Decision Phase of the ADAPT-ITT Framework: Insight From Scoping Review and Observations to for an Evidence-Based Intervention

Black, Indigenous, and people of color (BIPOC) and LGBTQ+ youth face overlapping challenges that increase their risk for poor mental health outcomes. These intersecting identities contribute to disproportionately high levels of psychological distress, including heightened suicide risk compared to their cisgender and heterosexual peers. One study identified that 88% of LGBTQ + youth who attempted suicide this past year were BIPOC LGBTQ+ youth. Primary care providers (PCPs) are often the first point of contact for these communities, positioning primary care as a critical setting for preventative care. However, a majority of studies are outside of primary care, leaving gaps in evidence-based strategies for BIPOC LGBTQ+ youth. The PCP Ally project, led by Dr. Sanders, aims to identify this gap by developing an electronic health record (EHR) tool for primary care providers. The project uses ADAPT-ITT framework, an eight-phase, assessment, decision-making, adaptation, production, consultation with topical experts, integration, training, and testing. The project is currently in phase 2 (Decision), consisting of a scoping review, literature review, and clinical observations to assess feasibility. A study staff member conducting a literature review and identifying search terms that led to the identification of several adult-focused interventions—such as cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), ESTEEM, EQuiP, AWARENESS, and TA-CBT. All were excluded from the scoping review due to limited relevance for primary care and youth populations. Clinical observations at CHOP Cobbs Creek Primary Care highlighted real-world challenges faced by providers, many expressing concern for a lack of time and resources. Phase 2 will conclude with provider input on the feasibility of integrating mental health supports into primary care. Findings will inform Phase 3 (Adaptation), in which promising strategies will be refined and tested for use with BIPOC LGBTQ+ youth. Early findings suggest that current interventions are designed for adults and delivered outside of primary care. Further research is needed to identify feasibility and adapt a proper intervention.