Refinement and Testing of Implementation Strategies to Promote Psychotherapy Attendance for Depression among Latinx Teens

项目总结/摘要 尽管经历了抑郁症状的患病率较高，拉丁裔青少年显着较少 可能接受重度抑郁症（MDD）治疗，更有可能退出 比非拉丁裔白色同龄人更早接受心理治疗。需要进行研究， 以家庭为重点的实施战略，以促进拉丁裔青少年的启动和保留， 抑郁症的心理治疗候选人的目标是确定，完善和测试一个以患者和家庭为中心的 执行战略，针对拉丁裔青年参加心理治疗的障碍。在目标1中，a 拉丁裔青少年（n=15）、父母（n=15）和医疗保健提供者（n=5）的全国样本将参与 焦点小组，以确定首选的战略，以促进心理治疗的出勤率。在目标2中，一系列设计 将与社区咨询委员会（N=8）一起举办思考研讨会，以完善和发展内容 执行战略。将采用定性描述方法和快速内容分析， 目标1和2。在目标3中，候选人将进行临床试验，以确定 以患者和家庭为中心的心理治疗出勤率和抑郁症状实施策略 拉丁裔青少年（N=60），并确定促进因素，障碍和早期实施结果 （可接受性、采纳性、可行性和忠实性）与策略和心理治疗的实施相关 在拉丁裔青少年中。被诊断为MDD或持续性抑郁症的拉丁裔青少年， 将从北卡罗来纳州的初级保健诊所招募一名接受心理治疗的患者， 实施策略组和常规治疗组各30例。测量将在 基线、12周和24周。将使用Wilcoxon双样本检验比较以下方面的组间差异： 在24周时接受预定心理治疗的百分比。将使用Wilcoxon符号秩检验 以确定从基线到第12周和从基线到第24周的抑郁症状的变化。 将对拉丁裔青少年、父母和医疗保健提供者进行定性访谈，以完成 对实施过程结果的多方法评价。研究结果将奠定基础 一项全面的R 01随机对照试验。确定的以患者和家庭为中心的实施 战略也可以作为解决其他种族群体之间行为健康差异的模式。 少数民族和移民青年。在此期间，候选人还将获得以下方面的关键培训 实施科学，为拉丁裔家庭调整方案，青少年抑郁症治疗， 临床试验设计。拟议的奖项将支持候选人促进心理健康的长期目标 拉丁裔青少年之间的公平和她的过渡到一个独立的，健康差距研究员。

PROJECT SUMMARY/ABSTRACT Despite experiencing a higher prevalence of depressive symptoms, Latinx adolescents are significantly less likely to receive treatment for Major Depressive Disorder (MDD) and are more likely to drop out of psychotherapy prematurely than their non-Latinx White peers. Research is needed to develop patient- and family-focused implementation strategies to promote Latinx adolescents' initiation of and retention in psychotherapy for depression. The candidate aims to identify, refine, and test a patient- and family-focused implementation strategy to target barriers to psychotherapy attendance among Latinx youth. In Aim 1, a national sample of Latino adolescents (n=15), parents (n=15), and healthcare providers (n=5) will participate in focus groups to identify preferred strategies to promote psychotherapy attendance. In Aim 2, a series of design thinking workshops will be carried out with a community advisory board (N=8) to refine and develop the content of the implementation strategy. Qualitative descriptive methods and rapid content analysis will be employed in aims 1 and 2. In Aim 3, the candidate will conduct a clinical trial to determine the preliminary effect of the patient- and family-focused implementation strategy on psychotherapy attendance and depressive symptoms among Latinx adolescents (N=60) and identify facilitators, barriers, and early implementation outcomes (acceptability, adoption, feasibility, and fidelity) related to the implementation of the strategy and psychotherapy among Latinx adolescents. Latinx adolescents diagnosed with MDD or Persistent Depressive Disorder and referred to psychotherapy will be recruited from primary care clinics in North Carolina and randomly assigned to the implementation strategy or treatment as usual group (n=30 each). Measurements will be taken at baseline, 12 weeks, and 24 weeks. Wilcoxon Two-Sample Tests will be used to compare group differences in the percent of scheduled psychotherapy visits attended at 24 weeks. Wilcoxon Signed Rank Tests will be used to determine change in the depressive symptoms from baseline to week 12, and baseline to week 24. Qualitative interviews with Latinx adolescents, parents, and healthcare providers will be conducted to complete a multi-method evaluation of implementation process outcomes. The results of the study will lay a foundation for a full-scale R01 randomized controlled trial. The identified patient- and family-focused implementation strategy might also serve as a model for addressing behavioral health disparities among other groups of ethnic minority and immigrant youth. During this award, the candidate will also obtain critical training in implementation science, adaptation of programs for Latinx families, adolescent depression treatment, and clinical trial design. The proposed award will support the candidate's long-term goal of promoting mental health equity among Latinx adolescents and her transition into an independent, health disparities researcher.