Black youth living in poverty-impacted communities are disproportionately burdened by
behavioral health challenges, notably serious disruptive behavioral difficulties (DBDs). In
some urban communities, prevalence rates of conduct related difficulties among young people
of color exceed 40%. Simultaneously, serious care disparities are widespread and persistent.
Without access to care, children with DBDs frequently suffer impairment in school
functioning, strained relationships with teachers, peers and family members, and coercive
interactions with school discipline or juvenile justice authorities. The seemingly
intractable challenges of identifying, engaging and retaining low-income children of color
and their families in needed mental health care has persisted despite significant scientific
advances, including: a) decades of research identifying the multi-level barriers to care
experienced by families of color; b) multiple investigations supporting a range of provider
training approaches capable of enhancing family engagement; and c) empirical support for
integrating outreach specialists, case managers and parent peer support staff across health,
mental health, school and community-based settings to address behavioral health care gaps.
This study is based on the premise that if care navigation models are going to succeed where
previous efforts have failed in eliminating racial disparities in child mental health care,
then the preparation and support for child behavioral health navigators (cbhNs) needs to
include: 1) training to deliver evidence-based family engagement, psychoeducation and support
interventions; 2) ongoing coaching and supervision focused on building collaborative
relationships between families and providers and; 3) skills to enhance community/system
buy-in, as well as to analyze and interrupt multi-level structural influences on disparities
and system gaps (including training to assess and intervene in the complex relationships
between youth, adult caregivers, providers, system leaders, and community-based networks)
within low-income communities.
The proposed study will be conducted in 2 phases. Phase 1 involves the recruitment and
training of a new cohort of cbhNs (n=15), intentionally involving committed individuals of
color from an existing community-based network of youth service system partners, HomeGrown
STL. CbhNs (n=15) will be hired based on experience serving youth and families in target
communities, St. Louis north city and county neighborhoods, but do not necessarily have
extensive mental health training. CbhNs will be prepared to collaborate with youth/families
via an interactive training protocol which integrates existing evidence-based cbhN
approaches, including engagement interventions, family support and education, adapted care
navigation models and empirically supported implementation strategies to address barriers.
Phase 2 is a mixed methods, hybrid effectiveness implementation experimental study, enrolling
390 early adolescent youth (10 to 14 years) of African descent and their families living in
geographically defined St. Louis north city and county neighborhoods (racially segregated
areas with high poverty concentration), aimed at simultaneously examining multi-level factors
that enhance or impede cbhN interaction and youth/family outcomes. This study exclusively
focuses on youth and families frequently missed or not retained in services.
The following specific aims guide the proposed study:
Primary Aim #1: To examine youth/family level outcomes associated with cbhNs (e.g. rates of
identification of DBDs, youth/family engagement and motivation, access to assessment/care,
alliance with and response to cbhNs, youth behavioral functioning over time); Primary Aim #2:
To identify multi-level factors that impede/facilitate navigation (e.g. stigma, gaps in
collaboration across youth, families, providers, system level limitations, relationship with
cbhN); Exploratory Aim #1: To explore the response to cbhNs by key network and system
stakeholders (e.g. perceptions of cbhN helpfulness, understanding and support for cbhN
relationships with families, attributions of reductions in system barriers), as well as of
the cbhNs, specifically their response to evidence-informed interactive training (e.g. child
behavioral health and care knowledge and navigation skill, efficacy regarding collaboration
with families, providers and systems).
This study is being conducted by a transdisciplinary network of scientists at Washington
University in St. Louis (STL) and New York University in collaboration with service
organizations, child behavioral health policy officials and the HomeGrown St. Louis (STL)
network, including an existing Advisory Board. The proposed study is set within high poverty
communities and focused on youth/families of color who rely on resource-constrained clinics
to address serious youth mental health needs. The study capitalizes on significant
preliminary work, including the mapping of all early adolescent youth of African descent in
the target communities and the collaborative refinement of an evidence-informed cbhN training
protocol. This application aligns with NIH's priorities to address underlying health
disparities, as well as to enhance public health impact of mental health focused research
studies.