Screening, Tracking and Treatment for Anxiety and Depression in Community Colleges

社区大学焦虑症和抑郁症的筛查、跟踪和治疗

基本信息

批准号：
10615195
负责人：
MICHELLE G CRASKE
金额：
$ 235.19万
依托单位：
UNIVERSITY OF CALIFORNIA LOS ANGELES
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-05-01 至 2027-03-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10615195
关键词：
Acceleration Address Adherence Administrator Advocacy Affect Algorithms Anxiety Area Awareness Behavioral Budgets California Caring Chronic Clinical Clinical Sciences Cognitive Cognitive Therapy Collaborations Communities County Data Data Science Decision Making Detection Economics Education Effectiveness Ethnic Origin Evaluation Financial Hardship Funding Geography Goals Health Care Costs Health Resources Health Status Healthcare Systems Hearing Homelessness Housing Investigation Investments Learning Life Life Stress Los Angeles Low income Mental Depression Mental Health Mental Health Services Methods Mind Modeling Outcome Pathway interactions Performance Persons Pilot Projects Policy Maker Population Prevention Provider Public Health Quality of Care Race Research Personnel Research Project Grants Research Support Resources Risk Risk Reduction Sampling Science Self Efficacy Self-Injurious Behavior Services Severities Source Students Suicide Suicide prevention Supervision Surveys Symptoms System Testing Training Triage Unemployment Update anxiety treatment behavior influence care systems cohort college community barrier community college cost effectiveness cultural competence data streams design digital mental health disparity gap early life adversity ethnic minority evidence base falls food insecurity health disparity health literacy health service use higher education implementation barriers implementation efforts implementation facilitators implementation framework implementation science improved innovation minority student operation peer coaching pilot trial prediction algorithm predictive modeling programs racial minority rapid detection recruit reduce symptoms satisfaction screening social determinants social stigma socioeconomics substance use success suicidal tool treatment response university student uptake user centered design

项目摘要

Overall Component Abstract Community colleges (CCs) are primary engines for economic advancement for persons from lower socio- economic backgrounds, but the promise of higher education is often thwarted by untreated mental health problems, especially among racial/ethnic minority students. Alarmingly high rates of depression and anxiety on community college campuses collide with daunting life challenges (such as early adversity, housing and food insecurity) and inadequate mental health resources. Untreated depression and anxiety can have dire consequences, extending from poor academic performance to suicide. To address the enormous mental health gap in a low income, highly diverse sample of CC students at East Los Angeles College (ELAC), we propose to evaluate a scalable, efficient, and evidence-based system of care called STAND for screening, tracking and treating anxiety and depression. STAND uses a stratified stepped care model, ranging from self-guided online cognitive behavioral prevention, to online cognitive behavioral therapy with coaching, to clinician-delivered care. Continuous tracking enables treatment adaptation as needs evolve plus rapid detection and management of suicidality. The STAND system was implemented on the UCLA campus from late 2017- early 2020. Since Fall 2019, we have been collaborating with ELAC administrators and students to adapt STAND for their needs, and have an ongoing pilot project funded through the Los Angeles County Department of Mental Health (2020-2022). This pilot lays the groundwork for ALACRITY in which we will optimize STAND at ELAC (n=1000) with continuing support from DMH and we will explore sustainability and spread to other CCs. The ALACRITY center focuses upon (1) optimizing effectiveness through multivariate predictive models, including social determinants of mental health, for improving stepped care triaging, adaptation, and risk detection, which will simultaneously advance the science of personalized mental health, (2) optimizing implementation through exploratory projects, pilot trials and Methods Scientific Area hubs that primarily target uptake and engagement as well as integration and cultural competency to meet the needs of this underserved, diverse student population, and (3) exploring sustainability via centralized state-wide data-streams, cost-effectiveness and return-on-investment projections for STAND implementation, investigation of generalizability, and exploration of barriers and facilitators of implementation across geographically diverse CCCs, that inform discussions with policy makers and stakeholders. The overall approach is guided by the Accelerated Creation to Sustainment implementation framework which allows for continuous evaluation and redesign over each annual cohort. The Administrative Core will oversee operations of the Center, pilot study program, training of junior investigators, and sustainability planning. The Methods Core will support research projects, implementation efforts, and innovative and synergistic collaborations that focus on increasing engagement of stakeholders. Our long-term goal is to optimize STAND through personalization tools and facilitate expansion of STAND’s reach across CCs statewide and ultimately nationwide.

总体组成摘要社区学院 (CC) 是社会底层人士经济进步的主要引擎经济背景，但高等教育的承诺往往因未经治疗的心理健康而受挫问题，特别是少数族裔学生的抑郁和焦虑率高得惊人。社区大学校园面临着令人畏惧的生活挑战（例如早期的逆境、住房和食物）不安全感）和心理健康资源不足而得不到治疗的抑郁和焦虑可能会带来可怕的后果。后果，从学业成绩不佳到自杀。东洛杉矶学院 (ELAC) 的低收入、高度多样化的 CC 学生样本存在差距，我们建议评估一个可扩展、高效且基于证据的护理系统 STAND，用于筛查、跟踪和 STAND 采用分层阶梯式护理模式，包括在线自我指导。认知行为预防、在线认知行为辅导治疗、临床医生提供的护理。持续跟踪可以根据需求的变化进行治疗调整，并快速检测和管理 STAND 系统于 2017 年底至 2020 年初在加州大学洛杉矶分校校园实施。 2019 年，我们一直与 ELAC 管理员和学生合作，根据他们的需求调整 STAND，并且有一个由洛杉矶县心理健康局资助的正在进行的试点项目（2020-2022 年）。该试点为 ALACRITY 奠定了基础，我们将在 ELAC (n=1000) 上优化 STAND，并继续来自 DMH 的支持，我们将探索可持续性并将其推广到 ALACRITY 中心的重点领域。 (1) 通过多变量预测模型优化有效性，包括心理的社会决定因素健康，以改善分级护理分类、适应和风险检测，这将同时推进个性化心理健康科学，（2）通过探索性项目、试点试验优化实施主要针对吸收和参与以及整合和文化的方法科学领域中心满足服务不足、多元化学生群体需求的能力，以及 (3) 探索可持续性通过 STAND 的集中全州数据流、成本效益和投资回报预测实施、普遍性调查以及实施障碍和促进因素的探索跨越地域不同的 CCC，为与政策制定者和利益相关者的讨论提供信息。该方法以“加速创造到维持”实施框架为指导，该框架允许行政核心将监督每个年度队列的持续评估和重新设计。中心的建设、试点研究计划、初级研究人员的培训以及可持续发展规划的核心。将支持研究项目、实施工作以及创新和协同合作，重点关注我们的长期目标是通过个性化优化 STAND。工具并促进 STAND 扩大联邦 CC 的影响范围，并最终扩大到全国范围。