3 - (SYM 30) Youth FIRST: Lessons from Community Co-design and a Hybrid Effectiveness-implementation Trial

Background: The standardized structure and focus on single disorders or homogeneous clusters of problems of many empirically supported treatments (ESTs) may not be ideal for clinically referred youths treated in community settings. Community providers also struggle to learn and sustain the multiple ESTs needed to treat large caseloads. These concerns prompted the development of FIRST, a transdiagnostic approach focused on five empirically supported principles of change to treat common youth mental health problems. This talk will describe the initial development of FIRST through community provider co-design, and the current multi-site randomized effectiveness trial in community mental health agencies.

Method: Community mental health providers (N = 61; 78% Female, 76% White, 75% non-Hispanic/Latinx) recruited from 5 partner agencies in Texas and Massachusetts were randomly assigned to FIRST or routine care. Youth participants (N = 102; 51% Female, 35% White, 45% Hispanic/Latinx) are recruited via natural referral and randomly assigned to FIRST or routine care and providers within their agency. Provider characteristics were collected before study treatment initiation. Sessions are recorded and coded for fidelity to evidence-based practices. Youth participants and their caregivers are assessed at baseline and quarterly intervals using broadband measures of internalizing and externalizing symptoms and brief weekly measures.

Results: During the three years of the active trial, 100% of the providers initially trained departed the clinic or changed roles, and new providers were trained. Providers differed substantially between state-funded agencies serving uninsured/underinsured youths and those that accept primarily private insurance. Youth client participants also differed between agencies in terms of ethnicity/race, socioeconomic status, diagnoses, and initial severity. Despite state mandates requiring ESTs in routine care, there were substantial differences in treatment patterns.

Discussion: These results illustrate the diagnostic complexity of youths in community mental health clinics and the variation among frontline mental health providers, underscoring the need for flexibility to accommodate comorbidity, complex caseloads, and culturally responsive tailoring. Scaling interventions like FIRST will require ongoing investments in training and support given the rapid turnover of community-based providers and the limited uptake of evidence-based practices despite state mandates.