Expanding minority youth access to evidence-based care: A pilot effectiveness trial of a digital mental health intervention

项目摘要 焦虑和抑郁在青少年中的患病率很高。与新冠肺炎相关的压力源 增加内在性障碍和自杀风险，特别是在少数民族青少年中 他们受到大流行的影响不成比例。尽管循证干预是 事实上，绝大多数少数民族青少年得不到任何卫生保健服务。校本保健服务 可以解决常见的护理障碍，如成本和交通问题。然而，即使有上学的机会- 在MH服务的基础上，学校的能力可能非常有限，一些青少年可能不愿寻求 由于对隐私、判断力和学术干扰的担忧，学校的服务。创新方法 为了向少数族裔青年提供可获得的、低成本的、循证的MH护理，迫切需要。技术 为治疗需要卫生保健服务的青少年创造机会，并可能扩大学校卫生服务的覆盖范围 服务。尽管数字护理的潜在影响，但到目前为止，还没有研究检查数字 心理健康干预改善弱势青少年获得校本心理健康服务的机会 服务。与NIMH信息通告MH-18-031一致，将数字健康技术指定为 此应用程序建议确定交付SilverCloud的可行性和可接受性， 临床医生指导、经验支持、基于应用程序的CBT计划，通过学校为弱势青少年提供 总部设在卫生中心(SBHC)。与大多数MH应用程序相比，SilverCloud表现出了强大的 参与度和中到大型效果大小。它的功能包括个性化反馈、来自 可联系的同事和常规的结果评估直接促进参与度。这将是第一次 将SilverCloud作为一种基于学校的干预措施进行评估，并对其进行改进以满足低收入、族裔/种族的需求 少数族裔青年。我们建议在布鲁克林的两所不同的公立学校进行一项分四个阶段的研究。同相 在SBHC的常规MH筛查期间，认可内在性症状(n=20)的参与者将 参与SilverCloud的公开试用。在第二阶段，公开试验参与者将提供以下反馈 用于改进SilverCloud计划。在第三阶段，将对参与者进行筛查(PHQ-9/GAD-7)。那些 认可症状将随机(N=100)到SilverCloud或照常治疗(TAU)。结果将是 每学期评估一次。在第四阶段，将系统地收集参与者和利益相关者的反馈，以 进一步通知大规模有效性试验的程序调整和实施策略改进。 主要目标是确定SilverCloud的可行性、可接受性和初步有效性 少数族裔青年通过SBHC提供服务，并检查SilverCloud是否改变了参与度(即， 启动、剂量)和临床(即情绪调节、消极认知、应对技能、行为激活) 目标，以及变化是否与临床益处相关(即，减少抑郁和焦虑)。

PROJECT ABSTRACT The prevalence of anxiety and depression are high among adolescents. COVID-19-related stressors have increases rates of internalizing disorders and risk for suicide, especially among ethnic minority adolescents who have been disproportionately affected by the pandemic. Although evidence-based interventions are effective, the vast majority ethnic minority adolescents do not access any MH care. School-based MH services can address common barriers to care such as cost and transportation. However, even with access to school- based MH services, capacity can be highly limited in schools, and some adolescents may be reticent to seek services at school due to concerns about privacy, judgment, and academic disruption. Innovative approaches to provide accessible, low-cost, evidence-based MH care to minority youth are urgently needed. Technology creates an opportunity to treat youth in need of MH services and could expand the reach of school health services. Despite the potential impact of digital care, to date there are no studies examining whether digital mental health interventions improve service access for vulnerable youth served by school-based mental health services. Consistent with NIMH Notice of Information MH-18-031 designating digital health technology as a priority, this application proposes to determine the feasibility and acceptability of delivering SilverCloud, a clinician-guided, empirically-supported, app-based, CBT program to vulnerable adolescents through school- based health centers (SBHCs). In contrast to most MH apps, SilverCloud has demonstrated strong engagement and medium-to-large effect sizes. Its features, including personalized feedback, stories from relatable peers, and routine outcome assessment, directly promote engagement. This would be the first trial to evaluate SilverCloud as a school-based intervention and refine it to meet the needs of low income, ethnic/racial minority youth. We propose a four-phase study conducted at two diverse, public schools in Brooklyn. In Phase I, participants who endorse internalizing symptoms (n=20) during routine MH screening at the SBHC will participate in an open trial of SilverCloud. In Phase II, open trial participants will provide feedback that will be used to refine the SilverCloud program. In Phase III participants will be screened (PHQ-9/GAD-7). Those who endorse symptoms will be randomized (N=100) to SilverCloud or treatment as usual (TAU). Outcomes will be evaluated each semester. In Phase IV, participant and stakeholder feedback will be collected systematically to further inform program adaptations and implementation strategy refinement for a large effectiveness trial. Primary aims are to establish the feasibility, acceptability, and preliminary effectiveness of SilverCloud among minority youth served through SBHCs and to examine whether SilverCloud changes engagement (i.e., initiation, dose) and clinical (i.e., emotion regulation, negative cognitions, coping skills, behavioral activation) targets, and whether changes are associated with clinical benefit (i.e., reduction in depression and anxiety).