Transforming adolescent mental health through accessible, scalable, technology-supported small-group instruction

摘要 内在化症状(即焦虑、抑郁症状、自杀)在 青少年。2019年，近37%的高中生表示感到焦虑、悲伤或绝望， 比2017年增加(即31%)，近19%的人严重考虑自杀1，这是一个增加 从2017年起(17%)。冠状病毒大流行加剧了这个问题，研究发现，社会 大流行导致的孤立与更高水平的压力、恐惧、孤独、焦虑、抑郁有关， 以及2-3岁青少年的自杀意念。重要的是，种族/种族差异已在 内化症状，拉丁裔和黑人男性39-45岁的负面结果更多。通用电流 以学校为基础的预防方法报告的效果参差不齐或有限，或者根本没有效果。 还提出了关于费用和可达性的问题49-59。尽管过去的记录参差不齐 普遍的以学校为基础(Tier 1)的方法，这导致一些人建议强调有针对性的(Tier 他们有几个优点。首先，鉴于风险因素在人口结构上的异质性， 除了不同的机会获得高质量的、对文化敏感的医疗保健23，学校仍然具有吸引力，因为它们 可确保公平获得初级预防服务。第二，通用程序避免了以下困难 识别有风险的青少年12，第三，他们最大限度地减少羞辱寻求或 指的是服务20-22。在本项目中，提交给转型研究奖倡议(RFA- RM-21-017)，我们将使用合作学习(CL)作为一种普遍的(Tier 1)校本预防计划，以 以基于同伴的可塑性风险因素为目标，并随后评估这些机制的变化如何 减少青少年内化症状。CL针对的是各种形式的不适应的对等关系， 压力是青春期内化症状的重要危险因素；CL也促进同龄人 可降低症状内化可能性的保护性因素(例如，同伴接受)27-34。CL有 也被发现促进了更多的跨种族互动和种族间的吸引，更大的跨种族 学术支持和更频繁的跨种族友谊95-97。为支持教师实施合作学习， 我们将使用基于Web的软件平台，提供可访问的高保真机制来交付CL 课程。我们不仅会测试干预效果，还会评估具体的， 理论上衍生的变化机制，并发现与实施相关的关键问题/障碍 使我们能够动态调整我们的实施方法，以在后续的 放大。我们的项目旨在确定教师和学校的可行性，并应对潜在的威胁 到实施保真度，同时也创建了一个路线图，以增强可扩展性和可持续实施。 这个项目的重大成果可能会激励我们的方法在教育背景下得到广泛采用， 在新冠肺炎大流行引发的危机时期，有可能满足重大的公共卫生需求。

Abstract Internalizing symptoms (i.e., anxiety, depressive symptoms, suicidality) are alarmingly common among adolescents. In 2019, nearly 37% of high school students reported feeling anxious, sad, or hopeless, representing an increase from 2017 (i.e., 31%), and nearly 19% seriously considered suicide1, an increase from 2017 (17%). The coronavirus pandemic has exacerbated this problem, with research finding that social isolation resulting from the pandemic was linked to higher levels of stress, fear, loneliness, anxiety, depression, and suicide ideation among adolescents2-3. Importantly, ethnic/racial disparities have been documented in internalizing symptoms, with more negative outcomes for Latinas and Black males39-45. Current universal school-based approaches to prevention have reported uneven or limited effects, or no effects at all6-12. Questions have also been raised regarding cost and accessibility49-59. Despite the uneven track record of universal school-based (Tier 1) approaches, which has led some to recommend an emphasis on targeted (Tier 2) approaches48, they possess several advantages. First, given the demographic heterogeneity in risk factors, as well as disparate access to high-quality, culturally-sensitive health care23, schools remain attractive as they can ensure equitable access to primary prevention services. Second, universal programs avoid the difficulty of identifying adolescents at risk12, and third, they minimize the risk of stigmatizing adolescents who seek out or are referred to services20-22. In this project, submitted to the Transformative Research Award initiative (RFA- RM-21-017), we will use cooperative learning (CL) as a universal (Tier 1) school-based prevention program to target malleable peer-based risk factors and subsequently evaluate how change in these mechanisms can reduce adolescent internalizing symptoms. CL targets various forms of maladaptive peer relations that create stress and comprise a significant risk factor for internalizing symptoms in adolescence; CL also promotes peer protective factors that can reduce the likelihood of internalizing symptoms (e.g., peer acceptance)27-34. CL has also been found to promote more cross-race interaction and interracial attraction, greater cross-ethnic academic support, and more frequent cross-ethnic friendships95-97. To support teachers in implementing CL, we will use a Web-based software platform that provides an accessible, high-fidelity mechanism to deliver CL lessons. We will not only test for intervention effects, but will also evaluate the relative strength of specific, theoretically-derived change mechanisms, and uncover key issues/barriers related to implementation that will allow us to dynamically adjust our implementation approach to achieve maximum impact during subsequent scale-up. Our project is designed to establish feasibility with teachers and schools and counter potential threats to implementation fidelity while also creating a roadmap to enhanced scalability and sustained implementation. Significant results from this project could inspire broad uptake of our approach in educational contexts, potentially addressing a significant public health need during a time of crisis due to the COVID-19 pandemic.