Adapting and testing an adjunctive, digital single-session intervention to increase caregiver adoption of early childhood mental health preventive services

PROJECT SUMMARY — RESEARCH PROJECT 2 (RP2) The American Academy of Pediatrics has endorsed primary care-based screening of mental health risk in young children as a key step toward improving youth mental health, but most early childhood mental health risks go undetected and unaddressed. Even when they receive screening, only 10%-25% of young children identified as “high risk” access mental health care. The availability of transdiagnostic decision tools for risk identification is a major advance; however, increasing uptake of post-screening mental health resources will require a community-partnered approach that centers families’ needs, concerns, and experiences with mental health systems. Such approaches must address caregiver preferences for certain types of support (e.g., for briefer, primary care-based resources); address caregivers’ beliefs and concerns that constrain help-seeking (e.g., beliefs that mental health interventions will not help their child); and grant agency to caregivers navigating complex support systems. Given the outsized impact of early prevention, there is a need for accessible adjunctive interventions that empower caregivers to increase their likelihood of seeking recommended supports after a positive screening for mental health risk at toddler pediatric well visits. Online single-session interventions (SSIs) have shown promise in increasing caregiver receptivity to mental health intervention and increasing linkage to intervention. For example, a digital (online) “growth mindset” SSI (GM-SSI, developed by Project Lead Schleider) teaching that emotions are malleable has strengthened both child mental health and caregiver support-seeking across multiple trials. Project Supporting Parent Action for Resilient Kids (SPARK) of the Mental Health, Earlier (MHE) Center seeks to adapt an online, evidence-based GM-SSI for caregivers of young children (ages 24-30 months) and test its potential to bridge the gap between primary care-based mental health risk screening and families’ access to child mental health support. When integrated into the Center’s Roll-Out Implementation Optimization design, it will bridge the Signature Project’s early identification decision tool and referral to the Family Checkup Online intervention. First, we will use human-centered design methods to ensure the GM-SSI is developmentally and contextually informed for early childhood primary care, via co-design with end-users (caregivers of toddlers) and key informants (pediatricians, administrative staff). Second, via usability testing, we will collect pre-, post-, and follow-up data on mechanisms (beliefs about mental health support; agency; hopelessness) and 3-month clinical outcomes (child mental health support access) of the GM-SSI. Third, we will use these results and conduct a pilot trial involving 30 primary care clinics and 350 caregivers of children screened as showing moderate-or-greater mental health risk. We expect caregivers who receive the adapted SSI (vs. the control) to report larger improvements in agency, hopelessness, and optimism about mental health support, and higher rates of accessing child mental health support within 6 months of risk screening.