Pilot Testing an Intervention to Enhance Coping and Increase Mental Health Help-seeking Among Transition-Age Youth in Foster Care

项目总结/摘要 从寄养系统过渡的年轻人患一系列心理健康诊断的风险增加， 对许多人来说，由于心理社会应对困难、支助网络稀少和脱离服务，情况更加恶化。这 人口科普心理健康挑战的准备不足，更有可能对帮助持负面看法- 寻求，增加了未满足的治疗需求的风险，因为服务使用率在离开寄养后迅速下降。 我们的长期目标是部署一个可扩展的二级预防计划，利用现有的寄养青年过渡 服务，以改善心理健康功能和服务使用之前和之后退出寄养。我们的短期 目标是远程测试一种名为“更强大的青年网络和应对”（SYNC）的跨诊断群体干预， 目标是影响压力反应的认知图式，包括心理健康求助和服务参与， 有行为健康风险的寄养青年SYNC旨在提高青少年评估压力和调节的能力 情绪反应，灵活选择适应性应对策略，促进非正式和正式求助， 有效的应对策略。SYNC的结果来自干预开发，以设计一个新的计划，使用证据- 基于认知变化的方法，包括调整应对有效性培训（CET）课程，以促进青年。 SYNC旨在由联邦政府资助的独立生活计划（ILP）的服务提供商提供， 在美国寄养的年轻人最多。寄养青少年、服务提供者和我们的顾问小组的初步反馈证实， SYNC课程主题的可接受性（例如，压力和应对，导航服务）和程序策略（例如，组 由具有寄养和精神卫生保健经验的“近同龄人”年轻人共同促进）。拟议的目标将 确定10模块程序是否与目标近端机制接合， 临床相关结局，以及SYNC的全功率RCT在预期服务环境中是否可行。我们 第一个具体目标是在远程单组试验中测试SYNC之前，完善我们的SYNC课程和培训材料 两组8-10名俄勒冈州16-20岁的寄养青年（N=16）。我们的第二个目标是进行远程双臂 俄勒冈州16-20岁有行为健康风险寄养青年的个体随机分组治疗试验 （N=80）考察：（a）干预组在应对自我效能和求助的近端机制上的变化 干预后和6个月随访时与常规服务相比的态度：和（B） 机制和目标结果，包括情绪调节，应对行为，心理健康服务的使用， 抑郁焦虑和创伤后应激障碍的症状我们的第三个目标是改进和规范干预和研究 有效性试验议定书，包括与国家利益攸关方确认可转让性。的示范 有针对性的参与，有初步的疗效证据，加上标准化的干预材料和可行的研究 协议，将为我们准备一个有效性试验（R 01）的模型，预计将广泛转移到 在全国范围内实施，并最终适用于其他青年服务环境（例如， 少年司法）和分组（例如，LGBTQ，有色人种青年），扩大长期公共卫生影响。

Project Summary/Abstract Young people transitioning from the foster care system have elevated risk for a range of mental health diagnoses that for many are exacerbated by psychosocial coping difficulties, sparse support networks, and service disengagement. This population is less prepared to cope with mental health challenges and more likely to have negative perspectives on help- seeking, increasing the risk of unmet treatment needs as service use rapidly declines following the exit from foster care. Our long-term goal is to deploy a scalable secondary prevention program that leverages existing foster youth transition services to improve mental health functioning and service use before and after exiting foster care. Our short-term objective is to remotely test a transdiagnostic group intervention called Stronger Youth Networks and Coping (SYNC) that targets cognitive schemas influencing stress responses, including mental health help-seeking and service engagement, among foster youth with behavioral health risk. SYNC aims to increase youth capacity to appraise stress and regulate emotional responses, to flexibly select adaptive coping strategies, and to promote informal and formal help-seeking as an effective coping strategy. SYNC results from intervention development to design a novel program using evidence- based cognitive change methods, including adapting the Coping Effectiveness Training (CET) curriculum for foster youth. SYNC is designed for delivery by service providers in federally-funded Independent Living Programs (ILPs) accessed by most foster youth in the US. Initial feedback from foster youth, service providers, and our advisory panel confirmed the acceptability of SYNC curriculum topics (e.g., stress and coping, navigating services) and program strategy (e.g., groups co-facilitated by “near-peer” young adults with foster care and mental health care experience). The proposed aims will establish whether the 10-module program engages the targeted proximal mechanisms with a signal of efficacy on clinically-relevant outcomes, and whether a fully-powered RCT of SYNC is feasible in the intended service context. Our first specific aim is to refine our SYNC curriculum and training materials, prior to testing SYNC in a remote single-arm trial with two cohorts of 8-10 Oregon foster youth aged 16-20 (N=16). Our second aim is to conduct a remote two-arm individually-randomized group treatment trial with Oregon foster youth aged 16-20 with indicated behavioral health risk (N=80) to examine: (a) intervention group change on proximal mechanisms of coping self-efficacy and help-seeking attitudes, compared to services-as-usual at post-intervention and 6-month follow-up: and (b) association between the mechanisms and targeted outcomes, including emotional regulation, coping behaviors, mental health service use, and symptoms of depression, anxiety, and PTSD. Our third aim is to refine and standardize the intervention and research protocol for an effectiveness trial, including confirming transferability with national stakeholders. The demonstration of target engagement with initial evidence of efficacy, plus standardized intervention materials and a feasible research protocol, will prepare us for an effectiveness trial (R01) of a model that is expected to be widely transferable for implementation across the country, and one that can ultimately be adapted for other youth service settings (e.g., juvenile justice) and subgroups (e.g., LGBTQ, youth of color), expanding long-term public health impact.