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Mental health disorders are the most common disease of childhood. Yet, millions of teens do not receive mental health care. Most at risk are teens from underserved populations (e.g., low socioeconomic status; racial/ethnic and/or gender/sexual minority), who face a myriad of barriers to mental health screening and care. As such, traditional methods for reaching underserved teens with mental health disorders are not working, resulting in life-long health disparities and a significant public health impact. Consistent with the recommendations made in the NIMH National Advisory Mental Health Council Workgroup report, the goal of this K08 application is to use and adapt existing digital mental health technologies to advance the engagement, assessment, detection, treatment, and delivery of services for pediatric mental health. Specifically, the Accelerated Creation-to-Sustainment Model will guide the development and implementation of the Teen Assess, Check, and Heal (TeACH) System into a pediatric primary care clinic serving teens and families from the West Side of Chicago. In Aim 1, the PI and her mentorship team will collaborate with underserved teens (n=20) and their parents (n=20) to identify strategies to target top barriers to engagement as well as top ethical concerns and requirements for cultural relevance, usability, and usefulness of the TeACH System. In Aim 2, the plan for implementing the TeACH System will be refined through observations, interviews, and co-design workshops with pediatric primary care pediatricians and staff. In Aim 3, the TeACH System will be implemented into a primary care clinic and evaluated in a randomized trial for: 1) engagement and implementation outcomes; and 2) assessment of remediation of health disparities by analyzing differential outcomes (e.g., race, insurance status, individual perceptions of mental health) in a randomized trial. This innovative research will inform general digital mental health technology engagement adaptations needed for underserved teens and identify implementation practices to support the TeACH System in pediatric primary care settings.
Technology-enabled services (TESs), which include mobile applications (apps) supported by low-intensity coaching or care-management, have shown great potential, with a large number of randomized controlled trials consistently demonstrating efficacy. However, the many attempts to implement these validated interventions into large value-based care systems have failed.
There are two broad reasons for these failures. First, patients in real world settings simply do not use the tools that were developed in research settings. Related to this issue, recruitment efforts in research trials have often focused on easily engaged populations. As such, it is unclear how inclusively designed and generalizable findings on TESs have been for traditionally underserved populations. Second, TESs have not been designed to fit into the workflows in clinical practice settings.
To address these issues, this research project will use a comprehensive user-centered design approach to engage patients, Family Medicine staff and physicians from Rush University Medical Center (RUMC) in the design of a TES — comprised of technologies, a service protocol and implementation plan — that can be successfully deployed in Family Medicine clinics. The design innovation focus of this research project will be to design a patient app that is simple, usable, useful and fits into the fabric of people’s lives.
To achieve this goal, we will first engage young people (13 years of age and older) from the West Side Communities of Chicago in user-centered design practices. Member checking of resulting designs will occur with adults from the West Side Communities to evaluate likely generalizability of the TES to broader age ranges. Concurrently, RUMC Family Medicine staff and physicians will be interviewed to inform an implementation plan of the TES into their care system. Following this, the effectiveness and implementation of the TES will be evaluated in a roll out cluster randomized trial in Family Medicine clinics at RUMC. This project will be the first to integrate the emerging capabilities of personal sensing into intervention apps informed by young people from communities most impacted by behavioral health disparities. The resulting TES has the potential to be the first that is usable by real-world patients, fits into clinic workflows and can be successfully implemented in Family Medicine clinics.