Adapting and Testing A Mental Health Services Engagement Program for Racial and Ethnic Minority Young Adults

项目总结/文摘

PROJECT SUMMARY/ABSTRACT With rates of mental health service utilization as low as 40%, racial and ethnic minority young adults with serious mental illnesses (SMI) are at high risk for disengaging from mental health services. They experience greater unmet need and increased risk for long-term health disparities, poverty, incarceration, and early mortality. Disparities in treatment engagement are often driven by the lack of services that take into account the unique developmental needs and relevant cultural factors that impact young adults’ on-going participation in treatment. The PI’s preliminary findings among racial and ethnic minority young adults indicate that they desired greater knowledge, appreciation, and support of their cultural identities from mental health providers. However, there are few evidence-based treatment engagement programs for young adults with SMI, and none that explicitly target both the developmental and cultural preferences of those who are racial and ethnic minorities. This Career Development Award proposes a comprehensive path towards becoming an independent clinician investigator adapting and optimizing evidence-based interventions to target cultural determinants of health and reduce mental health disparities among adolescents and young adults. This proposal uses the participatory ADAPT-IT framework to partner with racial and ethnic minority young adults with SMI (n=15), providers (n=9), and expert mentors to adapt a brief, evidence-based young adult treatment engagement intervention to include three new person-centered, cultural identity-focused components. The adapted intervention will then be evaluated in a mixed-methods pilot optimization trial for feasibility, acceptability, and preliminary impact on treatment engagement at an urban, publicly-funded, adult psychiatric rehabilitation program. The pilot comprises the preparation stage of the multiphase optimization strategy (MOST), during which young adults (n=80) will be assigned to one of eight conditions to test new components in an efficient factorial experiment. In-depth interviews administered post-intervention will contextualize and clarify findings. To further her long-term career goal of becoming an independent clinician investigator focused on improving mental health services for underserved youth during the transition to adulthood, the PI will pursue training in the following four areas: (1) developing empirically-driven engagement interventions for older adolescents and young adults, (2) adapting interventions to be culturally relevant to underserved, minoritized populations, (3) using MOST, and (4) grant writing. The product of this study will be an R01 of a large-scale optimization trial powered to test intervention components for efficacy and change in targeted mechanisms of treatment engagement. Overall, this award will ensure the PI’s successful transition to an independent investigator with an established program of research focused on intervention development, adaptation, and optimization for addressing mental health disparities in minoritized adolescents and young adults.