Prevention and Early Identification for High Risk Youth in School-based Clinics

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PROJECT SUMMARY AND ABSTRACT – Cambridge Health Alliance ALACRITY for Early Screening and Treatment of High Risk Youth (eSToRY) R34 Prevention and Early Identification for High Risk Youth in School-based Clinics The proposed project aims to implement and test tools necessary to prevent transitions to mental illness among at-risk youth, and particularly at-risk racial/ethnic and language (REL)-minority youth. Risk factors for REL-minority youth can be heightened due to their greater likelihood of experiencing discrimination and socioeconomic barriers and their subsequent impacts on access and engagement in treatment and overall wellness. The overall aim of this project is to prevent and remediate a surge in youth mental illness and to reduce persistent treatment disparities. First, we propose to use a remote adaptive testing technology, “K- CAT+”, to provide rapid community-based screening. Second, we will evaluate the effectiveness of a targeted, online health promotion intervention, COPE2THRIVE (C2T), to build resilience in a REL-diverse sample of school-aged youth. Third, we will assess whether this approach mitigates increased risk faced by racial/ethnic and language (REL)-minority youth. In Aim 1, we test the feasibility and acceptability of a parent- and youth-reported electronic mental health screener, K-CAT, among 12-17 year old youth in a school-based setting. The adaptive screening platform, K- CAT, reduces the time and total number of measures that are required. We supplement K-CAT (to make “K- CAT+”) with measures of functional status, complex trauma, and individual- and neighborhood-level social determinants of health (SDOH). In Aim 2, we test the feasibility, acceptability, and preliminary effectiveness of the COPE2THRIVE (C2T) intervention, a resilience intervention targeting the mechanism of coping self- efficacy to reduce symptoms and improve function. We select youth determined by the K-CAT+ to be at moderate risk for mental illness. In Aim 3, we assess whether the combination of early school-based screening and the preventive C2T intervention reduces disparities in engagement in treatment, and reduces symptoms and improves function for REL-minorities. The screening and preventive interventions tested in this project have the potential to reduce persistent REL disparities in access and engagement in treatment and mental health outcomes, by enhancing the availability and ease of screening, overcoming known biases in recognition and referral, and by intervening earlier than usual among at-risk REL-minority youth.