Advance-CTR

Advance RI-CTR Pilot Projects Program (Cycle 10)

"A direct-to-consumer dissemination campaign about exposure to increase treatment access"

It can take up to 15 years after a problem is recognized for someone with an anxiety or related disorder (e.g., obsessive-compulsive disorder (OCD); post-traumatic stress) to receive exposure therapy ("exposure"), which is the leading evidence-based intervention (EBI) for these disorders. Barriers to accessing exposure for youth are numerous, particularly for those whose symptoms severity makes them inappropriate for co-located services in schools or primary care. Addressing challenges to health care access requires intervention across the macro (e.g., health policy), meso (e.g., organizational policies), and micro levels (e.g., direct support to families).

This pilot grant application is informed by micro individual behavior change processes that occur within the larger eco-system of the mental health landscape. Youth receipt of EBIs is contingent on a sequence of steps that are typically caregiver driven. Thus, we will create, refine, and evaluate an advisory board-driven, direct-to-consumer dissemination campaign to increase caregivers' ability to successfully navigate the mental health system and improve their ability to connect their anxious youth to exposure therapists.

1. In Aim 1, we will develop and iteratively refine a dissemination campaign designed to target distinct mechanisms of help-seeking behavior for caregivers. This will be done in partnership with a community advisory board that is comprised of caregivers, school counselors, and pediatricians.
2. In Aim 2, we will conduct a pilot evaluation of the dissemination campaign with caregivers to assess target engagement using a randomized design administered via survey. We will recruit 100 caregivers concerned about their children's level of anxiety and randomize them to receive either dissemination-as-usual (i.e., pre-existing materials about exposure) or the novel dissemination campaign. Caregivers will complete measures of target mechanisms pre- and post-intervention to determine if the novel campaign leads to improvement in target mechanisms more than dissemination as usual. Directly increasing caregiver knowledge and awareness of EBIs and how to access them, as well as enhancing caregiver perceptions of acceptability and motivation to engage with EBIs, holds potentially to dually:
   1. improve caregiver treatment seeking and facilitate more rapid connection to appropriate care within the constraints of the mental health system and
   2. drive increased demand for EBIs among clinicians by placing external pressures on clinicians to deliver EBIs.

Data will lead to an R01 testing the cost effectiveness of the dissemination campaign relative to other strategies to improve youth care connection. This application aligns with the Rhode Island Department of Health's Strategic Framework priorities, particularly access to healthcare services and mental health in adults and youth.

In addition, it aligns with the National Institute of Mental Health's Strategic Objective 4.2 to "expedite adoption, sustained implementation, and continuous improvement of evidence-based mental health services."

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