Abstract
Approximately 20% of young people experience anxiety or depression by the time they turn 18, and rates are
higher among racial/ethnic minority youth. Improvement in problem-solving skills reduces depression, anxiety,
self-harm, and suicidal ideation, and corresponds to reduced symptoms and better adjustment for youth with
externalizing problems, pointing to its transdiagnostic potential. Problem-Solving Skills Training (PSST) is
consistently revealed to be the most common element across youth mental health prevention and promotion
programs; however, dosage and delivery vary - including the extent to which quantity, sequencing,
temporality, steps and strategies account for its transdiagnostic value and impact. Additionally, despite long-
standing psychotherapy literature documenting that cultural adaptation and tailoring predict engagement,
alliance, and outcomes for racial/ethnic minority youth and families, the prevention literature has been slower
to examine to what extent programs are designed with cultural diversity or specific groups in mind; delivered in
culturally congruent ways; and to what extent these lead to better outcomes. As a result, the field’s readiness
to disseminate evidence-based recommendations for maximum impact is limited. We have assembled an
Advisory Board of scientific and community experts to inform two aims. Specific Aims 1: Examine PSST for
variability in dosage, delivery, and cultural considerations, and variance in internalizing outcome effect sizes.
We will (a) identify universal and selected prevention programs (n=~90) for adolescents (ages 14-18)
outperforming a comparison in at least one trial on at least one internalizing outcome; (b) code dosage
(quantity, sequencing, temporality), delivery (steps and strategies), cultural content and tailoring, and impact
and (c) use random effects meta-regression to examine variance accounted for in problem solving skills and
internalizing outcomes. Findings will inform Specific Aim 2: Develop, assess, and deploy a best practice PSST
resource guide (TIPS = Teach It Plain & Simple) for youth service providers. We will recruit frontline providers
(n=15, ~30% non-Hispanic Black, ~70% Hispanic) from three youth service settings (5 high school counselors,
5 middle/high afterschool professionals, 5 community health workers) to receive, review and integrate TIPS
into their work. Two months later, we will receive feedback via surveys and semi-structured interviews in a
sequential mixed method design, and conduct thematic analysis to assess usability, appropriateness,
acceptability and feasibility. Findings will inform modifications to design for wider dissemination and an R01
application. Aligned with Strategic Plan Objective 4.2.C, the planned design allows for rapid infusion of
research findings into practice settings for underserved communities to increase the impact of mental health
interventions. By unpacking the black box of PSST, we hope to speed its scale-up as an efficient, effective,
stand-alone, culturally congruent brief intervention tool for youth service providers in a variety of settings.
