3 - (SYM 26) Telehealth Adaptation of Brief Behavior Therapy for Youth Anxiety and Depression in Primary Care

Anxiety and mood disorders are the most prevalent mental health problems in youth, but have the lowest lifetime service use rates. As primary care has become the de facto mental health system, implementation of evidence-based interventions in pediatrics may provide an ideal access point. In prior work, we developed a transdiagnostic Brief Behavior Therapy (BBT; Weersing et al., 2017) for youth anxiety and depression, designed to be delivered by behavioral health clinicians in primary care. The original trial was conducted in a face-to-face format, so we transitioned to telehealth in 2018 and prepared for future work in low-resource community health centers (CHCs). Telehealth may provide a bridge to bringing evidence-based interventions to CHCs, through there is critical need to test the effectiveness of telehealth programs in CHCs.

Here, we present results from two pilot open trials of BBT in primary care, with equal foci on treatment outcomes and barriers/successes in using telehealth for transdiagnostic treatment in internalizing youth. The first pilot (N=7) occurred in a large integrated health system, with translation of BBT materials into a web-based version with downloadable handouts, reformulation of the therapist manual to interface with web content, and development of a telehealth protocol and clinical and technical infrastructure. This work was successful: video sessions were delivered with minimum technical difficulty, families accessed web content on a range of devices, parent and youth satisfaction was high, and youth evidenced improvement in anxiety symptoms (pre-post ES d = 1.07), comparable in size to the original face-to-face RCT (d = 1.14). In the second pilot (R56MH125159), we obtained feedback from CHC stakeholders and further refined the telehealth program as part of routine practice in low-resource CHCs, including development of Spanish-language materials to accommodate caregivers in this setting. The final sample included 14 families, with initial examination of data suggesting acceptability and satisfaction. However, successfully contacting families required 2-3 times the number of attempts as in the original face-to-face RCT and the first telehealth adaptation.  

The final presentation will examine clinical outcomes, family engagement in treatment, acceptability of telehealth, and use of the website and other CHC (e.g., electronic progress note) data. Next steps in this work, and for use of telehealth in evidence-based intervention implementation in real-world settings, will be discussed.