SYMPOSIA
42.3 — 43.0
42.3 DEVELOPMENT OF A WEB-BASED TRAINING
PLATFORM FOR SCHOOL CLINICIANS IN
EVIDENCE-BASED PRACTICES FOR ADHD
Linda J. Pfiffner, PhD, University of California, San Francisco,
linda.pfiffner@ucsf.edu; Melissa R. Dvorsky, PhD; Lauren
M. Haack, PhD; Lauren Friedman, PhD; Madeline
I. Spiess, BA; Julia Morgan, PhD; Sara Chung, MA;
Sarah Griest, MS
Objectives: Web-based technology and videoconferencing are increasingly
applied to scale-up and/or disseminate interventions to populations that may
not otherwise have access to evidence-based services. We describe the
development and outcomes of a web-based clinician training platform for
school clinicians to gain skills in evidence-based practices for youth (ages 7-11
years) with ADHD.
Methods: The clinician training platform is adapted from an empirically
supported in-person training for a school-home behavioral intervention
(Collaborative Life Skills program), and it includes skill modules for working
with teachers, parents, and students. Training methods include web-accessed
manuals/handouts, skill example video clips, automated progress monitoring
tools, supervision/in-session coaching via videoconferencing, online help
desk, and social media groups. We gathered stakeholder (school clinician,
trainer) qualitative, and quantitative feedback during the discovery and design
phases of the iterative development. Following completion of the platform,
we gathered usability, acceptability, feasibility, and fidelity data from open
trials (4 clinicians, 24 students/parents/teachers) and a pilot randomized trial
(10 clinicians, 60 students/parents/teachers) comparing remote vs in-person
training.
Results: Focus group themes and qualitative feedback during the trials
identified clinician preferences for remote training features (eg, interactive,
brief, role-plays/coaching methods), video tools (recorded samples of skills
and therapy sessions), and progress monitoring tools (eg, clear, easy to use).
Clinician ratings of the platform were above average (scores
68) on the
System Usability Scale with most components rated as slightly to very useful/
easy to use. Iterative adaptations improved acceptability and usability to
address clinician time constraints and varying comfort with technology. Rates
of clinician fidelity implementing the treatment, engagement, and youth
outcomes were favorable and similar to our in-person training (all p > 0.05; all
D ¼ 0.09-0.14).
Conclusions: Results document acceptability, feasibility, usability, and utility
of remote, web-based clinician training and support the promise of this
approach for the dissemination of evidence-based practices.
ADHD, SC, TVM
Supported by the US Department of Education Institute of
Education Sciences Grant R305A170338
https://doi.org/10.1016/j.jaac.2020.07.796
42.4 RANDOMIZED TRIAL EVALUATION OF NOD,
A MOBILE APP ADDRESSING LONELINESS
AMONG FIRST-YEAR COLLEGE STUDENTS
Danielle Ramo, PhD, Hopelab/University of California, San
Francisco, dramo@hopelab.org; Emma Bruehlman-
Senecal, PhD; Jennifer Pfeifer, PhD; Brittany Davis;
Caroline Fitzgerald, MSC; Kevin Delucchi, PhD;
Jana Haritatos, PhD
Objectives: We describe a randomized trial testing the efficacy of Nod, a
mobile app addressing loneliness among college students.
Methods: College students (N ¼ 221; mean age ¼ 18.7 years; 59% female)
were recruited online during freshman orientation and randomized to either
immediate access to the Nod app (tx) or access to Nod after 4 weeks (waitlist
control). Nod delivered skills via: 1) challenges: suggested campus-based
social activities tailored to students’ social goals; and 2) reflections: in-app
exercises designed to help students process social experiences and reduce
self-criticism. Primary intent-to-treat analyses compared the tx and control
groups on loneliness and depressive symptoms between baseline (BL) and 4
weeks, controlling for BL depression and loneliness.
Journal of the American Academy of Child & Adolescent Psychiatry
Volume 59 / Number 10S / October 2020
Results: Week 4 retention was 97%. The tx group viewed an average of 36.7 (SD
¼ 38.5) pages of content. There was a significant interaction between BL
loneliness and condition to predict week-4 depressive symptoms (t ¼ –2.27; p ¼
0.02) in that students with high BL loneliness who received Nod had significantly
lower midsemester depressive symptoms than those in the control group (t ¼
–2.32; p ¼ 0.02). Likewise, there was a significant BL depressive symptoms x
condition interaction to predict loneliness (t ¼ –3.11; p ¼ 0.002) in that students
with high BL depressive symptoms who received Nod had significantly lower
midsemester loneliness (t ¼ –2.26; p ¼ 0.03), whereas students with low BL
depressive symptoms who received Nod had significantly higher midsemester
loneliness (t ¼ 2.32; p ¼ 0.02). Among the tx group, completion of challenges (all
r
0.20; all p < 0.05), but not reflections (all r  0.17; all p > 0.05), was signifi-
cantly positively associated with decreased anxiety and depression from BL to
week 4. Students with high BL loneliness assigned to Nod reported greater
social adjustment to college, greater trust in and social support from the
campus community, greater campus belonging, and higher sleep quality at
week 4 than those in the control group (all p > 0.05).
Conclusions: Results provide initial evidence that positive psychology and
cognitive behavioral skills delivered via a mobile app can buffer psycholog-
ically vulnerable first-year college students against heightened midsemester
loneliness and depressive symptoms, college maladjustment, and poor sleep.
ADOL, CBT, DDD
Supported by Hopelab
https://doi.org/10.1016/j.jaac.2020.07.797
SYMPOSIUM 43
FAMILY ENGAGEMENT AND SUPPORT IN
MENTAL HEALTH TREATMENT: CAREGIVER
PERSPECTIVES AND NEW APPROACHES TO
CARE DELIVERY
Andrea E. Spencer, MD, Boston University,
andreaespencer@gmail.com; Lisa R. Fortuna, MD, MPH,
University of California, San Francisco,
dr.lisa.fortuna@gmail.com
Objectives: Rates of engagement in mental health care are disproportion-
ately low for low-income, racial/ethnic minority youth. We will present novel
research on caregiver-reported challenges to engagement in care, and the
results of research on strategies supporting caregivers to overcome barriers to
engagement.
Methods: Andrea E. Spencer, MD, will present qualitative data on caregiver-
reported barriers and facilitators to engagement in services for ADHD experi-
enced by socioeconomically disadvantaged and minority families. Rheanna Platt,
MD, MPH, will present results of a qualitative study exploring strategies to pro-
mote engagement of immigrant Latina mothers in mental health care at group
pediatric well-child visits and within early childhood education centers. Kiara
Alvarez, PhD, will report on the development of a family-focused preventive
intervention to address risk factors for suicidal behaviors for first- and second-
generation Latinx immigrant youth. Emily Feinberg, ScD, CPNP, will present re-
sults of a mixed-Methods hybrid effectiveness-implementation RCT testing family
navigation on engagement with diagnostic evaluation for autism spectrum dis-
order with 249 low-income, racial/ethnic minority families. Speakers will use case
presentations to provide clinical context for scientific data and encourage ques-
tions and discussion throughout the session in order to improve audience
engagement and interaction between the speakers and the discussant.
Results: These presentations highlight the importance and effectiveness of
supporting caregivers to promote engagement, as well as the common and
unique challenges faced by diverse, socioeconomically disadvantaged care-
givers interfacing with the medical and mental health system at different
points and for different reasons.
Conclusions: New strategies can be used to support low-income and minority
caregivers of youth with mental health problems in order to engage their
families in care. Lisa R. Fortuna, MD, MPH, our discussant, will help to inte-
grate the findings across presentations—particularly highlighting similarities
and differences in the challenges faced by caregivers and the development of
www.jaacap.org S331