Evaluation of an Asynchronous Remote Communities Approach to Behavioral Activation for Depressed Adolescents

项目摘要 每年约有310万青少年被诊断患有抑郁症，其中超过60%的青少年没有接受或 从事心理健康护理。为了应对在获得和参与方面的重大挑战， 通过对青少年抑郁症的循证心理社会干预（EBPI）， 华盛顿大学精神病学和行为科学系（MPI Jenness）和人类学系 中心设计和工程（MPI Kientz）合作开展试点工作，以应对这些挑战 通过使用异步远程社区（ARC）支持的行为激活（BA+ARC）。弧 是使用私人在线平台的技术中介团体（例如，Slack，Microsoft Teams）每周交付 任务，包括异步治疗师和聊天机器人教练，生态 情绪、活动和技能使用跟踪的瞬时评估（EMA），以及旨在 改善支持和动机，以参与治疗和行为改变。试点工作包括成功设计 并开发了初步BA+ARC原型（ActivaTeen），该原型被认为是可接受的、可用的， 吸引临床医生和患者目标用户。本提案是对PAR-21-131“试点”的回应， 治疗、预防和服务干预措施的有效性试验”，旨在推进这一试点 通过进行混合方法研究来工作，1）构建并对功能，可用， 强大的BA+ARC平台，满足心理健康临床医生和青少年患者的需求 通过我们的试点研究确定（例如，数据安全性、HIPAA合规性、临床医生工作流程集成），以及2） 测试了BA+ARC的可行性、可用性和拟定目标机制的变化以及与之相比的结局 在我们的合作伙伴进行的一项中等规模的随机对照试验中， 现场精神病门诊。我们假设1）BA+ARC目标用户将报告可接受性增加， 可行性、可用性和负担低于仅BA用户; 2）BA+ARC青少年将证明 改善假设的治疗机制，包括治疗师联盟，及时干预， 与只有BA的青少年相比，社会责任感和更多的护理参与; 3）青少年 BA+ARC与BA+Only相比，在抑郁症状和诊断方面的结局有所改善， 功能障碍这项研究涉及更广泛的NIMH战略计划目标4.3：发展 创新的服务提供模式，以显着改善精神卫生服务的成果 通过调查一种新颖的、以技术为媒介的服务， 该模型有可能改善青少年抑郁症EBPI的可及性和有效性。

PROJECT SUMMARY Approximately 3.1 million adolescents are diagnosed with depression each year with over 60% not receiving or engaging in mental health care. In an effort to address the significant challenges in access to and engagement with evidence-based psychosocial interventions (EBPIs) for adolescent depression, investigators in the University of Washington’s Departments of Psychiatry and Behavioral Sciences (MPI Jenness) and Human Centered Design and Engineering (MPI Kientz) partnered to conduct pilot work addressing these challenges through the use of Asynchronous Remote Communities (ARC) supported behavioral activation (BA+ARC). ARCs are technology-mediated groups that use private online platforms (e.g., Slack, Microsoft Teams) to deliver weekly tasks to participants and includes features such as asynchronous therapist and chatbot coaching, ecological momentary assessment (EMA) of mood, activity, and skill-use tracking, and peer communities that aim to improve support and motivation to engage in therapy and behavior change. Pilot work included successful design and development of a preliminary BA+ARC prototype (ActivaTeen) that was found to be acceptable, usable, and engaging to clinician and patient target users. The present proposal responds to PAR-21-131 “Pilot Effectiveness Trials for Treatment, Preventive and Services Interventions” and aims to advance this pilot work by conducting a mixed-methods study that 1) builds and conducts usability testing on a functional, usable, and robust BA+ARC platform that will satisfy the needs of mental health clinicians and adolescent patients identified through our pilot study (e.g., data security, HIPAA compliance, clinician workflow integration), and 2) tests the feasibility, usability, and change in proposed target mechanisms and outcomes of BA+ARC compared to BA treatment only (BA-Only) within a moderately-sized randomized control trial conducted within our partner site’s outpatient psychiatry clinic. We hypothesize 1) BA+ARC target users will report increased acceptability, feasibility, usability, and less burden than users of BA-Only; 2) BA+ARC adolescents will demonstrate improvements on hypothesized treatment mechanisms including therapist alliance, timeliness of intervention, social belongingness, and greater engagement in care compared to BA-Only adolescents; 3) Adolescents treated by BA+ARC versus BA+Only will have improved outcomes in depression symptoms and diagnoses and functional impairments. This research addresses the broader NIMH Strategic Plan Goal 4.3: Develop innovative service delivery models to dramatically improve the outcomes of mental health services received in diverse communities and populations by investigating a novel, technology-mediated service model that has the potential to improve access to and effectiveness of EBPIs for adolescent depression.