Project Summary/Abstract Completion of EBTs for depression has been shown to be particularly problematic for Black adolescents. Rates of participation in treatments for depression are lower due to this population's negative perceptions of services and providers, and their reluctance to endorse the presence of symptoms. The overall goal of this R34 application is to examine the effectiveness of the Making Connections Intervention (MCI) and to identify key mediators of both engagement and response to treatment for depression. In addition, the study will tailor outreach strategies to the particular context and communication preferences of the adolescent and parents through the use of digital technologies. The MCI is a theoretically-driven 1-2 session intervention designed to improve engagement, perceived relevance, and treatment satisfaction among depressed, Black adolescents. It builds on prior evidence-based strategies found to be efficacious in a comprehensive review of engagement interventions targeting families in children mental health services (i.e., called the “common elements of engagement”). As an initial examination of its feasibility and acceptability via an NIMH R21 award, we implemented the MCI as an adjunct to the IPT-A, an evidence-based intervention delivered in schools. The small-scale study occurred in two phases via two open pilot trials, per each phase. Results of the R21 suggested that MCI has a positive impact on multiple mechanisms of change associated with treatment engagement and clinical outcomes. We propose a pilot RCT to examine the preliminary effectiveness of the MCI (in digitized format) in a multi- school trial involving adolescents in grades 6-12 who attend New York City (NYC) Department of Education (DOE) Public Schools. We will randomly assign 60 Black students with depression symptoms to two conditions: MCI+IPT-A vs. IPT-A-alone. We will also do qualitative research in the advancement of digital strategies to augment the implementation of the MCI. Primary outcomes include adolescent- and caregiver- level engagement and adolescent depression. Suicidal ideation is a secondary outcome. We will explore analytic strategies necessary for testing mediational mechanisms that can account for treatment outcomes and that will allow the MCI to be strengthened in future roll-outs of the protocol in school settings. This study will address an important public health issue: How best to connect Black adolescents with depression to treatment in clinically meaningful ways, and how best to deliver EBTs in school-based services to this most vulnerable population.

Project Narrative/Public Health Statement Completion of EBTs for depression has been shown to be particularly problematic for Black adolescents. Rates of participation in treatments for depression are lower due to this population's negative perceptions of services and providers, and their reluctance to endorse the presence of symptoms. If EBTs are to meet Black adolescents' depression needs, we must address the engagement challenge, and also understand factors that attenuate successful delivery of EBTs in the “real world.”