement. This would be the first trial to evaluate SilverCloud as a school-based intervention and refine it to meet the needs of low income, ethnic/racial minority youth. We propose a four-phase study conducted at two diverse, public schools in Brooklyn. In Phase I, participants who endorse internalizing symptoms (n=20) during routine MH screening at the SBHC will participate in an open trial of SilverCloud. In Phase II, open trial participants will provide feedback that will be used to refine the SilverCloud program. In Phase III participants will be screened (PHQ-9/GAD-7). Those who endorse symptoms will be randomized (N=100) to SilverCloud or treatment as usual (TAU). Outcomes will be evaluated each semester. In Phase IV, participant and stakeholder feedback will be collected systematically to further inform program adaptations and implementation strategy refinement for a large effectiveness trial. Primary aims are to establish the feasibility, acceptability, and preliminary effectiveness of SilverCloud among minority youth served through SBHCs and to examine whether SilverCloud changes engagement (i.e., initiation, dose) and clinical (i.e., emotion regulation, negative cognitions, coping skills, behavioral activation) targets, and whether changes are associated with clinical benefit (i.e., reduction in depression and anxiety).

项目摘要 青少年的焦虑和抑郁症患病率很高。共vid-19与19型应激源具有 增加内在疾病的率和自杀风险，尤其是在少数民族青少年中 受到大流行的影响不成比例的。尽管基于证据的干预措施是 有效，绝大多数少数民族青少年无法获得任何MH护理。基于学校的MH服务 可以解决诸如成本和运输之类的普通护理障碍。但是，即使可以上学 - 基于MH的服务，能力在学校中可能受到高度限制，一些青少年可能是沉默寡言的 由于担心隐私，判断和学术破坏，在学校的服务。创新的方法 迫切需要为少数族裔青年提供可访问的低成本，基于证据的MH护理。技术 创造机会治疗需要MH服务的青年，并可以扩大学校健康的影响 服务。尽管数字护理有潜在的影响，但迄今为止，尚无研究研究数字 心理健康干预措施改善了基于学校心理健康服务的脆弱青年的服务访问 服务。与NIMH信息通知MH-18-031一致 优先级，本申请建议确定交付Silvercloud的可行性和可接受性 临床医生指导，经验支持的，基于应用的CBT计划，通过学校向脆弱的青少年提供 基于健康中心（SBHC）。与大多数MH应用相反，SilverCloud表现出强大 参与度和中度到大效应大小。它的功能，包括个性化的反馈，来自 相关的同行和常规结果评估，直接促进参与度。这将是第一个试用 评估SilverCloud作为学校的干预措施，并将其改进以满足低收入，种族/种族的需求 少数民族青年。我们提出了一项在布鲁克林的两所不同的公立学校进行的四阶段研究。在阶段 我，在常规MH筛查SBHC期间认可内部症状（n = 20）的参与者将 参加SilverCloud的公开试验。在第二阶段，开放式试验参与者将提供反馈 用于完善SilverCloud程序。在第三阶段的参与者将进行筛选（PHQ-9/GAD-7）。那些人 认可症状将被随机（n = 100）作为silvercloud或像往常一样（tau）。结果将是 评估每个学期。在第四阶段，参与者和利益相关者的反馈将系统地收集到 进一步告知计划适应和实施策略改进，以进行大型有效试验。 主要目的是建立SilverCloud的可行性，可接受性和初步效果 少数民族青年通过SBHC服务，并检查SilverCloud是否改变了参与度（即 启动，剂量）和临床（即情绪调节，负认知，应对技能，行为激活） 目标，以及变化是否与临床益处相关（即减少抑郁和焦虑）。