Geospatial and Ecological momentary assessment Technology and Activity Engagement for at-risk youth

青春期与自杀想法和行为（STBs）的高风险相关。近年来，种族 性病风险的差异越来越明显，非洲裔美国人和其他黑人 青少年（在此，黑人）经历自杀行为的比率高于任何其他种族的青年群体 因此，有必要采取文化上适当的干预措施，以针对性传播疾病的风险因素， 种族多样化的年轻人不断增加。快感缺失，定义为对愉快的事物失去兴趣或乐趣。 或有价值的活动，是抑郁症的一个核心特征，也是青少年性传播感染的一个独立风险因素。行为 激活（BA）疗法是一种认知行为干预，直接针对快感缺失，通过减少 回避和孤立行为，使用积极强化来增加对有价值活动的参与， 奖励的经验。越来越多的证据支持BA对传统青少年的有效性。 面对面的心理治疗形式，BA在少数初步调查中表现出了希望，其中包括 不同种族的年轻人BA模式的一个关键优势是，对行为策略的关注非常适合 以适应结合了移动的感测并且可以生成关于活动的客观数据的数字平台。 由于数字BA方法允许向用户和提供者实时反馈治疗目标， 行为目标，它提供了一个显着的优势，传统的面对面的干预。迄今为止，没有研究 在包括黑人青年在内的多样化研究人群中测试了数字BA。因此，本研究的目的是， 是量身定制和测试健康教练支持的数字BA干预，以针对不同样本中的快感缺失， 青年，利用领先的实施科学框架。最初的BA平台是由 调查人员使用智能手机技术收集移动的加速度计和地理空间活动数据， 与健康教练或临床医生共享，以提供反馈并通过智能手机推送BA干预内容 附录我们将首先使用实施研究综合框架（CFIR）收集和分析 来自不同种族青少年、照顾者、提供者和管理者的焦点小组的定性数据， 他们对干预需求的看法以及BA干预和实施的障碍和促进因素 战略布局接下来，使用以人为本的设计方法，我们将迭代开发和调整BA干预 满足不同种族的高危青少年的需求。然后，我们将进行一项试点随机试验， 数字化地交付BA干预，以单独进行被动的基于智能手机的活动监测。一组75人 患有中度抑郁症和快感缺失症状的12 - 18岁青少年（35%黑人）将 从Signature R01招募的我们将检查可行性、可接受性和对快感缺乏（原发性）的影响。 次要结果包括活动、抑郁和STB风险。该项目将为一个更大的 BA的随机试验，并有可能直接解决心理健康差异研究中的关键差距。

Adolescence is associated with high risk for suicidal thoughts and behaviors (STBs). In recent years, racial disparities in risk for STBs have become increasingly evident, with African American and other Black-identifying adolescents (herein, Black) experiencing higher rates of suicidal behavior than any other racial group of youth in the U.S. Thus, there is a need for culturally appropriate interventions that target risk factors for STBs among a growing population of racially diverse youth. Anhedonia, defined as the loss of interest or pleasure in enjoyable or valued activities, is a core feature of depression and an independent risk factor for STBs in youth. Behavioral Activation (BA) therapy is a cognitive behavioral intervention that directly targets anhedonia, by decreasing avoidance and isolation behaviors, using positive reinforcement to increase engagement in valued activities and the experience of reward. Growing evidence supports the effectiveness of BA for adolescents in the traditional face-to-face psychotherapy format, and BA has shown promise in the few preliminary investigations that included racially diverse youth. A key advantage of the BA model is that the focus on behavioral strategies is well suited for adaptation to digital platforms that incorporate mobile sensing and can generate objective data on activity. As the digital BA approach allows for real-time feedback to both users and providers on treatment goals and behavioral targets, it offers a significant advantage over traditional face-to-face intervention. To date, no studies have tested digital BA in a diverse study population that includes Black youth. The goal of this study, therefore, is to tailor and test a health coach supported, digital BA intervention to target anhedonia in a diverse sample of youth, using leading implementation science frameworks. The initial BA platform was developed by the investigators to collect mobile accelerometer and geospatial activity data using smartphone technology that is shared with a health coach or clinician to provide feedback and push BA intervention content via a smartphone app. We will first use the Consolidated Framework for Implementation Research (CFIR) to collect and analyze qualitative data from focus groups with racially diverse adolescents, caregivers, providers, and administrators on their perspectives of intervention needs and barriers and facilitators to BA intervention and implementation strategies. Next, using human-centered design methods, we will iteratively develop and adapt the BA intervention to the needs of racially diverse, at-risk adolescents. We will then conduct a pilot randomized trial comparing the digitally delivered BA intervention to passive, smartphone-based activity monitoring alone. A group of 75 adolescents (35% Black), ages 12-18, with moderate depression and elevated anhedonia symptoms will be recruited from the Signature R01. We will examine feasibility, acceptability, and impact on anhedonia (primary target); secondary outcomes include activity, depression, and STB risk. This project will inform a larger randomized trial of BA and has the potential to directly address a critical gap in mental health disparities research.