Unpacking the Black Box of Problem-Solving: Dosage, Delivery, Culture, and Impact on Internalizing Problems for Adolescents

揭开解决问题的黑匣子：剂量、交付、文化以及对青少年问题内化的影响

• 批准号: 10539316
• 负责人: Maya M. Boustani
• 金额: $ 19.25万
• 依托单位: LOMA LINDA UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-01-01 至 2024-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10539316
• 关键词: Address; Adolescent; Age; Anxiety; Attention; Behavioral; Black race; Child; Code; Cognitive; Collaborations; Communication; Communities; Community Health Aides; Cultural Diversity; Data; Diagnostic; Educational process of instructing; Elements; Ensure; Family; Feedback; Feeling suicidal; Hispanic; Infusion procedures; Intervention; Interview; Lead; Literature; Mental Depression; Mental Health; Methods; Mind; Modification; National Institute of Mental Health; Not Hispanic or Latino; Outcome; Persons; Positioning Attribute; Prevention; Prevention program; Problem Solving; Process; Professional counselor; Provider; Psychotherapy; Readiness; Recording of previous events; Research; Resources; Risk; Risk Reduction; Scholarship; Schools; Science; Scientist; Self Direction; Self-Injurious Behavior; Service setting; Speed; Strategic Planning; Structure; Surveys; Testing; Time; Work; Youth; acceptability and feasibility; brief intervention; care providers; community partnership; comorbid depression; design; diagnostic value; dosage; ethnic minority; evidence base; evidence based guidelines; experience; flexibility; high school; improved; insight; learning strategy; marginalization; minority children; practice setting; prevent; programs; racial minority; recruit; reduce symptoms; resource guides; scale up; selective prevention; service providers; skills; skills training; tool; underserved community; universal prevention; usability

Abstract Approximately 20% of young people experience anxiety or depression by the time they turn 18, and rates are higher among racial/ethnic minority youth. Improvement in problem-solving skills reduces depression, anxiety, self-harm, and suicidal ideation, and corresponds to reduced symptoms and better adjustment for youth with externalizing problems, pointing to its transdiagnostic potential. Problem-Solving Skills Training (PSST) is consistently revealed to be the most common element across youth mental health prevention and promotion programs; however, dosage and delivery vary - including the extent to which quantity, sequencing, temporality, steps and strategies account for its transdiagnostic value and impact. Additionally, despite long- standing psychotherapy literature documenting that cultural adaptation and tailoring predict engagement, alliance, and outcomes for racial/ethnic minority youth and families, the prevention literature has been slower to examine to what extent programs are designed with cultural diversity or specific groups in mind; delivered in culturally congruent ways; and to what extent these lead to better outcomes. As a result, the field’s readiness to disseminate evidence-based recommendations for maximum impact is limited. We have assembled an Advisory Board of scientific and community experts to inform two aims. Specific Aims 1: Examine PSST for variability in dosage, delivery, and cultural considerations, and variance in internalizing outcome effect sizes. We will (a) identify universal and selected prevention programs (n=~90) for adolescents (ages 14-18) outperforming a comparison in at least one trial on at least one internalizing outcome; (b) code dosage (quantity, sequencing, temporality), delivery (steps and strategies), cultural content and tailoring, and impact and (c) use random effects meta-regression to examine variance accounted for in problem solving skills and internalizing outcomes. Findings will inform Specific Aim 2: Develop, assess, and deploy a best practice PSST resource guide (TIPS = Teach It Plain & Simple) for youth service providers. We will recruit frontline providers (n=15, ~30% non-Hispanic Black, ~70% Hispanic) from three youth service settings (5 high school counselors, 5 middle/high afterschool professionals, 5 community health workers) to receive, review and integrate TIPS into their work. Two months later, we will receive feedback via surveys and semi-structured interviews in a sequential mixed method design, and conduct thematic analysis to assess usability, appropriateness, acceptability and feasibility. Findings will inform modifications to design for wider dissemination and an R01 application. Aligned with Strategic Plan Objective 4.2.C, the planned design allows for rapid infusion of research findings into practice settings for underserved communities to increase the impact of mental health interventions. By unpacking the black box of PSST, we hope to speed its scale-up as an efficient, effective, stand-alone, culturally congruent brief intervention tool for youth service providers in a variety of settings.

抽象的 大约 20% 的年轻人在 18 岁时经历焦虑或抑郁，比例为 少数族裔青年解决问题能力的提高可以减少抑郁、焦虑、 自残和自杀意念，并对应于症状的减轻和青少年更好的调整 将问题外部化，指出其跨诊断潜力。 一直被认为是青少年心理健康预防和促进中最常见的因素 方案；然而，剂量和给药方式各不相同——包括数量、顺序、 尽管长期存在，但时间性、步骤和策略也解释了其跨诊断价值和影响。 现有的心理治疗文献记录了文化适应和定制可以预测参与度， 联盟，以及少数种族/族裔青年和家庭的成果，预防文献进展缓慢 检查项目的设计在多大程度上考虑到了文化多样性或特定群体； 文化上一致的方式；以及这些方式在多大程度上会带来更好的结果，该领域的准备情况。 传播基于证据的建议以发挥最大影响是有限的。 科学和社区专家咨询委员会告知两个具体目标 1：检查 PSST。 剂量、给药方式和文化因素的差异，以及内化结果效应大小的差异。 我们将 (a) 为青少年（14-18 岁）确定普遍和选择性的预防计划 (n=~90) (b) 在至少一项试验中，代码剂量优于对至少一项内化结果的比较； （数量、顺序、时间性）、交付（步骤和策略）、文化内容和定制以及影响 (c) 使用随机效应元回归来检查解决问题技能中所考虑的方差，以及 调查结果将为具体目标 2 提供信息：制定、评估和部署最佳实践 PSST 面向青少年服务提供者的资源指南（TIPS = Teach It Plain & Simple） 我们将招募一线提供者。 （n=15，约 30% 非西班牙裔黑人，约 70% 西班牙裔）来自三个青少年服务机构（5 名高中辅导员， 5 名中/高中课外专业人员、5 名社区卫生工作者）接收、审查和整合 TIPS 两个月后，我们将通过调查和半结构化访谈收到反馈。 顺序混合方法设计，并进行主题分析以评估可用性、适当性、 调查结果将为更广泛传播和 R01 的设计修改提供信息。 与战略计划目标 4.2.C 保持一致，规划的设计允许快速注入 针对服务不足社区的实践环境的研究结果，以增加心理健康的影响 通过揭开 PSST 的黑匣子，我们希望能够加快其规模化进程，使其成为一种高效、有效、有效的措施。 为各种环境下的青年服务提供者提供独立的、文化上一致的简短干预工具。