Supporting Mental Health in Underserved Youth: Engagement with Digital Mental Health Technologies in Pediatric Primary Care

项目摘要/摘要 心理健康障碍是儿童最常见的疾病。然而，数以百万计的青少年没有收到 心理健康护理。大多数面临风险的青少年来自服务不足的人群(例如，社会经济地位低； 种族/族裔和/或性别/性少数群体)，他们在心理健康筛查和护理方面面临着无数障碍。 因此，帮助患有心理健康障碍的未得到充分服务的青少年的传统方法并不奏效， 造成了终生的健康差距和重大的公共健康影响。与 NIMH国家咨询精神健康理事会工作组报告中提出的建议，目标是 这个K08应用程序是为了使用和调整现有的数字心理健康技术来推进参与， 评估、检测、治疗和提供儿科精神卫生服务。具体地说， 加速从创建到持续的模式将指导青少年的发展和实施 评估、检查和修复(教学)系统到为青少年和家庭提供服务的儿科初级保健诊所 芝加哥的西区。在目标1中，PI和她的指导团队将与未得到充分服务的青少年合作 (n=20)和他们的父母(n=20)，以确定针对最高参与障碍和最高道德标准的战略 对教学系统的文化相关性、可用性和有用性的关注和要求。在目标2中， 实施教学系统的计划将通过观察、访谈和共同设计来完善 有儿科初级保健儿科医生和工作人员参加的讲习班。在目标3中，教学系统将是 在初级保健诊所实施，并在随机试验中进行评估：1)参与度和 实施结果；和2)通过分析差异对补救健康差距的评估 结果(例如，种族、保险状况、个人对心理健康的看法)在随机试验中。这 创新研究将为一般数字心理健康技术参与提供信息，以适应 服务不足的青少年，并确定实施做法，以支持儿科小学的教学系统 护理设置。PI和她的指导团队还将决定授课的可行性和满意度 系统，为PI计划将系统扩展到多个初级保健诊所做准备 未来的R01提案。拟议的研究和职业发展计划合乎逻辑地建立在PI的基础上 儿科/行为健康、以用户为中心的设计和移动健康(MHealth)方面的基础培训 评价，以提供获得以下方面知识和技能的机会：1)儿科健康差距；2) 传播和实施科学；以及3)特定于部署数字心理健康的伦理 为服务不足的人群提供技术。在跨学科专家小组的支持下，在机构 投资于支持创新举措的环境，以改善老年人的心理和行为健康 服务不足的人群，这一K08将启动PI作为独立的临床成功的职业生涯 科学家。

Project Summary/Abstract Mental health disorders are the most common disease of childhood. Yet, millions of teens do not receive mental health care. Most at risk are teens from underserved populations (e.g., low socioeconomic status; racial/ethnic and/or gender/sexual minority), who face a myriad of barriers to mental health screening and care. As such, traditional methods for reaching underserved teens with mental health disorders are not working, resulting in life-long health disparities and a significant public health impact. Consistent with the recommendations made in the NIMH National Advisory Mental Health Council Workgroup report, the goal of this K08 application is to use and adapt existing digital mental health technologies to advance the engagement, assessment, detection, treatment, and delivery of services for pediatric mental health. Specifically, the Accelerated Creation-to-Sustainment Model will guide the development and implementation of the Teen Assess, Check, and Heal (TeACH) System into a pediatric primary care clinic serving teens and families from the West Side of Chicago. In Aim 1, the PI and her mentorship team will collaborate with underserved teens (n=20) and their parents (n=20) to identify strategies to target top barriers to engagement as well as top ethical concerns and requirements for cultural relevance, usability, and usefulness of the TeACH System. In Aim 2, the plan for implementing the TeACH System will be refined through observations, interviews, and co-design workshops with pediatric primary care pediatricians and staff. In Aim 3, the TeACH System will be implemented into a primary care clinic and evaluated in a randomized trial for: 1) engagement and implementation outcomes; and 2) assessment of remediation of health disparities by analyzing differential outcomes (e.g., race, insurance status, individual perceptions of mental health) in a randomized trial. This innovative research will inform general digital mental health technology engagement adaptations needed for underserved teens and identify implementation practices to support the TeACH System in pediatric primary care settings. The PI and her mentorship team will also determine the feasibility and satisfaction of the TeACH System in preparation for the PI’s planned expansion of the System across multiple primary care clinics in a future R01 proposal. The proposed research and career development plans logically build from the PI’s foundational training in pediatrics/behavioral health, user-centered design, and mobile health (mHealth) evaluation to provide opportunities to gain knowledge and skills in: 1) pediatric health disparities; 2) dissemination and implementation science; and 3) ethics specific to deploying digital mental health technologies for underserved populations. Supported by an interdisciplinary team of experts and in institutional environment invested in supporting innovative initiatives to improve the mental and behavioral health of underserved populations, this K08 will launch the PI into a successful career as an independent clinical scientist.