Refinement and Testing of Implementation Strategies to Promote Psychotherapy Attendance for Depression among Latinx Teens

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PROJECT SUMMARY/ABSTRACT Despite experiencing a higher prevalence of depressive symptoms, Latinx adolescents are significantly less likely to receive treatment for Major Depressive Disorder (MDD) and are more likely to drop out of psychotherapy prematurely than their non-Latinx White peers. Research is needed to develop patient- and family-focused implementation strategies to promote Latinx adolescents' initiation of and retention in psychotherapy for depression. The candidate aims to identify, refine, and test a patient- and family-focused implementation strategy to target barriers to psychotherapy attendance among Latinx youth. In Aim 1, a national sample of Latino adolescents (n=15), parents (n=15), and healthcare providers (n=5) will participate in focus groups to identify preferred strategies to promote psychotherapy attendance. In Aim 2, a series of design thinking workshops will be carried out with a community advisory board (N=8) to refine and develop the content of the implementation strategy. Qualitative descriptive methods and rapid content analysis will be employed in aims 1 and 2. In Aim 3, the candidate will conduct a clinical trial to determine the preliminary effect of the patient- and family-focused implementation strategy on psychotherapy attendance and depressive symptoms among Latinx adolescents (N=60) and identify facilitators, barriers, and early implementation outcomes (acceptability, adoption, feasibility, and fidelity) related to the implementation of the strategy and psychotherapy among Latinx adolescents. Latinx adolescents diagnosed with MDD or Persistent Depressive Disorder and referred to psychotherapy will be recruited from primary care clinics in North Carolina and randomly assigned to the implementation strategy or treatment as usual group (n=30 each). Measurements will be taken at baseline, 12 weeks, and 24 weeks. Wilcoxon Two-Sample Tests will be used to compare group differences in the percent of scheduled psychotherapy visits attended at 24 weeks. Wilcoxon Signed Rank Tests will be used to determine change in the depressive symptoms from baseline to week 12, and baseline to week 24. Qualitative interviews with Latinx adolescents, parents, and healthcare providers will be conducted to complete a multi-method evaluation of implementation process outcomes. The results of the study will lay a foundation for a full-scale R01 randomized controlled trial. The identified patient- and family-focused implementation strategy might also serve as a model for addressing behavioral health disparities among other groups of ethnic minority and immigrant youth. During this award, the candidate will also obtain critical training in implementation science, adaptation of programs for Latinx families, adolescent depression treatment, and clinical trial design. The proposed award will support the candidate's long-term goal of promoting mental health equity among Latinx adolescents and her transition into an independent, health disparities researcher.