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 青少年中焦虑和抑郁的患病率很高。与 COVID-19 相关的压力源 增加内化障碍的发生率和自杀风险，尤其是少数族裔青少年 他们受到这一流行病的影响尤为严重。尽管基于证据的干预措施 实际上，绝大多数少数民族青少年无法获得任何 MH 护理。校本 MH 服务 可以解决常见的护理障碍，例如费用和交通。然而，即使有机会上学—— 基于 MH 服务，学校的容量可能非常有限，一些青少年可能不愿寻求 由于对隐私、判断力和学术干扰的担忧，学校无法提供服务。创新方法 迫切需要向少数族裔青年提供方便、低成本、基于证据的 MH 护理。技术 为治疗需要 MH 服务的青少年创造机会，并可以扩大学校健康的覆盖范围 服务。尽管数字护理具有潜在影响，但迄今为止还没有研究检验数字护理是否 心理健康干预措施改善弱势青少年接受学校心理健康服务的机会 服务。与 NIMH 信息通知 MH-18-031 一致，将数字医疗技术指定为 优先考虑的是，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、基于应用程序的 CBT 计划，通过学校向弱势青少年提供 总部健康中心 (SBHC)。与大多数 MH 应用程序相比，SilverCloud 表现出了强大的 参与度和中到大的效应大小。它的功能包括个性化反馈、来自的故事 相关的同伴和日常结果评估可以直接促进参与。这将是第一次试验 评估 SilverCloud 作为一种基于学校的干预措施，并对其进行完善以满足低收入、民族/种族的需求 少数民族青年。我们建议在布鲁克林的两所多元化公立学校进行四阶段研究。同相 I，在 SBHC 常规 MH 筛查期间认可内化症状 (n=20) 的参与者将 参与 SilverCloud 的公开试用。在第二阶段，公开试验参与者将提供反馈 用于完善 SilverCloud 程序。在第三阶段，将对参与者进行筛选（PHQ-9/GAD-7）。那些 认可症状将被随机 (N=100) 接受 SilverCloud 或照常治疗 (TAU)。结果将是 每个学期进行评估。在第四阶段，将系统地收集参与者和利益相关者的反馈，以 进一步为大型有效性试验的计划调整和实施策略细化提供信息。 主要目标是建立SilverCloud的可行性、可接受性和初步有效性 通过 SBHC 为少数族裔青年提供服务，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、消极认知、应对技巧、行为激活） 目标，以及变化是否与临床获益相关（即减少抑郁和焦虑）。