Adaptive multi-tiered school-based prevention to promote youth mental health and create equitable and sustainable systems of care

University Of Oregon, Eugene OR

Investigators

Linked publications, trials & patents

Abstract

SIGNATURE PROJECT SUMMARY The ACCESS center Signature Project will focus on addressing the gap in mental health service delivery for youth by examining the effectiveness of a school-based, multilevel prevention model in a sequential multiple armed randomized trial (SMART). Mental health distress among adolescents is at an all-time high, yet few services are available for youth and families in underserved communities due to staffing shortages and workforce decline. The Signature Project will test a blended school- and family-level prevention model in middle schools that targets key mechanisms of change (e.g., emotional regulation, family relationships, school climate) that promote long-term mental health. We propose to evaluate an adaptive design for intervention delivery at both the school and family level, also known as a clustered dynamic treatment regimen SMART design. A total sample of 30 middle schools will be randomly assigned to receive the school-level intervention or school as usual (SAU). We will recruit schools in three cohorts, with 10 schools recruited each year during Years 1-3 of the project (20 youth/families per school for a total N=600). In Aim 1 we will examine main effects of the Inclusive Skill-building Learning Approach (ISLA) school-level intervention relative to a waitlist control condition or (SAU), and within the proposed adaptive design we will focus specifically on youth who are not responsive to the school-level intervention (non-responders) and whether re-assignment to an individualized digital, family-centered intervention (Family Check-Up Online; FCU-O) with telehealth coaching or without telehealth coaching is the optimal adaptive intervention strategy (AIS) for youth who need additional supports. In the context of the SMART optimal sequencing, we will examine whether the FCU-O with and without coaching differentially impacts proximal targets that may mitigate risk for future mental health concerns through intervention targeted mediators (Aim 2). Moderators of differential response to treatment, including poverty, family stress, and baseline risk factors, will also be examined (Aim 3). Because the proposed SMART design is a hybrid study combining effectiveness and implementation evaluation, we will collect implementation data from school providers and families to understand factors that promote successful and sustainable implementation and intervention outcomes (Aim 4). Guided by the ACCESS center Implementation Research Logic Model, relationships between determinants and implementation outcomes will be examined. Our investigative team is multidisciplinary and includes expertise in mental health prevention, cultural adaptation of interventions, school-level implementation of evidence-based practice, and quantitative analysis through our Methods core. This research will significantly contribute to our understanding of effective multilevel mental health prevention to enhance long-term positive outcomes for both youth and families from underserved backgrounds, with the potential for high impact on school-based mental health delivery systems in the US.