Screening, Tracking and Treatment for Anxiety and Depression in Community Colleges

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Overall Component Abstract Community colleges (CCs) are primary engines for economic advancement for persons from lower socio- economic backgrounds, but the promise of higher education is often thwarted by untreated mental health problems, especially among racial/ethnic minority students. Alarmingly high rates of depression and anxiety on community college campuses collide with daunting life challenges (such as early adversity, housing and food insecurity) and inadequate mental health resources. Untreated depression and anxiety can have dire consequences, extending from poor academic performance to suicide. To address the enormous mental health gap in a low income, highly diverse sample of CC students at East Los Angeles College (ELAC), we propose to evaluate a scalable, efficient, and evidence-based system of care called STAND for screening, tracking and treating anxiety and depression. STAND uses a stratified stepped care model, ranging from self-guided online cognitive behavioral prevention, to online cognitive behavioral therapy with coaching, to clinician-delivered care. Continuous tracking enables treatment adaptation as needs evolve plus rapid detection and management of suicidality. The STAND system was implemented on the UCLA campus from late 2017- early 2020. Since Fall 2019, we have been collaborating with ELAC administrators and students to adapt STAND for their needs, and have an ongoing pilot project funded through the Los Angeles County Department of Mental Health (2020-2022). This pilot lays the groundwork for ALACRITY in which we will optimize STAND at ELAC (n=1000) with continuing support from DMH and we will explore sustainability and spread to other CCs. The ALACRITY center focuses upon (1) optimizing effectiveness through multivariate predictive models, including social determinants of mental health, for improving stepped care triaging, adaptation, and risk detection, which will simultaneously advance the science of personalized mental health, (2) optimizing implementation through exploratory projects, pilot trials and Methods Scientific Area hubs that primarily target uptake and engagement as well as integration and cultural competency to meet the needs of this underserved, diverse student population, and (3) exploring sustainability via centralized state-wide data-streams, cost-effectiveness and return-on-investment projections for STAND implementation, investigation of generalizability, and exploration of barriers and facilitators of implementation across geographically diverse CCCs, that inform discussions with policy makers and stakeholders. The overall approach is guided by the Accelerated Creation to Sustainment implementation framework which allows for continuous evaluation and redesign over each annual cohort. The Administrative Core will oversee operations of the Center, pilot study program, training of junior investigators, and sustainability planning. The Methods Core will support research projects, implementation efforts, and innovative and synergistic collaborations that focus on increasing engagement of stakeholders. Our long-term goal is to optimize STAND through personalization tools and facilitate expansion of STAND’s reach across CCs statewide and ultimately nationwide.