Adolescent Well Being, Community Mental Health Services, Health Equity, Resilience, Psychological, Screening
Conditions
Keywords
Resilience, Adolescent mental health, Digital therapy, Prevention, Health disparities
Brief summary
The proposed research project provides a novel approach to screening, early assessment, and preventive interventions for high-risk youth in racial/ethnic/linguistically (REL)-diverse communities. * The investigators assess a health promotion intervention as a way of reducing treatment disparities in REL-minority youth. This population is underrepresented in child psychiatry research. It is often excluded from clinical trials of medication or therapy because of challenges with transportation, literacy, resources, or other issues. * The study will take place during or following a healthcare crisis and economic recession, making findings relevant to understanding the mechanisms by which hardship translates into youth mental illness. * The innovative integration of online screening into school-based clinics and community-based settings in REL-minority communities is made possible by the combination of access to a new technology (CAT) in the context of a learning health community serving a REL-minority population. * Empirical research on the impact of a resilience-based prevention intervention in youth and youth at risk is both innovative and much needed during this period of health, social and economic crisis.
Detailed description
Four hundred high school students will be screened for psychiatric symptoms and functional impairment using the Kiddie Computerized Adaptive Testing (K-CAT) and the Weiss Functional Impairment Rating Scale - Self Report (WFIRS-S) in CHA's catchment area (Cambridge, Chelsea, Everett, Malden, Revere, Somerville, Winthrop. Students will be classified into three tiers: normal, at risk, and clinical . The cut off scores that differentiate the tiers are drawn from the ROC values generated by the psychometrics of the measures themselves as follows: * Tier 1: K-CAT Normal & WFIRS \<0.8 - \>1.0 (T \<1SD). * Tier 2: K-CAT Mild & WFIRS 0.8 - \>1.0, K-CAT Moderate & WFIRS 0.8 - 1.0 (T between 1 and 1.5 SD), K-CAT Severe & WFIRS 0.8 - 1.0 (T between 1 and 1.5 SD) * Tier 3: K-CAT Moderate & WFIRS \>1.0 (T \>1.5 SD), K-CAT Severe & WFIRS \>1.0 (T \>1.5 SD) If patients are symptomatic but not functionally impaired, status is determined by function because symptoms without impairment do not necessarily warrant intervention. If the patient is impaired but not symptomatic, the threshold is determined by symptoms because the patient may be impaired from factors other than the diagnosis. These scores are based on the results of the most severe module of either the K-CAT or the WFIRS. .All students will be eligible to participate in C2T, independent of how they are classified by Tier, unless they meet one of the exclusion criteria. Tier 3 will be informed that the participants' responses suggest that the participants are experiencing some symptoms which are causing them difficulty. As long as the participants are not assessed as critical imminent risk, Tier 3 will also be invited to participate in C2T. A stepped wedge design with 3 clusters of 36 students each will be used to group students into clusters based on rolling recruitment into COPE2Thrive. The stepped wedge design assigns a random cluster to be switched from the control group to the C2T intervention group at either one, two, or three-week intervals starting at week 1 and ending at week 23 of the study.
Interventions
BEHAVIORALCOPE2Thrive
Cognitive Behavioral Therapy-based program to help teens deal with anxiety, stress and depression by showing them how to develop skills needed to stop negative thoughts and start thinking and behaving in more positive ways.
OTHERUsual care
The control group receives usual care for youth at risk in the area of study.
Sponsors
Cambridge Health Alliance
National Institute of Mental Health (NIMH)
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
12 Years to 24 Years
Healthy volunteers
Yes
Inclusion criteria
* High school students in CHA's catchment area (Cambridge, Chelsea, Everett, Malden, Revere, Somerville, Winthrop) * Youth who are fluent in English, Haitian Creole, Portuguese, or Spanish. * Youth who experience at least some symptoms, defined as a K-CAT-S score (from Aim 1) of moderate on at least one diagnosis with at least mild functional impairment. Patients with more severe symptoms or functional impairment or who do not meet the
Exclusion criteria
are also eligible. Inclusion Criteria for COPE2Thrive: * High school students in CHA's catchment area (Cambridge, Chelsea, Everett, Malden, Revere, Somerville, Winthrop) * Youth who are fluent in English, Haitian-Creole, Portuguese, or Spanish. * Youth who have completed WFIRS and K-CAT, and who do not meet the
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Kiddie Computerized Adaptive Testing Self Report (K-CAT-S) | The time frame of assessment of the K-CAT-S is: baseline (at initiation of the intervention, which is 1-, 2-, or 3-weeks after initial screen); completion (1-3 weeks after baseline); and follow-up 3 months | The K-CAT-S is a computerized adaptive test for assessment of DSM 5 conditions in youth. Adaptive testing allows the assessment to be done in less than 10 minutes with high validity compared against diagnostic interviews. High scores indicate greater psychopathology. For each of six domains, the minimum score is 0, a score between 45-64 is moderate, a score greater than 65 is severe, and the maximum score is 100. For this primary outcome, the Total K-CAT was used, adding scores across all six domains for a range of 0-600. Change in the numeric level of these symptoms will be the primary outcome of the testing of the preliminary effectiveness of the COPE2Thrive intervention. |
| Weiss Functional Impairment Rating Scale - Self Report (WFIRS-S) | The time frame of assessment of the WFIRS-S is: baseline (at initiation of the intervention, which is 1-, 2-, or 3-weeks after initial screen); completion (1-3 weeks after baseline); and follow-up 3 months | The Weiss Functional Impairment Scale Self Report (WFIRS-S) is an assessment of the student's perception of how emotional and behavior problems have impacted functional impairment over the past month, across six domains including family, school, life skills, child's self-concept, social activities, and risky activities. Higher mean item scores indicate greater functional impairment. The minimum mean item score is 0, the maximum mean item score is 3, and the ROC population cut-off is 0.65. A mean change score of 0.25 is the minimal clinical important difference. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Kiddie Computerized Adaptive Testing Parent Report(K-CAT-P) | Single assessment at Baseline | We administered a single assessment of The Kiddie Computerized Adaptive Testing (K-CAT-P) to participants' parents at baseline to obtain collateral parent report of youth symptoms. The scoring metrics of this testing are identical to the Kiddie Computerized Adaptive Testing Student Report (K-CAT-S). The Kiddie Computerized Adaptive Testing Parent Report (K-CAT-P) screener provides a combined numeric score for each module based on validated quantitative comparisons. Higher scores indicate higher levels of symptoms. The minimum score for any module is 0, a numeric score between 45-64 for any module is considered moderate, a numeric score of 65 or above for any module is considered severe, and the maximum score for any module is 100. Scores for each of the six modules are reported. |
| Weiss Functional Impairment Rating Scale - Parent Report (WFIRS-P) | Single assessment at baseline | We administered a single assessment of the Weiss Functional Impairment Scale Parent Report (WFIRS-P) to participants' parents at baseline to obtain collateral parent data. The Weiss Functional Impairment Scale Parent Report (WFIRS-P) is an assessment of the parent's perception of the child's functional impairment over the past month, across six domains including family, school learning and behavior, life skills, child's self-concept, social activities, and risky activities. Higher mean item scores indicate greater functional impairment. The minimum mean item score is 0, the maximum mean item score is 3, and the ROC population cut-off is 0.65. A mean change score of 0.25 is the minimal clinically important difference. Scores for each of the six domains are reported. |
Countries
United States
Contacts
STUDY_CHAIRBenjamin Cook, PhD
Health Equity Research Lab
Participant flow
Recruitment details
Recruitment for the COPE2Thrive (C2T) intervention was contingent on prior participation in the initial screening phase of the study. Of the students who completed the initial screening for mental health symptoms and functional impairment, 128 were eligible and invited to enroll in the C2T program. Of these, 39 students provided consent/assent and enrolled in the intervention.
Baseline characteristics
| Characteristic | — |
|---|---|
| Age, Continuous | 15.8 years STANDARD_DEVIATION 1.2 |
| Kiddie Computerized Adaptive Testing Self Report (K-CAT-S) | 45.08 Score on a scale STANDARD_DEVIATION 11.4 |
| Race/Ethnicity, Customized Race/Ethnicity Asian | 4 Participants |
| Race/Ethnicity, Customized Race/Ethnicity Black or African American | 8 Participants |
| Race/Ethnicity, Customized Race/Ethnicity Hispanic/Latino | 7 Participants |
| Race/Ethnicity, Customized Race/Ethnicity Native American | 0 Participants |
| Race/Ethnicity, Customized Race/Ethnicity Other | 0 Participants |
| Race/Ethnicity, Customized Race/Ethnicity White | 12 Participants |
| Sex/Gender, Customized Gender Female | 10 Participants |
| Sex/Gender, Customized Gender Male | 5 Participants |
| Weiss Functional Impairment Rating Scale - Self Report (WFIRS-S) | 0.0864358 Score on a scale STANDARD_DEVIATION 0.1426804 |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 39 | 0 / 39 | 0 / 39 |
| other Total, other adverse events | 0 / 39 | 0 / 39 | 0 / 39 |
| serious Total, serious adverse events | 0 / 39 | 0 / 39 | 0 / 39 |
Outcome results
None listed