Adapting a mindfulness-based stress reduction intervention for emotion regulation and impulsivity in homeless young adults: a pilot project

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Mindfulness-based interventions (MBIs) enhance self-observation and self-regulation and build skills to increase non-judgmental attention and emotional reappraisal. While found to be effective in many youth populations, to date, very few rigorous trials testing these methods have been conducted among YEH and none of the tested interventions have been tailored specifically for YEH in a trauma-informed way that is optimized for delivery in a shelter setting. To implement a rigorous randomized controlled trial (RCT), we must first determine the feasibility of conducting an attention control randomized trial and optimize outcome measures, as well as recruitment and retention strategies. Building on the promising results of our pilot study, the goal of this R34 is to further tailor an MBI .b (pronounced dot-b) and conduct a feasibility pilot at a homeless youth shelter in Houston, TX. Data from this study will lay the groundwork for rigorous intervention testing in a real-world sheltered sample of YEH. Our strong partnerships with shelters will ensure that the intervention is modified in a trauma-informed way in collaboration with point-of-care service providers to approximate broad dissemination. A trauma-informed approach has three elements 1. realizing the prevalence of trauma, 2. recognizing how trauma affects all individuals involved, and (3) putting this knowledge into practice. MBIs may address the root causes of risk behaviors in YEH by targeting stress and emotion regulation using mindfulness strategies 2 to decrease stress, improve emotion regulation, impulsivity, and increase executive function. We will use a participatory action approach to develop, beta test, and conduct an attention control randomized pilot study. The specific aims for this R34 exploratory clinical trial of a mind and body intervention are to: 1. Tailor .b and finalize the attention control condition using focus group discussions (n=56), key informant interviews (n=12), and iterative beta-testing with the Homeless Youth Working Group (HYWG; n=10); 2. Optimize RCT outcome measures using cognitive interviews with the HYWG (n=10); 3. Conduct an attention control randomized trial of the final tailored MBI with 60 YEH 18-24 years old recruited from a shelter to test real-world feasibility and acceptability (Evaluate recruitment, randomization, and follow-up strategies; adherence to intervention dose; retention benchmarks; and acceptability among YEH, and evaluate the preliminary assessment of outcome measures and outcome effects. Data from this R34 will inform the development of a Phased Innovation Award to Optimize Mind and Body Interventions by finalizing the intervention, optimizing the recruitment and retention strategies, informing the final sample size for a larger randomized trial, and finalizing the outcome measures needed.