Abstract
Implementation of evidence-based interventions (EBIs) in under-resourced schools serving ethnic and racial minority youth is challenged by intervention, individuals', and setting characteristics. Engaging community members in equitable partnership improves implementation outcomes and provides resources (e.g., workforce capacity, funding), but can be time intensive. Rapid and rigorous approaches for improving the implementation of EBIs in under-resourced schools is necessary to address youth mental health needs. In this paper, we describe a 6-week internship program for high school students (n = 8) that used community-based participatory research (CBPR) and user-centered design (UCD) principles to adapt a cognitive behavioral skills curriculum. We assessed the process by categorizing barriers discussed and addressed using the Consolidated Framework for Implementation Research, and qualitatively exploring youth perceptions of the adapted curriculum. Barriers included intervention complexity, intervention design, communication, and resource availability. Adaptations focused on design simplification (e.g., renaming the curriculum TEB: Thoughts, Emotions, Behaviors) and dissemination strategies (e.g., creating social media content). Thematic analysis of intern interviews revealed the adapted curriculum as appropriate for students, helpful, and broadly applicable. Interns also expressed ownership over the curriculum and provided recommendations for future implementation. Overall, our study suggests the following: (1) CBPR and UCD can be integrated to adapt EBIs for racial and ethnic minority youth in school settings; (2) UCD principles can expedite the adaptation process; (3) design participation fosters a sense of ownership; (4) youth involvement in the design process can spur support from other stakeholder groups including policymakers; and (5) engaging youth as co-creators requires financial and human resources.
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Notes
UCD is distinct from Human Centered Design (HCD) and Design Thinking; yet, the terms are closely related and frequently used interchangeably. For this paper, we conceptualize UCD as an approach focused on specific end users, characteristics also used by HCD (an approach focused more broadly on humans), and Design Thinking (an approach focused on integrating user, technology, and business).
The need for mental health programming was determined by CHS leaders based on their knowledge of students and mental health risk factors present in the community (e.g., financial stress, violence). Other mental health programs, such as existing social emotional learning curricula, were considered by funders and leaders at CHS. A cognitive behavioral approach was chosen because community members were seeking transdiagnostic and preventive skills that could be flexibly delivered within their school. PRIDE, having conducted prior research develo** and implementing a cognitive behavioral curriculum for at-risk populations, was chosen to collaboratively refine and implement a similar program within CHS.
For current implementation of the curriculum created for high-risk justice-involved youth visit our community partner site: rocainc.org/the-roca-impact-institute/rewire-by-roca/.
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Approval was obtained from the IRB of Massachusetts General Hospital. All authors contributed to the study conception and design. Data collection was conducted by ADB, LB, KED, NL, SY and LM. Qualitative analyses were performed by ADB, LB, and JD. The manuscript was outlined by ADB and drafted by ADB, LB, and JD. All authors commented on previous versions of the manuscript and approved the final manuscript.
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Bartuska, A.D., Blanchard, L., Duan, J. et al. #TEBWorks: Engaging Youth in a Community-Based Participatory Research and User-Centered Design Approach to Intervention Adaptation. School Mental Health (2024). https://doi.org/10.1007/s12310-024-09659-5
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DOI: https://doi.org/10.1007/s12310-024-09659-5