Scaling a Parenting EBI for Latinx Youth Mental Health in Primary Care

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Project Summary The prevention of adolescent mental health disorders is an underused but scientifically justified approach to improving the public’s mental health. Youth with mental health disorders before the age of 18 have poorer outcomes in education, social, employment, and health compared with youth without mental health or substance use disorders. Hispanic youth report higher rates of depressive and anxiety symptoms, drug use, suicide ideation and attempts, compared to their non-Hispanic White peers. Interventions designed to interrupt the sequelae of mental health disorders and other poor outcomes are imperative for maximizing health among Hispanic youth. Familias Unidas, which was highlighted in the National Academies of Sciences, Engineering, and Medicine prevention report, has been found to be efficacious and effective in the reduction and/or prevention of adolescent health problems. Familas Unidas has had crossover effects on internalizing symptoms for youth who report low family communication, the intervention’s primary mediational pathway. It has also reduced suicide ideation rates for youth reporting this same mediational pathway of poor family communication. The online adaptation of Familias Unidas, eHealth Familias Unidas, has also been found to reduce adolescent health problems. However, to date, evidence-based preventive interventions such as Familias Unidas and eHealth Familias Unidas have largely been tested in schools and delivered mostly by research staff. Evaluating these interventions in real world studies of primary care and understanding the implementation processes that facilitate or impede the integration of interventions in systems is key to improving mental health and reducing disparities in the U.S. The goal of the proposed application is to evaluate in an effectiveness-implementation type I hybrid trial, an enhanced version of eHealth Familias Unidas for reducing depressive and anxious symptoms as well as suicide behavior in Hispanic youth. Using a randomized rollout design of 18 clinics, the study’s aims are: AIM 1: Evaluate the effectiveness of eHealth Familias Unidas for Mental Health in preventing/reducing depressive, anxiety symptoms, suicide ideation and behavior, and drug misuse among those screened as having poor family communication or elevated levels of depressive or anxiety symptoms, or a history of suicide behavior (ideation or attempts); AIM 2: Determine whether intervention effects are partially mediated by family communication and externalizing behaviors, including drug misuse, and moderated by parental depression; and Exploratory AIM 3: Intervention impact on mental health and drug misuse as well as sustainment will vary by quality of implementation at the levels of clinic and clinician. Participants will be assed at baseline, 3, 6, and 18-months post baseline.