Targeted Intervention to Increase MH Treatment Among Depressed Black Adolescents

描述(申请人提供)：患有抑郁症的黑人青少年代表了一个不太可能接受心理健康治疗的群体，主要是由于非经济原因，包括负面的家庭影响，对服务和提供者的负面看法，以及与抑郁症状相关的自我羞辱。增加抑郁的黑人青少年与心理健康服务的联系的干预措施很重要，因为未经治疗的抑郁症是这一群体其他严重问题的先兆，包括辍学、青少年怀孕和自杀。虽然以前的战略被用来改善成年人的服务参与度，但专门针对处于中学年龄的抑郁的黑人青少年的战略或干预措施还很少。此R21应用程序的总体目标是检查建立连接干预(MCI)的可行性和可接受性。MCI是一个理论上驱动的一次(可能是两次)疗程的干预，旨在提高抑郁的黑人青少年的参与度、感知相关性和治疗满意度。作为对其可行性和可接受性的初步检验，我们将实施MCI作为抑郁青少年人际心理治疗(IPT-A)的辅助工具，IPT-A是一种在学校提供的循证干预措施。为了应对MCI的不断发展和完善，本R21应用程序的目标是：(1)在抑郁的黑人青少年中检验MCI在学校心理健康服务中的可行性(例如，招募挑战，记录MCI能否在1到2节课内提供，对MCI协议的忠诚度)；(2)对MCI参与者(青少年和照顾者)进行深入访谈，以得出以下观点：(A)MCI的内容；(B)影响MCI参与的任何社会规范；(C)与MCI参与相关的求助自我效能的任何改善；以及(D)对参与MCI的期望；(3)在10名青少年初步试点的基础上修订MCI手册；(4)通过更大规模的试点开放试验来检查修订后的MCI的可接受性；以及(5)进行初步分析，以探索参与IPT-A的青少年中与MCI相关的结构，包括感知障碍、治疗态度和对改变的准备情况，以及照顾者参与MCI课程、抑郁严重程度和参加IPT-A课程的次数是否会随着时间的推移对关键的MCI结构的变化产生积极或负面影响。拟议研究的结果将提供：(1)初步支持潜在的参与战略，以提高抑郁黑人青少年在学校精神健康服务中的精神健康治疗利用率；(2)为未来更大规模的MCI试验提供宝贵的试点数据。

DESCRIPTION (provided by applicant): Black adolescents with depression represent a group less likely to receive mental health treatment, primarily due to non-financial reasons including negative family influences, negative perceptions of services and providers, and self-stigma associated with experiencing depressive symptoms. Interventions that increase the connection of depressed, Black adolescents to mental health services are important because untreated depression is a precursor to other serious problems for this population, including school dropout, teen pregnancy, and suicidality. While previous strategies have been used to improve service engagement for adults, there is a dearth of strategies or interventions that specifically target depressed, Black adolescents in their middle school-age years. The overall goal of this R21 application is to examine the feasibility and acceptability of the Making Connections Intervention (MCI). The MCI is a theoretically driven 1- (possibly 2-) session intervention designed to improve engagement, perceived relevance, and treatment satisfaction among depressed Black adolescents. As an initial examination of its feasibility and acceptability, we wil implement the MCI as an adjunct to the Interpersonal Psychotherapy for Depressed Adolescents (IPT-A), an evidence-based intervention delivered in schools. To address the continued development and refinement of the MCI, the goals of this R21 application are: (1) to examine the feasibility of the MCI among depressed Black adolescents in school mental health services (e.g., recruiting challenges, documenting whether the MCI can be delivered in 1 or 2 sessions, fidelity to the MCI protocol); (2) to conduct in-depth interviews with MCI participants (adolescents and caregivers) to elicit perspectives on: (a) the MCI's content; (b) any social norms that influence MCI participation; (c) any improvements in help-seeking self-efficacy associated with MCI participation; and (d) expectancies about participating in the MCI; (3) to revise the MCI manual based on the initial pilot with 10 adolescents; (4) to examine the acceptability (via satisfaction ratings) of the revised MCI via a larger pilot open trial; and (5) o conduct preliminary analyses to explore MCI-relevant constructs, including perceived barriers, treatment attitudes, and readiness to change among adolescents who participate in the IPT-A, and whether caregiver participation in the MCI session, level of depression severity, and attended number of IPT-A sessions positively or negatively influence change over time regarding the key MCI constructs. The outcome of the proposed studies will provide: (1) preliminary support for a potential engagement strategy to enhance the mental health treatment utilization of depressed Black adolescents in school mental health services; and (2) valuable pilot data for a future, larger trial of the MCI.