The Caregiver-Informed Treatment Engagement (CITE) Program: a Pilot Trial of a Treatment Engagement Intervention for Historically Underserved Youth - Project Summary. Mental illness is common, impairing, and associated with heightened suicide risk among youth, but access to proper care is sorely limited, particularly for youth of color (YOC). Despite racial inequities in access to mental health services (MHS) being well known, there has been little meaningful improvement in MHS access for YOC over time.1 Thus, innovative strategies to improve access to care among historically underserved populations is imperative and has potential to have a profound public health impact. Given the challenges YOC face in obtaining adequate MHS, MHS access-promoting interventions designed with and for families of color in a culturally sensitive manner may be particularly helpful. Brief, accessible, and culturally sensitive interventions to improve access to and engagement in quality MHS among MHS- referred youth are understudied in diverse pediatric populations. This proposal seeks to address this critical gap in knowledge and promote equity in children’s MHS delivery by developing and piloting a virtual group intervention for caregivers of patients who have been referred to MHS by a pediatric community primary care center that predominantly serves YOC from low-income backgrounds (the Caregiver-Informed Treatment Engagement [CITE] Program). For Aim 1, we will form a CITE Steering Committee of community partners (caregivers and community mental health & primary care providers) to develop CITE for YOC referred to MHS. The Steering Committee will convene to guide each subsequent stage of CITE development and piloting. First, the Steering Committee will develop questions to asked in in-depth interviews (IDIs) of community stakeholders, including caregivers in the local community and community mental health and primary care providers; IDIs will assess stakeholder views on appropriate foci for a brief, virtually delivered access-promoting intervention as well as MHS access barriers and facilitators. We will use these data to inform the targets of the CITE intervention to ensure that CITE appropriately addresses the needs of the intended audience (YOC from low-income backgrounds). For Aim 2, we will conduct a pilot RCT of CITE recruiting caregivers of youth referred to MHS by their primary care provider. Youth will be randomized to CITE or to facilitated MHS referral. We will examine program feasibility, acceptability, and CITE fidelity. Additionally, youth will be assessed at the start of the study, at the end of the intervention and at 60- and 90-days post-intervention to examine whether CITE improved youths’ psychiatric symptoms, caregiver stress, and families’ access to and engagement in MHS. Finally, for Aim 3, we will examine mechanisms contributing to improved treatment initiation, engagement, and psychosocial outcomes among CITE participants. Specifically, we will explore whether social connectedness, MHS related knowledge, CITE acquired cognitive behavioral and parenting -skills, and parenting stress are associated with CITE engagement and with more favorable mental health outcomes.
