Supporting Mental Health in Underserved Youth: Engagement with Digital Mental Health Technologies in Pediatric Primary Care

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Project Summary/Abstract Mental health disorders are the most common disease of childhood. Yet, millions of teens do not receive mental health care. Most at risk are teens from underserved populations (e.g., low socioeconomic status; racial/ethnic and/or gender/sexual minority), who face a myriad of barriers to mental health screening and care. As such, traditional methods for reaching underserved teens with mental health disorders are not working, resulting in life-long health disparities and a significant public health impact. Consistent with the recommendations made in the NIMH National Advisory Mental Health Council Workgroup report, the goal of this K08 application is to use and adapt existing digital mental health technologies to advance the engagement, assessment, detection, treatment, and delivery of services for pediatric mental health. Specifically, the Accelerated Creation-to-Sustainment Model will guide the development and implementation of the Teen Assess, Check, and Heal (TeACH) System into a pediatric primary care clinic serving teens and families from the West Side of Chicago. In Aim 1, the PI and her mentorship team will collaborate with underserved teens (n=20) and their parents (n=20) to identify strategies to target top barriers to engagement as well as top ethical concerns and requirements for cultural relevance, usability, and usefulness of the TeACH System. In Aim 2, the plan for implementing the TeACH System will be refined through observations, interviews, and co-design workshops with pediatric primary care pediatricians and staff. In Aim 3, the TeACH System will be implemented into a primary care clinic and evaluated in a randomized trial for: 1) engagement and implementation outcomes; and 2) assessment of remediation of health disparities by analyzing differential outcomes (e.g., race, insurance status, individual perceptions of mental health) in a randomized trial. This innovative research will inform general digital mental health technology engagement adaptations needed for underserved teens and identify implementation practices to support the TeACH System in pediatric primary care settings. The PI and her mentorship team will also determine the feasibility and satisfaction of the TeACH System in preparation for the PI’s planned expansion of the System across multiple primary care clinics in a future R01 proposal. The proposed research and career development plans logically build from the PI’s foundational training in pediatrics/behavioral health, user-centered design, and mobile health (mHealth) evaluation to provide opportunities to gain knowledge and skills in: 1) pediatric health disparities; 2) dissemination and implementation science; and 3) ethics specific to deploying digital mental health technologies for underserved populations. Supported by an interdisciplinary team of experts and in institutional environment invested in supporting innovative initiatives to improve the mental and behavioral health of underserved populations, this K08 will launch the PI into a successful career as an independent clinical scientist.