The aims of the current project are to: 1) Engage stakeholders to identify targets for ACT SMART redesign to optimize its fit for middle and high school providers who serve autistic adolescents; 2) Conduct prototyping and usability field testing of the redesigned ACT SMART and iteratively refine to ensure usability, feasibility, acceptability, and appropriateness for use in schools.
Patient Population: Adolescents
Autism Community Toolkit: Systems to Measure and Adopt Research-Based Treatments- Educational Redesign (ACT SMARTER)
The aims of the current project are to: 1) Engage stakeholders to identify targets for ACT SMART redesign to optimize its fit for middle and high school providers who serve autistic adolescents; 2) Conduct prototyping and usability field testing of the redesigned ACT SMART and iteratively refine to ensure usability, feasibility, acceptability, and appropriateness for use in schools.
Evidence Based Practice Institute (EBPI)
The Evidence-Based Practice Institute (EBPI) is a partnership between the University of Washington and the Washington State Healthcare Authority (HCA), housed at CoLab. We promote the use of evidence-based practices in Washington State through training, research, workforce development, and data sharing. EBPI was initially established as an independent institute in 2007 by the Washington State Legislature House Bill 1088, with the goal of strengthening the quality of public children’s behavioral healthcare. Now, EBPI is housed under the broader umbrella organization of CoLab and continues to serve as a statewide resource to promote high quality mental health services for children and youth in Washington State.
Evaluation of an asynchronous remote communities approach to behavioral activation for depressed adolescents
In an effort to address the significant challenges in access to and engagement with evidence-based psychosocial interventions for adolescent depression, the proposed research is piloting the use of Asynchronous Remote Communities (ARC) supported behavioral activation (BA) to treat adolescent depression. We aim to 1) build and conduct usability testing on a functional and robust ActivaTeen platform that will satisfy the needs of mental health clinicians and adolescent patients and 2) test the feasibility, usability, and change in proposed target mechanisms (therapist alliance, timeliness of intervention, social belongingness, and engagement) and outcomes of BA+ActivaTeen compared to BA treatment only within a moderately-sized randomized control trial conducted within Seattle Children’s Hospital outpatient psychiatry clinic.
Developing a pediatric telebehavioral health consultation model for emergency departments
As rates of pediatric mental health emergencies have skyrocketed over the last decade – and even more so since the Covid-19 pandemic – the number of youth staying in emergency departments (EDs) and medical units while awaiting inpatient psychiatric care or stabilization (i.e., “boarding”) has reached unprecedented levels. The massive surges in patient volume, coupled with widespread staff shortages and lack of staff expertise in treating mental health, are overwhelming ED and hospital resources. This causes dangerous or even life-threatening delays in care for youth populations in greatest need of medical and psychiatric treatment. Prolonged ED stays not only delay necessary mental health care, but they can cause additional trauma and distress for youth already in crisis. While the boarding crisis affects all hospitals and EDs, it poses an even greater challenge to community EDs that lack on-site mental health specialists and/or pediatric providers.
To address the boarding crisis, this project will pilot a model in which a multidisciplinary team of mental health clinicians at Seattle Children’s Hospital provides telebehavioral health consultation to community EDs in Western Washington to guide care for youth who are boarding. The primary goals of this model are (1) to improve timeliness of mental health care and reduce length of stay for youth boarding in community EDs, and (2) to support ED staff in providing more developmentally appropriate and evidence-informed mental healthcare. The Seattle Children’s team will provide case consultation to ED providers and staff, including support with decisions about hospitalization, medication treatment, behavioral interventions and case management services. The team will also deliver practical trainings to community ED staff to build their internal capacity to care for boarding youth. If this initiative is successful, additional funding could expand ED telebehavioral health consultation services statewide, with a focus on rural communities.
Expanding access to adolescent depression care by non-specialists with a digital intervention
Adolescent depression is one of the most common mental health concerns during adolescence and can be a cause of significant impairment across the lifespan, particularly if untreated. Access to evidence-based psychotherapy is poor and pandemic-related increased demand for services has greatly worsened access issues, leaving many adolescents without effective and critically needed treatment. Adolescent depression is often first identified in primary care, making it the ideal setting for improving early access to treatment. While treatment by mental health specialists within primary care is effective, the workforce is not adequate to meet the high demand for services. Online depression treatment has been shown to be effective and has the added potential to expand access, particularly given adolescent’s comfort with digital technology. Importantly, the addition of human coaching alongside online treatments has been shown to boost engagement and treatment outcomes.
The goal of this project is to increase early access to evidence-based depression treatment in primary care settings. The project team will work with adolescents, caregivers and providers to develop an accessible and engaging online treatment for delivery in primary care. To support integration and enhance engagement, the project will also develop a coaching toolkit that can be utilized by a range of non-mental health specialists, including nurses, medical providers, social workers and bachelor’s level staff.
Improving mental health in adolescents and young adults with long COVID through exercise
Long Covid includes symptoms of fatigue, sleep changes, anxiety and depression lasting at least three months following infection with COVID-19 and occurs in 10-20% of individuals following infection. Approximately 16% of children experience persistent mood symptoms as part of their Long Covid symptoms. This amounts to over two million children with new symptoms of anxiety and depression after COVID-19 in the US since the onset of the pandemic. Studies show that gradual increases in exercise targets or “pacing” improves symptoms in adults with Long Covid, but this treatment remains to be evaluated in children. Most pacing programs require weekly in-person physical therapy visits and therefore, are difficult to access. Our group has demonstrated improvement in mental health outcomes for adolescents following concussion using a virtual paced exercise program, Mobile Subthreshold Exercise Program (MSTEP). This project aims to evaluate MSTEP as an intervention to improve function and improve mental health symptoms in adolescents and young adults with Long Covid.
Decreasing engagement and transmission of suicide-related content on TikTok
In the US, approximately one in five adolescent and young adults have seriously thought about suicide and one in 11 have made a suicide attempt. Unfortunately, a third to half of adolescent and young adults who are experiencing suicidal and self-injurious thoughts do not seek professional help and when they do, there is a nationwide shortage of mental health professionals available to support them. When adolescent and young adults are in distress, many seek out support and validation through social media. Some content can be helpful and allow them to find a community where they feel connected, receive the support they need, or share effective coping strategies. Other content can be harmful by encouraging them to commiserate and share or promote harmful coping strategies.
TikTok is the most popular digital platform currently used by over 63% of US adolescent and young adults. Its content recommendation algorithms select and display highly personalized content to each individual user such that the more a user engages with a specific type of content, the more this content will be displayed to them. Many other social media platforms are developing similar content recommendation algorithms to increase user engagement. For adolescent and young adults who are experiencing suicidal thoughts and urges, these content recommendation algorithms can amplify their exposure to suicide-related content and increase suicide risk. The purpose of our project is to identify TikTok content and usage behaviors that increase suicide risk. These findings can inform the development of social media interventions for adolescent and young adults who are experiencing suicidal thoughts and urges.
Adapting a resilience intervention for youth athletes
Youth mental health is in crisis and we do not have adequate providers to treat the current burden of illness. We must identify innovative approaches to support youth mental health that utilize the existing infrastructure and can be administered by non-clinicians. While sports are predominantly a positive outlet for youth, they also bring stressors due to experiences with failure, injury and challenging time commitments, and thus provide an ideal laboratory to develop coping skills for managing stress.
This project aims to build psychological resilience in high school athletes by adapting an intervention developed for youth with chronic illness (PRISM). The intervention will be delivered through the coach via an educational platform with five modules: 1) background/ psychoeducation; 2) creating a supportive team culture; 3) stress management (breathing exercises, visualization and mindfulness); 4) mindset (goal setting, cognitive reframing and meaning making); and 5) fueling the machine (sleep and nutrition). The team will utilize a community-engaged research process to adapt the PRISM approach to an athletic space, using the term “Mentally Strong” to center it in the sport context, and will partner with youth athletes and coaches to ensure the tools we develop support their needs. The Mentally Strong approach has the potential to increase the emotional literacy of a broad swath of high school youth beyond the athletic environment, enhancing their ability to negotiate the acute and chronic stressors they encounter in daily life. The ultimate goal of the project is to prevent the outcomes which occur with negative emotional coping—including depression, anxiety, substance use, burnout, violence, withdrawal from school and even suicide.
Using teen Mental Health First Aid to address mental health inequity among school youth
Over 2.5 million US adolescents struggle with mental health challenges, and multiracial adolescents are at greatest risk due to limited access to mental health programs. As roughly half of lifetime mental disorders have their first onset by mid-adolescence, it is vital to promote help-seeking for prevention and early intervention during this important developmental stage.
This project will test the implementation of an evidence-based mental illness prevention program — teen Mental Health First Aid (tMHFA) — in a diverse and underserved school district to facilitate help seeking among teens aged 16-18. While tMHFA has a proven track record of effectively enhancing knowledge of mental health problems, reducing stigma and promoting help-seeking behaviors, its efficacy across dimensions of race and ethnicity is underexamined in the US.
Academic (UW & SMART Center), education (Tacoma Public Schools) and behavioral health organization (MultiCare) stakeholders will address this gap by conducting a mixed-methods study with 1) focus groups to obtain diverse teens aged 15-18 opinions about facilitators and barriers in help-seeking; and 2) longitudinal data collection to examine the impact of the innovative tMHFA’s potential to address help-seeking barriers across dimensions of race and ethnicity. The findings of this project will guide both the revisions to the program to improve its efficacy and the scaling of this program to support government legislation to expand service delivery to other schools and to rural areas across the state.
