Unpacking the Black Box of Problem-Solving: Dosage, Delivery, Culture, and Impact on Internalizing Problems for Adolescents

摘要 大约20%的年轻人在18岁时经历焦虑或抑郁， 在少数民族/种族青年中更高。解决问题能力的提高可以减少抑郁、焦虑、 自我伤害和自杀意念，并对应于减少症状和更好地调整青年， 将问题外化，指出它的跨诊断潜力。问题解决技能培训（PSST） 一直被发现是青少年心理健康预防和促进中最常见的因素 程序;然而，剂量和交付变化-包括数量，顺序， 时间性、步骤性和策略性决定了它的转诊价值和影响。此外，尽管长期以来- 长期的心理治疗文献记录了文化适应和剪裁预测参与， 联盟，以及种族/少数民族青年和家庭的结果，预防文献的速度较慢， 检查在多大程度上计划是设计与文化多样性或特定群体的想法;交付 文化一致的方式;以及在多大程度上这些导致更好的结果。因此，该领域的准备工作 传播循证建议以取得最大影响的努力有限。我们制定了一份 咨询委员会的科学和社区专家告知两个目标。具体目标1：检查PSST 剂量、递送和文化因素的可变性，以及内化结果效应大小的差异。 我们将（a）确定针对青少年（14-18岁）的普遍和选定预防方案（n=~90） 在至少一个试验中在至少一个内化结果上优于比较;（B）代码剂量 （数量、顺序、时间性）、交付（步骤和战略）、文化内容和定制以及影响 以及（c）使用随机效应元回归来检查解决问题技能中的方差， 内化成果。调查结果将告知具体目标2：制定、评估和部署最佳实践PSST 为青年服务提供者提供的资源指南（TIPS =简单明了地教）。我们将招募一线供应商 （n=15，~30%非西班牙裔黑人，~70%西班牙裔）来自三个青年服务机构（5名高中辅导员， 5名中学/高中课后专业人员，5名社区卫生工作者）接受、审查和整合TIPS 投入到他们的工作中两个月后，我们将通过问卷调查和半结构化访谈收到反馈， 顺序混合方法设计，并进行专题分析，以评估可用性，适当性， 可接受性和可行性。调查结果将为更广泛的传播和R 01的设计修改提供信息 应用程序.根据战略计划目标4.2.C，计划的设计允许快速注入 将研究结果用于服务不足社区的实践环境，以增加心理健康的影响 干预措施。通过打开PSST的黑盒子，我们希望加快其作为一种高效，有效， 为各种环境中的青年服务提供者提供的独立的、文化上一致的简短干预工具。

Abstract Approximately 20% of young people experience anxiety or depression by the time they turn 18, and rates are higher among racial/ethnic minority youth. Improvement in problem-solving skills reduces depression, anxiety, self-harm, and suicidal ideation, and corresponds to reduced symptoms and better adjustment for youth with externalizing problems, pointing to its transdiagnostic potential. Problem-Solving Skills Training (PSST) is consistently revealed to be the most common element across youth mental health prevention and promotion programs; however, dosage and delivery vary - including the extent to which quantity, sequencing, temporality, steps and strategies account for its transdiagnostic value and impact. Additionally, despite long- standing psychotherapy literature documenting that cultural adaptation and tailoring predict engagement, alliance, and outcomes for racial/ethnic minority youth and families, the prevention literature has been slower to examine to what extent programs are designed with cultural diversity or specific groups in mind; delivered in culturally congruent ways; and to what extent these lead to better outcomes. As a result, the field’s readiness to disseminate evidence-based recommendations for maximum impact is limited. We have assembled an Advisory Board of scientific and community experts to inform two aims. Specific Aims 1: Examine PSST for variability in dosage, delivery, and cultural considerations, and variance in internalizing outcome effect sizes. We will (a) identify universal and selected prevention programs (n=~90) for adolescents (ages 14-18) outperforming a comparison in at least one trial on at least one internalizing outcome; (b) code dosage (quantity, sequencing, temporality), delivery (steps and strategies), cultural content and tailoring, and impact and (c) use random effects meta-regression to examine variance accounted for in problem solving skills and internalizing outcomes. Findings will inform Specific Aim 2: Develop, assess, and deploy a best practice PSST resource guide (TIPS = Teach It Plain & Simple) for youth service providers. We will recruit frontline providers (n=15, ~30% non-Hispanic Black, ~70% Hispanic) from three youth service settings (5 high school counselors, 5 middle/high afterschool professionals, 5 community health workers) to receive, review and integrate TIPS into their work. Two months later, we will receive feedback via surveys and semi-structured interviews in a sequential mixed method design, and conduct thematic analysis to assess usability, appropriateness, acceptability and feasibility. Findings will inform modifications to design for wider dissemination and an R01 application. Aligned with Strategic Plan Objective 4.2.C, the planned design allows for rapid infusion of research findings into practice settings for underserved communities to increase the impact of mental health interventions. By unpacking the black box of PSST, we hope to speed its scale-up as an efficient, effective, stand-alone, culturally congruent brief intervention tool for youth service providers in a variety of settings.