Overview

The goal of this study is to test the efficacy and feasibility of a clinician-guided, app-based cognitive behavioral therapy (CBT) program, SilverCloud, as a school-based mental health intervention for vulnerable youth. An open trial of SilverCloud will be conducted to determine preliminary efficacy in this sample and inform program refinements by collecting outcome self-report assessments and conducting interviews on feasibility and acceptability. After the program and its implementation strategy are refined, we will conduct an randomized controlled trial. Adolescents who screen positive for significant mental health symptoms and who are enrolled in their school-based health center (SBHC) will be randomized to receive SilverCloud or treatment as usual (TAU). Efficacy will be assessed through outcome self-reports. Feasibility and acceptability feedback will again be collected from participants, SBHC staff, and community members.

Eligibility

Inclusion Criteria:

        In order to be eligible to participate in the phase I open trial of this study, an
        individual must meet all of the following criteria:
          -  Enrolled in the SBHC at the high school
          -  Score of 10+ on GAD-7 or PHQ-9
          -  Speak/read English. The current investigational version of SilverCloud that will be
             used in this study is only available in English.
        In order to be eligible to participate in the RCT of this study, an individual must meet
        all of the following criteria:
          -  Enrolled in 9th through 11th grades.
          -  Score of 10+ on GAD-7 or PHQ-9
          -  Enrolled in the SBHC at the high school
          -  Speak/read English. The current investigational version of SilverCloud that will be
             used in this study is only available in English.
        Exclusion Criteria:
        An individual who meets any of the following criteria will be excluded from participation
        in the phase I open trial of this study:
          -  Current (within 1 month of enrollment) mental health treatment at the SBHC
          -  Does not use a smartphone
          -  Mental health concerns for which intensive treatment is indicated. Because SilverCloud
             has not been evaluated in people with serious mental illness, participants who exhibit
             symptoms of mania or psychosis will be referred to a higher level of care.
          -  Current suicidal ideation with intent. Participants who have a suicide plan and intent
             to act on it will be referred to the SBHC suicide risk protocol and will not be
             eligible until their suicidal thoughts have abated.
        An individual who meets any of the following criteria will be excluded from participation
        in the RCT of this study:
          -  Current (within 1 month of enrollment) mental health treatment at the SBHC
          -  Does not use a smartphone
          -  Mental health concerns for which intensive treatment is indicated. Because SilverCloud
             has not been evaluated in people with serious mental illness, participants who exhibit
             symptoms of mania or psychosis will be referred to a higher level of care.
          -  Current suicidal ideation with intent. Participants who have a suicide plan and intent
             to act on it will be referred to the SBHC suicide risk protocol and will not be
             eligible until their suicidal thoughts have abated.