Digital Delivery of Evidence-Based Mental Health Content and Mentoring to Adolescents

Pilot Study (1 year). Optimize Study Procedures and Participant Retention (6 months). In an initial pilot study with N=75 youth, the researchers will examine the adapted Appa Health and research study content, offering data for optimization and retention incentive decisions prior to larger scale RCT through the following research questions (RQs): RQ 1.1: Are research and incentive protocols sufficient for recruiting and retaining adolescents in the study, and how can they be optimized? RQ 1.2. Do Appa's modified engagement strategies developed in preliminary studies increase use of CBT video content? This pilot study will enable the research team to identify and address any problems in recruitment, study procedures, and retention prior to the effectiveness trial.

Setting. The study will be carried out within the Appa Health remote platform, which comprises over 20 trained youth mentors serving, on average, 400 youth every 3 months. Clients come primarily from school-based partnerships. Appa has several existing school partners who refer students to Appa either through a paid partnership from the school or through access to parents of students.

Recruitment and Randomization. Participants will be recruited from the Appa Health client population using email outreach. As described in the Commercialization Plan, the Appa client base from individual paying clients, school systems, and B2B customers is expected to be sufficient to meet this goal within the study timeframe. Screening of youth using the PHQ-8 and GAD is standard protocol for Appa; those who score above 10 on either instrument will be invited to participate in the study. Due to the relatively small sample size of the pilot trial, the research team will use stratified random sampling to ensure approximate balance to the three study conditions on baseline covariates (gender, age, baseline severity on GAD & PHQ-8, race/ethnicity, and LGBTQ status), with stratification blocks created via nearest neighbor matching on all variables.

Interventions. Youth will be randomized to three conditions, which in the larger RCT will enable analyses of the main effect of the traditional Appa package as compared to a waiting list control group, as well as exploring the impact of a light touch version of Appa for commercial purposes. This will also permit examination of the impact of the two components on specific psychosocial mechanisms, as appropriate in an experimental therapeutics paradigm.

"Appa Lite": Unguided EBP videos and materials. Participants assigned to the Appa Lite condition will have unlimited access to the Appa website, including short form CBT-based videos and materials such as an emotions wheel pdf and thoughts, feelings, and behavior worksheets.