This Mentored Career Development Award (K08) is designed to provide intensive training in developing a strong program of research that investigates the adaptation and implementation of health information technologies within the school context to increase the availability of high-quality mental health interventions for underserved youth and families. A field of implementation science has recently emerged to address the significant gap between the proliferation of evidence-based practices (EBP) for treating youth mental health problems and their use in usual care treatment settings. Nowhere is this gap more apparent than in schools. Schools provide the bulk of youth mental health services (>70%) and effectively reduce service access disparities by ethnicity and socioeconomic status. Nevertheless, implementation research focused on the school context has been disproportionately limited. To address these gaps and advance implementation science, the candidate's long term career objective is to develop effective methods for promoting the use of EBP among mental health providers in educational settings. Standardized assessment (SA) of psychiatric symptoms is a cornerstone of all EBP and has been significantly associated with improvements in treatment- related outcome. Nevertheless, SA is infrequently utilized by school-based providers, resulting in sub-optimal care. Measurement feedback systems (MFS) use the results of SA to deliver information to clinicians about client progress, represent a structured way to introduce SA into service systems, and have the potential to support effective, client-centered care. The candidate's immediate focus is therefore to increase clinicians' administration of SA tools and incorporation of SA feedback into routine practice through the development of a MFS and an accompanying contextualized adaptation process that are designed specifically for schools. The current K08 Award will uniquely position the candidate to advance this research agenda. His background includes specialized training in child clinical psychology, evidence-based assessment and intervention approaches, research on school-based mental health, mental health services research, and collaboration with community stakeholders. To more effectively bridge the gap between typical and optimal mental health care in schools, he seeks to extend his training to include: (1) design of healthcare technologies that are user-friendly and contextually appropriate, (2) experience with theory and methods to support innovation uptake/implementation in schools, (3) advanced statistics and research methodology, and (4) advanced academic writing. The University of Washington is an outstanding environment in which to engage in the interdisciplinary training required to achieve these training goals. The candidate's primary mentors-Drs. Elizabeth McCauley and Jurgen Unutzer have combined expertise in the assessment and treatment of adolescent psychopathology, training with school-based providers, development of computer products to support evidence-based service delivery, implementation science, and the development and dissemination of measurement feedback tools for client progress monitoring. Additional local and national consultants will contribute expertise in implementation research for youth/family services, user-centered design, school-based mental health, community service provision, decision support tools for youth treatment providers, cultural diversity and mental health care, mental health policy, and qualitative and mixed methods research. The proposed project draws on the training and expertise above to develop and evaluate a contextually- adapted, web-based MFS for use in school-based health centers (SBHCs) through a series of qualitative, quantitative, and mixed methods research aims. The University of Washington Care Management Tracking System is a MFS, developed by Dr. Unutzer, previously found to result in improved care, symptom reductions, and increased functioning among patients. The current study proposes to use SBHC clinician focus groups and direct clinician feedback to adapt this MFS for use by SBHC clinicians. The candidate's prior research has revealed that SBHC providers infrequently utilize SA measures, but supports the feasibility of using structured, computerized methods to increase SA administration. A sample of SBHC clinicians (n = 20) and youth (n = 64, Aim 3) will participate in the project to advance the following Research Aims: (1) evaluate the SBHC context to inform MFS adaptation; (2) assess the adaptation's effectiveness in context; (3) evaluate the system impact on clinician behavior and youth outcomes; and (4) assess the added utility of providing academic data to school clinicians for use in progress monitoring. SBHC clinicians will provide feedback on the optimal design of the MFS and use it to track outcomes among youth experiencing depression and anxiety.
Aims 1 and 2 will be evaluated descriptively, using existing benchmarks when applicable.
Aim 3 will be tested experimentally via a small-scale randomized trial in which clinicians (and a subset of their caseloads) will be randomized to one of two conditions: (a) use of the school MFS to monitor progress using SA or (b) assessment as usual.
Aim 4 will be tested using the MFS, with randomization of youth to two conditions: (a) clinicians receive the results of SA and students' school attendance data from the MFS or (b) data include SA results only. Based on the results of this work, a R01 grant application will be submitted to investigate the larger-scale implementation of the school MFS and contextualized adaptation process among a range of school service delivery models, allowing for more thorough evaluation of its impact on clinician behavior and student functioning.
Evidence-based mental health services are infrequently provided by school-based clinicians, resulting in sub- optimal outcomes for the 'safety net' populations most likely to receive care in that setting (i.e., low- socioeconomic status, ethnic minority youth). By identifying innovative health technologies that systematically support the implementation of evidence-based practices and adapting them for use in schools, the proposed research and training carries considerable potential to enhance the availability of high-quality care for underserved youth, thereby more effectively alleviating symptoms and promoting functioning across domains.
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