Digital Strategies to Advance Help-Seeking in Youth at Clinical High Risk for Developing Psychosis

Project Summary Early psychosis intervention is critical to improving clinical and functional outcomes, yet treatment initiation is typically delayed for months to years, resulting in severe and long-term impairment. Online self-screening has emerged as a powerful tool capable of exponentially increasing the reach of effective early identification efforts, however most youth searching for mental health information online do not expeditiously advance towards care. For instance, over 100,000 youth between the ages of 13-26 screen above threshold for psychosis-risk annually via The Prodromal Questionnaire (PQ-B), available on Mental Health America’s (MHA) national online screening platform, warranting a thorough clinical evaluation. However, only 17.1% subsequently state an intention to seek care, and under 1% proceed to initiate one of MHA’s recommended professionally delivered digital supports, representing a critical limitation to existing online psychosis screening efforts. In collaboration with MHA, the world’s largest mental health screening and advocacy organization, and Strong365, an online resource hub dedicated to early psychosis awareness and care navigation, this R01 proposal aims to develop a Digital Laboratory focused on advancing help-seeking in youth at Clinical High Risk (CHR) for developing psychosis from self-directed online screening towards treatment initiation. Qualified youth with CHR will be referred to AMP- SCZ, a NIH funded national network of clinical and research programs across the US. We will begin by characterizing help-seeking subtypes based on the Health Action Process Approach Model (HAPA) in 25,000 youth who score above PQ-B threshold on MHA’s screening platform (Aim 1). Next, leveraging this large and unique dataset, we will establish the PQ-B threshold score most effective at identifying CHR youth in an online environment, thus reducing the risk of false positives, given that optimal threshold values can vary depending upon case mix and setting (Aim 2). Last, using a series of Micro Randomized Trials (MRTs) in 25,000 youth who score positive for psychosis risk, followed by a Sequential Multiple Assignment Randomized Trial (SMART) with another 1,000 youth, we will iteratively develop and test the effectiveness of data and theory driven help-seeking advancement strategies, designed to facilitate the transition from online information seeking at baseline to action, and determine the most effective strategies to maintain help-seeking at critical timepoints when youth are most likely to disengage (Aim 3). Further, through the proposed incorporation of Strong365’s provider interaction tools (text and video chat) directly into MHA’s website, designed to support and assess youth who score above PQ-B threshold, we will leverage Natural Language Processing to determine if text data carries important information related to advancement patterns and further develop targeted help-seeking advancement strategies to be tested through MRTs. Our platform would provide an innovative and scalable agile solution to address a major public health challenge by reaching youth earlier in the course of serious mental illness development, screening large volumes of youth for psychosis-risk online and advancing help-seeking trajectories towards care.