PROJECT SUMMARY/ABSTRACT
With rates of mental health service utilization as low as 40%, racial and ethnic minority young adults with
serious mental illnesses (SMI) are at high risk for disengaging from mental health services. They experience
greater unmet need and increased risk for long-term health disparities, poverty, incarceration, and early
mortality. Disparities in treatment engagement are often driven by the lack of services that take into account
the unique developmental needs and relevant cultural factors that impact young adults’ on-going participation
in treatment. The PI’s preliminary findings among racial and ethnic minority young adults indicate that they
desired greater knowledge, appreciation, and support of their cultural identities from mental health providers.
However, there are few evidence-based treatment engagement programs for young adults with SMI, and none
that explicitly target both the developmental and cultural preferences of those who are racial and ethnic
minorities. This Career Development Award proposes a comprehensive path towards becoming an
independent clinician investigator adapting and optimizing evidence-based interventions to target cultural
determinants of health and reduce mental health disparities among adolescents and young adults. This proposal
uses the participatory ADAPT-IT framework to partner with racial and ethnic minority young adults with SMI
(n=15), providers (n=9), and expert mentors to adapt a brief, evidence-based young adult treatment
engagement intervention to include three new person-centered, cultural identity-focused components. The
adapted intervention will then be evaluated in a mixed-methods pilot optimization trial for feasibility,
acceptability, and preliminary impact on treatment engagement at an urban, publicly-funded, adult psychiatric
rehabilitation program. The pilot comprises the preparation stage of the multiphase optimization strategy
(MOST), during which young adults (n=80) will be assigned to one of eight conditions to test new components
in an efficient factorial experiment. In-depth interviews administered post-intervention will contextualize and
clarify findings. To further her long-term career goal of becoming an independent clinician investigator focused
on improving mental health services for underserved youth during the transition to adulthood, the PI will pursue
training in the following four areas: (1) developing empirically-driven engagement interventions for older
adolescents and young adults, (2) adapting interventions to be culturally relevant to underserved, minoritized
populations, (3) using MOST, and (4) grant writing. The product of this study will be an R01 of a large-scale
optimization trial powered to test intervention components for efficacy and change in targeted mechanisms of
treatment engagement. Overall, this award will ensure the PI’s successful transition to an independent
investigator with an established program of research focused on intervention development, adaptation, and
optimization for addressing mental health disparities in minoritized adolescents and young adults.