Strategic Treatment Assessment with Youth (STAY): A measurement-based care approach to promote treatment retention among racial and ethnic minoritized youth with depression or suicide risk

Despite high rates of need, REM youth are significantly more likely to prematurely dropout of mental health services as compared to their White peers. This is due in part to poor therapeutic alliance and concerns about treatment relevance and acceptability. Existing engagement interventions are limited, with few addressing treatment retention for REM youth at risk for depression and suicide. Measurement-based care (MBC) is the use of patient-reported progress data throughout mental health treatment to promote collaborative, patient-centered treatment plan adjustments. MBC is an outstanding candidate to improve treatment engagement due to its focus on personalized treatment planning and is also highly effective when integrated in depression treatment. Yet, MBC could be tailored to better address the unique needs of REM youth. MBC has not been examined as a treatment engagement strategy for REM youth with depressive symptoms or suicide risk. Further, no clinical protocols, guidelines or training supports exist to facilitate clinician use of MBC with REM youth and their caregivers. Based on past research, we have developed a theoretically-driven, culturally-tailored MBC approach, Strategic Treatment Assessment for Youth (STAY). STAY targets therapeutic alliance and treatment relevance and acceptability, concerns which are particularly relevant to REM youth and their caregivers, to improve treatment retention, depression symptoms and suicide outcomes. Initial pilot data suggest STAY is acceptable, feasible, and appropriate. In Aim 1, we will refine the developed STAY protocol and implementation plan to support delivery in a wide variety of clinical contexts. Specifically, we will employ a user centered design approach with N=12 expert stakeholders and develop measures of STAY fidelity, knowledge, skills and attitudes to be used in the Aim 2 trial. Aim 2 will involve a pilot effectiveness-implementation Hybrid Type 2 trial to examine the effectiveness of STAY as compared to an active control condition (MBC As Usual). Clinicians (N=20) at three community mental health clinics will be randomly assigned to STAY or MBC As Usual and N=60 of their adolescent patients who meet inclusion criteria will also be recruited to participate. We will assess STAY implementation outcomes of fidelity, feasibility, acceptability, and appropriateness via mixed methods during and at the conclusion of the trial. It is hypothesized that STAY will result in greater reduction in depressive symptoms, suicidal ideation and behavior via treatment retention outcomes (engagement, treatment retention) and treatment retention mechanisms (treatment alliance, relevance and acceptability). Disparities in depression and suicide rates are a national public health crisis. This project offers an innovative, culturally-tailored approach to retain REM youth in mental health services, reduce disparities and improve patient outcomes. This study contributes to NIMH Strategic Goal 4.3 to strengthen the public health impact of usual care mental health services by reducing disparities in treatment retention for REM youth with depression or suicide risk.

Funding: NIMH R34

Promoting Positive School Climate Among Newcomer Immigrant Adolescents

Newcomer immigrant adolescents (NIA) are a large and growing population who face a number of risk factors for the development of academic and social-emotional concerns. School climate has been put forth as a critical mechanism that can protect NIA from experiences of risk and positively impact academic and social-emotional functioning. Despite this, past research examining school climate among immigrant youth has been plagued by inconsistencies in conceptualization, contradictory findings, and methodological shortcomings, thus limiting the ability to provide specific recommendations for developing targeted interventions to improve school climate. The purpose of the current project is to address this gap by identifying culturally and developmentally-specific aspects of NIA's perceptions of school climate and determining how these indicators of school climate relate to academic and social emotional outcomes among NIA.

Funding: Spencer Foundation

Strategic Treatment and Assessment for Youth (STAY) Pilot Study

Disparities in mental health treatment engagement have been attributed to several factors, including structural and sociopolitical barriers. These barriers have been shown to disproportionately affect racial and ethnic minoritized youth leading to disparities in engagement and retention in mental health care services. Measurement-based care is an evidence-based, patient-centered practice which involves collecting patient-reported progress data throughout treatment to inform shared decision-making. Measurement-based care allows the clinician and patient to work collaboratively to set goals, track progress, and evaluate the effectiveness of the treatment approach. This project seeks to examine the acceptability and feasibility of measurement-based care as an engagement strategy for racial and ethnic minoritized youth in depression treatment.

Funding: Teachers College, Columbia University

Cultural Adaptations of Evidence-Based Interventions

Although numerous evidence-based mental health interventions for youth exist, their relevance and use with ethnic minoritized populations have been questioned. A key concern is whether the cultural adaptation of interventions can improve the engagement of children and families from ethnic minoritized groups in evidence-based mental health care. Despite the proliferation of theory to guide the adaptation of mental health interventions for ethnic minoritized youth, no measure of cultural adaptation exists in the literature. Thus, there remains a pressing need for a tool that can bridge the gap between the rich conceptual foundation in the literature to the practical steps researchers and their community partners must take to culturally adapt evidence-based interventions for ethnic minoritized children and families. This project seeks to develop and pilot an innovative tool that will provide a standardized method of rating cultural adaptations made to evidence-based mental health interventions for ethnic minoritized youth.

Funding: Tulane University

Evaluating a Brief Behavior Rating Scale as a Progress Monitoring Measure of Depression in Schools

The successful implementation of evidence-based social-emotional interventions for students requires the use brief, psychometrically sound, and change sensitive assessment tools to continually monitor treatment progress. Despite the widespread availability of progress monitoring measures assessing academic and externalizing behavior functioning, limited evidence is available supporting brief progress monitoring measures for students’ depressive disorders in school. This project seeks to apply a four-stage model for creating brief behavior rating scales to create and validate a progress monitoring tool for depressive symptoms that is appropriate for use in a school setting.

Funding: Society for the Study of School Psychology.

Evaluation of a Suicide Prevention Training for Secondary School Teachers in Guyana

Student Investigator: Sarika Persaud

Guyana, a country in South America, has the highest adolescent suicide rate globally. School based efforts to help address these concerns are needed. Using a participatory action research approach, this study seeks to adapt and examine the feasibility and acceptability of a school-based suicide prevention gatekeeper training for secondary school teachers in Guyana.

School Based Mental Health for Asian American Immigrant Youth

Despite the promise of school based mental health (SBMH) in increasing access to mental health services among Asian American (AA) youth, AA youth continue to underutilize such services. This study sought to obtain in-depth information from urban-residing, first- and second-generation immigrant AA youth regarding their perceptions of SBMH services, as well as their recommendations for how schools can seek to better engage and address the mental health needs of AA immigrant youth.

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