An Iteratively Adapted Transdiagnostic Prevention Program for Diverse High School Settings (U-PEACE): Protocol for a Randomized Controlled Trial.

Abstract

Background: Despite many adolescents experiencing mental health concerns, a substantial portion lack access to evidence-based treatments (EBTs) for psychopathology; this issue is magnified for adolescents belonging to communities considered marginalized. One way to ameliorate this is by adapting existent EBTs-typically delivered in research settings-so that they are feasible and scalable in adolescent settings, such as high schools. The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents may be particularly suited for this purpose due to its transdiagnostic, modular approach and its focus on adolescent clients.

Objective: This study aimed to iteratively adapt and implement the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents in 3 Title 1 high schools, with a focus on feasibility and scalability of the intervention in diverse high school settings.

Methods: For initial adaptation, members of participating high school communities will be presented with original, unadapted intervention materials and asked to provide qualitative feedback on how to make the program more appropriate and feasible for their schools (aim 1). After initial adaptations are implemented, an open-trial pilot case series will assess the appropriateness and feasibility of the resulting program: the Unified Protocol for Emotional and Academic Challenges in Education (aim 2). Initial outcome data and qualitative feedback from pilot case series participants will then inform final adaptations for the randomized controlled trial-in which the adapted program will be compared to high schools' mental health services as usual (aim 3). The adapted program's effectiveness will be evaluated by using a mixed methods approach, and feasibility will be preliminarily assessed through cost-effectiveness analyses (aim 4).

Results: Data collection for the study was concluded in May 2025, with primary outcome analyses anticipated to be completed by August 2025.

Conclusions: This protocol may serve as a promising guide for adapting youth EBTs in more accessible, diverse settings, as well as result in a useful prevention program for youth with emotional concerns.

Trial registration: ClinicalTrials.gov NCT06056674; https://clinicaltrials.gov/study/NCT06056674.

International registered report identifier (irrid): DERR1-10.2196/74080.