SUPERA: Supporting Peer Interactions to Expand Access to Digital Cognitive Behavioral Therapy for Spanish-speaking Safety-Net Patients in Primary Care

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Project Summary Limited English Proficiency (LEP) Latinxs experience longer duration of untreated mental health disorders. In the case of depression and anxiety, Latinxs are half as likely as whites to receive quality, evidence-based care despite primary care providers recommending treatment at equivalent rates. There are known barriers for LEP Latinx patients with depression and anxiety, especially at the healthcare setting level. Because these patients are more likely to receive care in public healthcare settings which disproportionately care for patients on Medicaid or who are uninsured, there are often language and culturally concordant care models in these systems yet an overall deficiency of Spanish-speaking behavioral/mental health clinicians. In addition, these under-resourced healthcare systems also are less likely to be the site for implementation of innovations that might increase access to mental health care for their population. Digital interventions, i.e., those that leverage Internet and mobile technologies, can provide an effective option for overcoming these barriers. In many countries, digital treatments are frontline treatments for mental health issues such as depression and anxiety, creating a standard of care that can overcome disparities and promote health equity. In the United States, few patients have access to evidence-based digital treatments, and even when available, uptake and engagement is often low. This proposal aims to implement and evaluate an evidence-based digital cognitive-behavioral therapy intervention in safety-net primary care clinics for LEP Latinx patients with depression and/or anxiety. Primary care is the de facto treatment setting for the treatment of common mental health problems such as depression and anxiety and Latinx patients tend to prefer to remain treated in primary care rather than being referred to other specialty mental health services. We will conduct an effectiveness-implementation hybrid trial (Type 2) design with both provider- and patient-level randomization. This will generate data on effectiveness of digital peer support for mental health outcomes for LEP Latinx patients while simultaneously generating rigorous data on the implementation strategies with the highest chance of dissemination in future work. At the provider-level we will compare outreach (using our clinic patient registry) with inreach (traditional provider referral), at the patient-level we will compare two modes of delivery of the dCBT platform (peer-supported vs. unsupported). The long-term goal of this research is to aid in the implementation of digital mental health interventions that can be sustainable implemented in low-resourced settings, while reducing the reliance on professionals, overcoming workforce deficits, and increasing relevance for diverse populations. Such interventions could be provided at scale and address the substantial burden of disease resulting from common mental disorders while making resources more available to those traditionally underserved by our health system.