# Video-visit behavior therapy for anxiety and depression in youth: A randomized effectiveness-implementation study in low-resource primary care settings.

> **NIH NIH R56** · SAN DIEGO STATE UNIVERSITY · 2020 · $464,430

## Abstract

The proposed mixed-methods study will (a) test the effectiveness of brief behavioral therapy (STEP-UP)
for youths with anxiety and/or depression recruited from primary care community health centers (CHCs),
(b) evaluate a population-based method of implementation of STEP-UP, and (c) explore patient, provider, and
clinic reactions to identify target mechanisms for successful and sustainable implementation. Anxiety
and mood disorders in youth are prevalent and impairing, with a high current and lifetime comorbidity in part
due to shared etiologic factors. Untreated, these disorders lead to sustained functional impairment and convey
increased risk for recurrent disorder and suicidal behavior. Only 1 in 5 anxious and 2 in 5 depressed youth
report any lifetime mental health use, the lowest treatment rates for any youth mental health condition. Further,
there are notable disparities in care, with minority youths significantly less likely to receive services than non-
Hispanic white (NHW) youths, despite experiencing similar or higher rates of disorder. Therefore, effective
treatment of anxiety and depression is a critical public health priority, especially for traditionally
underserved minority youths. STEP-UP is a streamlined behavioral intervention developed to efficiently treat
anxiety and depression as a unified problem area by targeting avoidance behavior common to both disorders.
The proposed study builds on a multi-site randomized trial demonstrating the effectiveness of STEP-UP, with
especially strong effects for Hispanic youths. This application responds to RFA-MH-20-400 and focuses on
implementing and testing this promising evidence-based practice in the OCHIN network of CHCs and federally
qualified health centers which serves a diverse population of vulnerable families. STEP-UP has been
adapted to a digital health framework with video visits to increase dissemination potential, scalability, and
cost-effectiveness. We propose to conduct an innovative hybrid effectiveness-implementation study (type
1) testing digitally delivered STEP-UP compared to facilitated referral to traditional outpatient mental health
services (treatment-as-usual, TAU). Youths (age 8-17, N = 250) will be identified and recruited at the
population level through electronic health records (EHR) and direct clinician referral of new cases. Eligible
youths will be randomized to (a) STEP-UP or (b) facilitated referral to TAU. Clinical outcomes will be
assessed at Weeks 16 and 32 and process measures collected over the course of care. Qualitative interviews
will occur with 20 youth-parent dyads, 35 CHC providers and staff, and 20 administrators sampled from
enrolled clinics. Aims include testing the clinical effectiveness of STEP-UP and engagement of the intervention
mechanism in the vulnerable CHC population of families (Aim 1), evaluating the impact of STEP-UP on equity
in mental health outcomes for minority youths (Aim 2), estimating the implementation cost and incremental co...

## Key facts

- **NIH application ID:** 10247224
- **Project number:** 1R56MH125159-01
- **Recipient organization:** SAN DIEGO STATE UNIVERSITY
- **Principal Investigator:** FRANCES L LYNCH
- **Activity code:** R56 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $464,430
- **Award type:** 1
- **Project period:** 2020-09-18 → 2022-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10247224

## Citation

> US National Institutes of Health, RePORTER application 10247224, Video-visit behavior therapy for anxiety and depression in youth: A randomized effectiveness-implementation study in low-resource primary care settings. (1R56MH125159-01). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10247224. Licensed CC0.

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