Assisted Identification and Navigation of Early Mental Health Symptoms in Children

The specific aim of the pragmatic trial is to:

Test a MH navigator model to promote early access, engagement, coordination, and personalization of mental health treatment and services as soon as early symptoms of mental health problems are detected in children.

The navigator model and implementation to be tested include:

• Automated identification of early symptoms for children meeting study criteria to populate an Epic "reporting workbench" for eligibility screening and randomization;
• Virtual collection of self-reported, standardized assessment scores;
• Psychologists interpreting assessment scores and providing feedback to families and PCPs;
• Trained clinicians serving as MH "navigators" to conduct family outreach, engage them in MH care, and coordinate with and between clinicians for up to 6-months;
• An Epic reporting workbench for MN navigators to manage their active panel of patients;
• An Epic "smart form" to facilitate the MH navigator's outreach, monitoring and follow-up to their panel;
• Up to 4 video-based behavioral health sessions with the MH navigator, as needed, while barriers to initiation of ongoing mental health services can be explored and addressed over the 6-month period.

This study will employ an encouragement trial design, an alternative to a traditional RCT design. Guardians of randomized youth are offered the opportunity to receive additional services (navigation, FAST brief therapy sessions), but allowed to choose whether to receive the services. That is, acceptance of or adherence to the offered study services is not a condition of participation. Whether or not guardians choose to accept intervention services from the beginning is a measure of the effectiveness of the program. Guardians who decline the additional services (navigation, FAST sessions) must remain in the intervention arm in order to measure the effectiveness of the intervention without bias. This allows an intent-to-treat comparison between arms. That is, patients remain enrolled in the study regardless of the navigators' ability to contact the family by phone or the family's perceived need for or willingness to accept or participate in study-based services.