Black adolescents with depression represent a group less likely to receive mental health treatment, primarily due to non-financial reasons including negative family influences, negative perceptions of services and providers, and self-stigma associated with experiencing depressive symptoms. Interventions that increase the connection of depressed, Black adolescents to mental health services are important because untreated depression is a precursor to other serious problems for this population, including school dropout, teen pregnancy, and suicidality. While previous strategies have been used to improve service engagement for adults, there is a dearth of strategies or interventions that specifically target depressed, Black adolescents in their middle school-age years. The overall goal of this R21 application is to examine the feasibility and acceptability of the Making Connections Intervention (MCI). The MCI is a theoretically driven 1- (possibly 2-) session intervention designed to improve engagement, perceived relevance, and treatment satisfaction among depressed Black adolescents. As an initial examination of its feasibility and acceptability, we wil implement the MCI as an adjunct to the Interpersonal Psychotherapy for Depressed Adolescents (IPT-A), an evidence-based intervention delivered in schools. To address the continued development and refinement of the MCI, the goals of this R21 application are: (1) to examine the feasibility of the MCI among depressed Black adolescents in school mental health services (e.g., recruiting challenges, documenting whether the MCI can be delivered in 1 or 2 sessions, fidelity to the MCI protocol);(2) to conduct in-depth interviews with MCI participants (adolescents and caregivers) to elicit perspectives on: (a) the MCI's content;(b) any social norms that influence MCI participation;(c) any improvements in help-seeking self-efficacy associated with MCI participation;and (d) expectancies about participating in the MCI;(3) to revise the MCI manual based on the initial pilot with 10 adolescents;(4) to examine the acceptability (via satisfaction ratings) of the revised MCI via a larger pilot open trial;and (5) o conduct preliminary analyses to explore MCI-relevant constructs, including perceived barriers, treatment attitudes, and readiness to change among adolescents who participate in the IPT-A, and whether caregiver participation in the MCI session, level of depression severity, and attended number of IPT-A sessions positively or negatively influence change over time regarding the key MCI constructs. The outcome of the proposed studies will provide: (1) preliminary support for a potential engagement strategy to enhance the mental health treatment utilization of depressed Black adolescents in school mental health services;and (2) valuable pilot data for a future, larger trial of the MCI.
Depressed, Black adolescents have low rates of mental health service utilization, and untreated depression has led to their increased rates of school dropout, substance abuse, and suicidality. To improve the initiation and utilization of mental health treatment for this population, strategies that target perceptual and actual barriers and tha enhance the acceptability of treatment must be developed. The outcome of the proposed studies will identify a potential engagement strategy to enhance the utilization of mental health treatment of depressed Black adolescents in school mental health services.