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

项目摘要 青少年中焦虑和抑郁的发病率很高。COVID-19相关的压力源 增加内化障碍和自杀风险的比率，特别是在少数民族青少年中 这些人受到大流行病的严重影响。尽管基于证据的干预措施 尽管少数民族儿童的保健服务是有效的，但绝大多数少数民族青少年得不到任何精神卫生保健服务。以学校为基础的MH服务 可以解决常见的护理障碍，如成本和交通。然而，即使有机会上学- 基于MH服务，学校的能力可能非常有限，一些青少年可能不愿意寻求 由于担心隐私，判断和学术中断，学校提供服务。创新办法 迫切需要向少数民族青年提供可获得的、低成本的、基于证据的MH护理。技术 创造了一个机会，治疗需要MH服务的青少年，并可以扩大学校卫生的覆盖面 服务尽管数字化护理具有潜在的影响，但迄今为止，还没有研究探讨数字化护理是否 心理健康干预措施改善了学校心理健康服务的弱势青年的服务机会 服务符合NIMH信息通知MH-18-031指定数字健康技术为 本申请旨在确定交付SilverCloud的可行性和可接受性， 通过学校向弱势青少年提供临床医生指导、医疗支持、基于应用程序的CBT计划， 健康中心（SBHC）。与大多数MH应用程序相比，SilverCloud表现出强大的 参与度和中到大的效应量。它的功能，包括个性化的反馈， 相互关联的同行和常规成果评估直接促进参与。这将是第一次审判， 评估SilverCloud作为一种基于学校的干预措施，并对其进行改进，以满足低收入、族裔/种族 少数民族青年。我们建议在布鲁克林的两所不同的公立学校进行四阶段研究。同相 I，在SBHC常规MH筛查期间认可内化症状的参与者（n=20）将 参加SilverCloud的公开试用。在第二阶段，开放试验参与者将提供反馈， 用于改进SilverCloud程序。在III期，将对受试者进行筛选（PHQ-9/GAD-7）。的人 支持症状的患者将随机（N=100）接受SilverCloud或常规治疗（TAU）。成果将 每学期评估。在第四阶段，将系统地收集参与者和利益攸关方的反馈， 进一步为大型有效性试验的项目调整和实施策略改进提供信息。 主要目标是在以下人群中确定SilverCloud的可行性、可接受性和初步有效性： 通过SBHC服务的少数民族青年，并检查SilverCloud是否改变了参与度（即， 起始，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).