Study Development

Study 1

Principal Investigators: Ana Radovic-Stakic & Oliver Lindhiem

Implementation of universal screening for depression and suicidal ideation is an important first step in reducing public health impact of these common conditions in adolescents. 

The United States Preventive Services Task Force (USPSTF) recommends a service where adolescents are annually screened for major depression when formal procedures are in place to follow-up on a positive test. 

The Screening Wizard develops a decision support system that elicits information on comorbidity, acuity, and parent treatment preferences and barriers. 

The Screening Wizard aims to develop a physician support tool which:

  • Gathers information about patient/family preferences and barriers to care
  • Recommends urgency and level of care 
  • Also provides talking points for results of screen 

Benefits to Families:

  • Recommendation that takes into account acuity and need for specialty care
  • Treatment recommendation that more closely reflects their needs and preferences 
  • Satisfaction with care 

Benefits to Primary Care Providers:

  • Provides immediate scoring and interpretation of PHQ-9
  • Rapid assessment of comorbid conditions (e.g. mania, anxiety) 
  • Assessment of suicidal risk 

Take a look at a mock-up of how the provider report will look like!

Study 2

Principal Investigators: Tina Goldstein & Brian Suffoletto

Connecting depressed and suicidal adolescents with mental health treatment can play a critical role in reversing the alarming trend of suicide.

Currently, rates of linkage with treatment among depressed and suicidal youth identified in primary care are as low as 18%, and, in one survey, increase only to 32% with integrated mental health services. Aside from structural barriers such as treatment availability and cost, the major barriers to mental health care among at-risk adolescents are motivational. In a review of an electronic health record, Dr. Ana Radovic found that around 1/4th of patients referred for mental health treatment attended at least one session. In order to be motivated to engage in care, an individual must first perceive themselves to be susceptible to depression and suicide, and understand that treatment can help reduce these risks. Even then, there may still be significant stigma around depression labels and mental health treatment that keep them from acting. 

Text2Connect texting intervention is for patient and parents to increase attendance to primary care provider's treatment recommendations for embedded mental health care. 

The ability to repeatedly prompt awareness of treatment targets in daily life and deliver on-demand tailored support based on patient and parent attitudes, readiness to change, and perception of need for treatment. 

Benefits to Families: 

  • More likely to pursue treatment with personalized psycho educational text messages 
  • Improve knowledge and attitudes toward treatment 
  • Low time requirement and able to message anywhere at preferred times 

Benefits to Primary Care Providers: 

  • Intervention takes place out of office; minimal in time commitment 
  • Patients more likely to pursue treatment recommendation and express satisfaction

Have a look at how the text intervention might look like!

Study 3

Principal Investigators: Stephanie Stepp & David Brent

While collaborative care models for adolescent depression have been tested in primary care, none have addressed suicidality, and none have targeted embedded clinicians but rather added research clinicians to practices. Thus, a wide gap remains between identifying adolescents at high risk and delivery of effective services. 

BRITEPath, an app-supported psychosocial intervention targeting depression and suicidality in adolescents and optimized for delivery by mental health clinicians embedded in pediatric primary care clinics. It systemizes the development of an effective safety plan to be loaded on the patient's smartphone. 

Benefits to Families: 

  • App has resulted in improved outcomes (e.g. suicide attempts) with relatively little burden 
  • May reduce need for emergency referrals 
  • High satisfaction with app and treatment 

Benefits to Primary Care Providers: 

  • Will increase communication between therapist and patient regarding between session deployment of skills and distress ratings 
  • Can provide support in developing a safety plan 
  • Can extend the reach of the therapist by providing tools for distress tolerance and emotion regulation 
  • Offer therapist opportunity to employ skills with technology 
  • Clinician dashboard (BRITEBoard) can track patient progress and can be placed in medical record

Here is a screenshot of how the BRITEapp looks like on a phone!