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

项目摘要/摘要 从寄养系统过渡的年轻人患一系列精神健康诊断的风险增加 对于许多人来说，心理社会应对困难、稀少的支持网络和服务脱离加剧了他们的问题。这 人们对应对心理健康挑战的准备较少，更有可能对帮助持负面看法- 寻求，增加未得到满足的治疗需求的风险，因为服务使用在退出寄养后迅速下降。 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 在脱离寄养前后改善心理健康功能和服务使用的服务。我们的短期计划 目标是远程测试名为更强大的青年网络和应对(SYNC)的跨诊断团体干预 针对影响压力反应的认知图式，包括心理健康寻求帮助和服务参与， 在有行为健康风险的寄养青年中。SYNC旨在提高年轻人评估压力和调节压力的能力 情感反应，灵活选择适应性应对策略，促进非正式和正式求助为 有效的应对策略。同步来自干预开发的结果，以使用证据设计一个新的计划- 以认知改变为基础的方法，包括为寄养青年调整应对有效性培训(CET)课程。 Sync旨在由服务提供商在联邦资助的独立生活计划(ILP)中提供服务，该计划由 大多数寄养在美国的年轻人。来自寄养青少年、服务提供者和我们的咨询小组的初步反馈证实了 同步课程主题(例如，压力和应对、导航服务)和计划策略(例如，小组)的可接受性 由具有寄养和心理健康护理经验的“近乎同行”的年轻人共同协助)。拟议的目标将 确定10个模块的程序是否与目标近端机制接合，并发出有效信号 临床相关的结果，以及在预期的服务背景下，SYNC的全功率随机对照试验是否可行。我们的 第一个具体目标是在远程单臂试验中测试SYNC之前，完善我们的SYNC课程和培训材料 俄勒冈州寄养16-20岁青少年(N=16)，年龄8-10岁。我们的第二个目标是进行远程双臂 俄勒冈州16-20岁有行为健康风险的寄养青年的个人随机分组治疗试验 (n=80)检查：(A)干预组改变应对自我效能和求助的近端机制 与干预后和6个月随访时照常提供服务相比的态度：和(B) 机制和目标结果，包括情绪调节、应对行为、精神卫生服务使用以及 抑郁、焦虑和创伤后应激障碍的症状。我们的第三个目标是细化和规范干预和研究 有效性试验议定书，包括与国家利益攸关方确认可转让性。演示了 具有初步疗效证据的目标参与，外加标准化干预材料和可行性研究 协议，将为我们做好有效性试验(R01)的准备，预计该模型将广泛移植到 在全国范围内实施，并最终可适用于其他青年服务环境(例如， (例如，LGBTQ，有色人种青年)，扩大了对公共卫生的长期影响。

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.