Guidelines for implementing and adapting evidence-based interventions with marginalized youth in schools.

Abstract

With growing diversity within the U.S. population and notable barriers to accessing behavioral health care, marginalized youth are placed at risk for developing psychosocial and mental health problems. Promoting evidence-based interventions (EBIs) through school-based mental health services may improve accessibility and quality of care for marginalized youth facing mental health disparities. Culturally sensitive interventions (CSIs) may further improve engagement with and effectiveness of EBIs with marginalized youth. In this article, we provide guidelines for advancing CSIs when implementing and adapting EBIs with marginalized youth in schools. First, we emphasize inclusive strategies for advancing CSIs with marginalized youth in schools, focusing on antiracist adaptations to interventions and using a community-based participatory research approach when implementing EBIs. Following, we discuss techniques for tailoring CSIs to more effectively support marginalized youth and their families with school-based prevention and treatment. Specifically, we recommend using the Adapting Strategies for Promoting Implementation Reach and Equity framework as a guide to promote equitable implementation as well as key strategies for engaging marginalized youth and their families with school-based EBIs. Ultimately, we offer these guidelines to address disparities and inform more equitable practice in youth mental health care-and to motivate future studies advancing culturally responsive services with marginalized youth in schools. Public Policy Relevance StatementPromoting evidence-based interventions (EBIs) through school-based mental health services may improve accessibility and quality of care for marginalized youth facing mental health disparities. Inclusive and culturally sensitive EBIs may be especially useful for addressing inequities in marginalized youths' mental health outcomes. We provide guidelines and practical recommendations for implementing and adapting inclusive and culturally sensitive EBIs with marginalized youth in schools. Mental health issues are rising among adolescents aged 12-17 years, with a 52% increase in significant internalizing symptoms since 2005 (Twenge et al., 2019). Furthermore, a substantial increase in depression and anxiety symptoms was seen in youth during the COVID-19 lockdown (in March 2020) compared to rates observed before the lockdown (Panchal et al., 2021). Mental health challenges are compounded for youths from low-income families, those within the juvenile justice and child welfare systems, those identifying with racial/ethnic minoritized communities, and those with substance abuse problems (Hodgkinson et al., 2017;Masi & Cooper, 2006). Populations that may be especially vulnerable to lower rates of mental health service access include marginalized youth and the uninsured (Kataoka et al., 2002;Larson & Halfon, 2010).Marginalized youth-who experience racism, discrimination, and exclusion because of unequal power relationships across economic, social, racial, and cultural conditions-r...