PROJECT ABSTRACT The prevalence of anxiety and depression are high among adolescents. COVID-19-related stressors have increases rates of internalizing disorders and risk for suicide, especially among ethnic minority adolescents who have been disproportionately affected by the pandemic. Although evidence-based interventions are effective, the vast majority ethnic minority adolescents do not access any MH care. School-based MH services can address common barriers to care such as cost and transportation. However, even with access to school- based MH services, capacity can be highly limited in schools, and some adolescents may be reticent to seek services at school due to concerns about privacy, judgment, and academic disruption. Innovative approaches to provide accessible, low-cost, evidence-based MH care to minority youth are urgently needed. Technology creates an opportunity to treat youth in need of MH services and could expand the reach of school health services. Despite the potential impact of digital care, to date there are no studies examining whether digital mental health interventions improve service access for vulnerable youth served by school-based mental health services. Consistent with NIMH Notice of Information MH-18-031 designating digital health technology as a priority, this application proposes to determine the feasibility and acceptability of delivering SilverCloud, a clinician-guided, empirically-supported, app-based, CBT program to vulnerable adolescents through school- based health centers (SBHCs). In contrast to most MH apps, SilverCloud has demonstrated strong engagement and medium-to-large effect sizes. Its features, including personalized feedback, stories from relatable peers, and routine outcome assessment, directly promote engagement. This would be the first trial to evaluate SilverCloud as a school-based intervention and refine it to meet the needs of low income, ethnic/racial minority youth. We propose a four-phase study conducted at two diverse, public schools in Brooklyn. In Phase I, participants who endorse internalizing symptoms (n=20) during routine MH screening at the SBHC will participate in an open trial of SilverCloud. In Phase II, open trial participants will provide feedback that will be used to refine the SilverCloud program. In Phase III participants will be screened (PHQ-9/GAD-7). Those who endorse symptoms will be randomized (N=100) to SilverCloud or treatment as usual (TAU). Outcomes will be evaluated each semester. In Phase IV, participant and stakeholder feedback will be collected systematically to further inform program adaptations and implementation strategy refinement for a large effectiveness trial. Primary aims are to establish the feasibility, acceptability, and preliminary effectiveness of SilverCloud among minority youth served through SBHCs and to examine whether SilverCloud changes engagement (i.e., initiation, dose) and clinical (i.e., emotion regulation, negative cognitions, coping skills, behavioral activation) targets, and whether changes are associated with clinical benefit (i.e., reduction in depression and anxiety).

PROJECT NARRATIVE The prevalence of anxiety and depression are high among adolescents, but most ethnic minority adolescents in need do not access any MH care. The White House, the U.S. Surgeon General, the American Academy of Pediatrics, and the American Academy of Child and Adolescent Psychiatry, have all called for action to address the youth MH crisis and have highlighted accessible, effective school-based MH interventions for diverse students as a key strategy; research is needed to determine how to implement digital tools to improve mental health service access and outcomes for vulnerable youth served by school-based health centers.