The Design of a Scalable Intervention for Adolescents With Internalizing Problems

EMPOWER is a program aimed at building the capacity of frontline workers to deliver brief, evidence-based psychosocial interventions for mental health conditions. We describe the design of such an intervention for adolescents with internalizing problems, a leading cause of morbidity for this age group in the United States. The intervention design was founded on the findings of a meta-analysis by Fitzpatrick et al. (2023) of 263 randomized controlled trials of youth psychotherapies, which identified five empirically supported principles of change (EPSCs) underlying the most effective interventions for internalizing and externalizing mental health problems. This study gathered additional qualitative insights to inform the selection of the best-fit EPSC(s) and intervention delivery model by consulting an expert advisory group and conducting focus group discussions with the intended provider population. Two ESPCs— Feeling Calm and Solving Problems —emerged as the most scalable and feasible for delivery by frontline workers. A two-level progressive stepped-care protocol was chosen to accommodate diverse settings and the unique needs of each adolescent. The protocol starts with a universal first-meeting intervention that explores the adolescent’s problems and teaches a brief calming technique to those in distress. For adolescents requiring further support, this is followed by one to two additional meetings focused on learning a condensed procedure for Problem Solving. A three-course, competency-based digital training program was created for scalable dissemination of this intervention to frontline workers in adolescent-focused roles. This study illustrates the value of triangulating multiple forms of evidence (i.e., research, experts, and providers) to design an intervention protocol and training program that align with best practices in clinical and implementation science. Further research piloting the program will evaluate its acceptability and feasibility and provide implementation insights to support its scalability in real-world settings, with the aim of increasing adolescents’ access to effective mental health care.