Designing an Implementation Strategy for Delivering Routine Mental Health Screening and Treatment for Adolescents and Adults with Sickle Cell Disease

摘要 患有慢性疾病的非裔美国人更有可能经历抑郁症和其他 精神健康障碍比健康的同龄人更容易经历严重的抑郁症 与白人相比，但被诊断或接受治疗的可能性更小。一个特别脆弱的群体是患者 患有镰状细胞病(SCD)，这是一种遗传性血液疾病，主要影响非洲人后裔，许多人 其中一些人生活在不利的环境中，在资源不足的环境中得到照顾。SCD原因 严重的急性和慢性疼痛、终末器官损伤和早期死亡。患者从 青春期至成年期(16-30岁)是精神健康障碍和自杀的高危人群。 使用移动技术，我们可以提供高质量的、基于证据的行为心理健康治疗 在不同的环境中接触到患者。数字认知行为疗法(CBT)是治疗 抑郁和焦虑，可以低成本规模化。尽管数字CBT前景看好，但仍有 阻碍其广泛使用的障碍，特别是在为少数群体服务的低资源环境中。定性数据显示 文化因素--缺乏关联性、代表性和心理健康方面的耻辱 治疗-限制参与数字CBT计划。特定于人口和环境的适应 干预措施可导致这些措施的成功实施和更广泛使用。我们将与数字CBT合作 减少耻辱并使其与患有SCD的年轻人更相关和相关的计划，通过设计 更改广告和促销，并与综合健康教练进行量身定制的沟通，目标1： 使用实施科学(IMS)和以人为中心的设计方法来定义交付的障碍 对患有SCD的青少年和青壮年进行常规心理健康筛查和数字CBT。目标2：迅速 迭代、测试和评估针对教练增强的数字心理的实施策略的适应性 医疗服务。目标3：展示针对特定人群的实施战略可提高参与度 以数字CBT为基础的精神健康服务。 我们将充分利用我们的移动技术工具、跨学科专业知识和基于社区的 合作伙伴调查数字CBT在低资源诊所和社区的实施情况 为患有镰状细胞病的青少年和成年人提供服务的组织。这项研究将产生必要的 数据和基础设施进行大规模、R01资助、多站点的务实试验，以确定如何 数字CBT可用于青少年和青少年的有效、低成本和可扩展的心理健康治疗 患有SCD的年轻人，这将推广到其他服务不足、抑郁的人群 慢性疼痛综合症。 1

ABSTRACT African Americans living with chronic health conditions are more likely to experience depression and other mental health disorders than their healthy counterparts, and are more likely to experience severe depression than whites, but less likely to be diagnosed or receive treatment. One especially vulnerable group is patients with sickle cell disease (SCD), a genetic blood disorder that primarily affects people of African descent, many of whom live in disadvantaged circumstances and are cared for in under-resourced settings. SCD causes severe acute and chronic pain, end-organ damage, and early mortality. Patients transitioning from adolescence to adulthood (ages 16-30) are at high risk for mental health disorders and suicide. Using mobile technology, we can provide high-quality, evidence-based behavioral mental health treatment that reaches patients in different settings. Digital cognitive behavioral therapy (CBT) is effective for treating depression and anxiety and can be brought to scale at low cost. Despite the promise of digital CBT, there are barriers to its widespread use, particularly in low-resource settings serving minorities. Qualitative data show that cultural factors—lack of relatability, representation, and perceived stigma regarding mental health treatment—limit engagement with digital CBT programs. Population- and setting-specific adaptations to interventions can lead to their successful implementation and wider use. We will work with a digital CBT program to decrease stigma and make it more relatable and relevant to young adults with SCD, by devising changes to advertising and promotion, and tailoring communication with an integrated health coach, Aim 1: Use implementation science (ImS) and human-centered design methods to define the barriers to delivering routine mental health screening and digital CBT to adolescents and young adults with SCD. Aim 2: Rapidly iterate, test, and evaluate adaptations to the implementation strategy for a coach-enhanced digital mental health service. Aim 3: Demonstrate that a population-specific implementation strategy improves engagement with a digital CBT-based mental health service. We will capitalize on our mobile technology tools, interdisciplinary expertise, and community-based partnerships to investigate the implementation of digital CBT into low-resource clinics and community-based organizations serving adolescents and adults with sickle cell disease. This study will generate the necessary data and infrastructure to conduct a large scale, R01-funded, multi-site pragmatic trial to determine how digital CBT can be used as an effective, low-cost, and scalable mental health treatment for adolescents and young adults with SCD, and that will be generalizable to other underserved, depressed populations with chronic pain syndromes. 1