Intervention Youth Research Articles

Evaluation of a Ready4LifeProgram for US Refugee and Immigrant Youth

program on 4 outcome measures: (1) communication skills; (2) conflict resolution/conflict management, and problem-solving skills; (3) healthy relationship and marriage skills; and (4) progress towards greater economic stability. Methods. Refugee and immigrant youth (N = 341) were randomly assigned to either an intervention group or a comparison group. Intervention participants received a 16-hour relationship enhancement (RE) program developed for refugee populations. In addition to the RE program, intervention participants also received case management. Participants in the comparison group only received case management. All participants, intervention and control, completed self-report questionnaires prior to the beginning of the program. Intervention youth participated in the RE program. All participants completed a posttest questionnaire at the end of the program, and again 6 months after the end of the program. Results. Intervention participants made statistically significant improvements from pretest to 6-month follow-up (p < .05) compared to control participants for 3 of the 4 outcome variables. Conclusion. These results indicate the positive impact of an RE program on refugee and immigrant youth. Future researchers should consider including specific health programming as part of the intervention and also examine health behavior and other direct health outcomes.

Long-term impact of the Fostering Healthy Futures for Preteens program on suicide-related thoughts and behaviors for youth in out-of-home care: A randomized controlled trial.

Youth in out-of-home care are at high risk for suicide-related thoughts and behaviors (STB), yet there are no known efficacious interventions that reduce STB for this population. Fostering Healthy Futures for Preteens (FHF-P) is a 9-month community-based mentoring and skills training preventive intervention for children in out-of-home care. A randomized controlled trial enrolled 156 participants aged 9-11 years who were placed in out-of-home care over the prior year. Participants were 48.9% female, 54.1% Hispanic, 30.1% Black, and 27.1% American Indian. Follow-up interviews, conducted 7-12 years postintervention (85.2% retention rate), asked young adult participants, aged 18-22, to self-report lifetime STB as indexed by non-suicidal self-injury, suicidal thoughts, plans, and/or attempts. There was a nonsignificant reduction in the odds of STB for the intervention group at follow-up (OR = 0.74; CI, 0.32, 1.69). However, FHF-P significantly moderated the effect of baseline STB; control youth who reported baseline STB had 10 times the odds of young adult STB (OR = 10.44, CI, 2.28, 47.78), but there was no increase in the odds of adult-reported STB for intervention youth. Findings suggest that FHF-P buffers the impact of pre-existing STB on young adult STB for care-experienced youth. Further research is needed to identify mechanisms that may reduce STB in this population.

“We are not all gangbangers”: Youth in high-poverty urban U.S. communities of color describe their attitudes toward violence, struggles, and resilience

ABSTRACT Centering youth voices in a participatory cross-age mentoring program in urban high-poverty communities, this paper addresses three problems in knowledge about youth of color experiencing low-income: 1) Misrepresenting youth as disproportionately violence-prone, 2) minimizing stressors youth experience, and 3) ignoring youths’ goals. Those knowledge problems can be framed as a contemporary form of DuBois’ construct of “scientific racism.” To counteract scientific racism, promote epistemic justice, and support youths’ goals of demonstrating they are not “all gangbangers,” this study reports data from a cross-age mentoring program about youths’ beliefs about aggression, attitudes towards violence and gangs, stress experiences, and goals expressed in field notes and letters. Most of the 549 control group and intervention youth strongly repudiated violence and gangs. Youth participating in the intervention as mentors and mentees were revolted by societal racism, community violence and police assaults. They reported many more stressors than any U.S subculture and regarded racism and obstacles against exiting poverty as tightly interwoven and formidable. Unlike privileged youth, for these youth the central element in their resilience was survival, framed as collective struggle. Demonstrating their cultural wealth, mentors and mentees aspired to academic and personal competence and sought closeness and collective uplift. To match youths’ needs and goals, intervention providers and researchers should focus on developing positive social networks, provide survival resources and stress management, support youths’ academic and employment goals, and afford youth maximal participation and self-expression.

Staging's determinants in early intervention youth: a retrospective study

ObjectivesSince 2019 our early intervention unit has assessed help-seekers, mainly referred by psychiatric departments, and we have conducted a descriptive retrospective study. Our objective was to identify clinical determinants associated to staging at assessment for our three groups: “no psychosis”, “ultra-high risk” and “first episode psychosis”. MethodsOne hundred and thirteen participants (mean age 20.05±3.28) were enrolled, mainly referred by adult psychiatry (81.4%). We tested the association of each group with the following determinants: age, gender, family history of psychosis, referral (adolescent or adult psychiatry), cognitive, depressive complaint, cannabis active consumption, and current activity (scholar or employment). ResultsMultivariate analyses showed significant association with depressive symptoms (P=0.019) but an absence of family history of psychosis (P=0.002) or current activity (P=0.09) for “no psychosis” group. “Ultra-high risk” was significantly correlated with a family history of psychosis (P=0.001) and adolescent psychiatry referral (P=0.044) but an absence of depressive complaint (P=0.04). As for “first episode psychosis”, we found significant cognitive complaint (P=0.026), family history (P=0.024) and current activity (0.026). ConclusionsAs all our participants were seen in tertiary care, adolescent psychiatrists were more efficient in detecting a high-risk state. “No psychosis” help-seekers presented in fact mood issues, which have been confused with attenuated psychotic symptoms by their addressers, who have probably been misled by their absence of activity integration. High-risk and characterized psychotic episodes were logically correlated with family history. Surprisingly, “first episode psychosis” youth were currently integrated in scholarly or professional life despite an active cognitive complaint. Robust studies, especially prospective cohorts, are needed to test these associations.

"Project YES! has given me a task to reach undetectable": Qualitative findings from a peer mentoring program for youth living with HIV in Zambia.

The Project YES! clinic-based peer mentoring program was a randomized controlled trial (RCT) conducted among 276 youth from four HIV clinics to test the impact of the program on promoting HIV self-management and reducing internalized stigma among youth living with HIV (ages 15-24 years) in Ndola, Zambia. We conducted a qualitative sub-study involving in-depth interviews with 40 intervention youth participants (21 female, 19 male) to explore their experiences with Project YES! which included: an orientation meeting led by a healthcare provider, monthly individual and group counseling sessions over six months, and three optional caregiver group sessions. Using baseline RCT data, we used maximum variation sampling to purposively select youth by sex, age, change in virologic results between baseline and midline, and study clinic. A four-person team conducted thematic coding. Youth described their increased motivation to take their HIV care seriously due to Project YES!, citing examples of improvements in ART adherence and for some, virologic results. Many cited changes in behavior in the context of greater feelings of self-worth and acceptance of their HIV status, resulting in less shame and fear associated with living with HIV. Youth also attributed Project YES! with reducing their sense of isolation and described Project YES! youth peer mentors and peers as their community and "family." Findings highlight that self-worth and personal connections play a critical role in improving youths' HIV outcomes. Peer-led programs can help foster these gains through a combination of individual and group counseling sessions. Greater attention to the context in which youth manage their HIV, beyond medication intake, is needed to reach global HIV targets.

Engagement and outcomes of marginalised young people in an early intervention youth alcohol and other drug program: The Street Universities model.

Early intervention alcohol and drug (AOD) programs for disadvantaged young people have the potential to substantially decrease the need for future intervention, however there is little research about how young people use these programs or the substance use and other outcomes of such programs. This paper uses data from an Australian AOD early intervention program, The Street Universities, to: describe young people's participation; examine changes in substance use and wellbeing over 90 days; and assess which young people are most positively impacted. Data come from a prospective study of new attendees, measuring retention in and attendance patterns in an 'engagement' program focussed on arts and lifestyle activities (n = 95), and a routine service dataset collected from seven years of therapeutic intervention (n = 3,893), measuring substance dependence (SDS), psychological distress (K10) and quality of life (EQoL). Analysis reveals that young people were retained in the program at high proportion (63% at six months) and more than half of these returned at a frequency of weekly or more often. Young people participating in the therapeutic component of the program reported significant improvements in all key wellbeing indicators with SDS, K10 and EQoL scores significantly improving (at p < .001). These improvements occurred rapidly, within the first 30 days, and were maintained over the 90 day study period. Moreover, young people with the highest SDS and K10 scores and lowest quality of life at baseline experienced the most positive changes. Aligning engagement program with therapeutic intervention can provide comprehensive support to disadvantaged young people, producing substantial improvements in AOD use, distress and wellbeing.

Premature mortality in young people accessing early intervention youth mental healthcare: data-linkage cohort study

Understanding premature mortality risk from suicide and other causes in youth mental health cohorts is essential for delivering effective clinical interventions and secondary prevention strategies. To establish premature mortality risk in young people accessing early intervention mental health services and identify predictors of mortality. State-wide data registers of emergency departments, hospital admissions and mortality were linked to the Brain and Mind Research Register, a longitudinal cohort of 7081 young people accessing early intervention care, between 2008 and 2020. Outcomes were mortality rates and age-standardised mortality ratios (SMR). Cox regression was used to identify predictors of all-cause mortality and deaths due to suicide or accident. There were 60 deaths (male 63.3%) during the study period, 25 (42%) due to suicide, 19 (32%) from accident or injury and eight (13.3%) where cause was under investigation. All-cause SMR was 2.0 (95% CI 1.6-2.6) but higher for males (5.3, 95% CI 3.8-7.0). The mortality rate from suicide and accidental deaths was 101.56 per 100 000 person-years. Poisoning, whether intentional or accidental, was the single greatest primary cause of death (26.7%). Prior emergency department presentation for poisoning (hazard ratio (HR) 4.40, 95% CI 2.13-9.09) and psychiatric admission (HR 4.01, 95% CI 1.81-8.88) were the strongest predictors of mortality. Premature mortality in young people accessing early intervention mental health services is greatly increased relative to population. Prior health service use and method of self-harm are useful predictors of future mortality. Enhanced care pathways following emergency department presentations should not be limited to those reporting suicidal ideation or intent.

Social Network Analysis of Diffusion Among American Indian Youth in a Culturally Adapted, Family-focused Prevention Program.

Diffusion can contribute to the spread of preventive intervention effects from participants to non-participants, but best practices for randomized trials prevent contamination of conditions. These practices conflict with cultural values of community benefit, which are salient among American Indians. This study embedded social network measures within a randomized trial of the Bii-Zin-Da-De-Dah (BZDDD) family-focused prevention program to characterize youth's social networks, describe the nature and content of sharing, and test for diffusion effects on cultural engagement (ethnic identification, cultural socialization, cultural practices) and substance use. Participants were 256 American Indian youths enrolled in the trial who provided self-reports of their social networks and indicated whether specific program content was shared with or received from others, while completing cultural engagement and substance use questionnaires across three waves. Results indicated that social networks were comprised mainly of peers and same-age family members (e.g., cousins). Program sharing was not uncommon. For example, 51% of responding intervention youth reported talking with non-participants about BZDDD at wave 2, typically (53%) with similar-age friends and family who were, most often (71%), out of the home. Evidence for diffusion effects was limited, but did indicate that control youth who had some exposure to BZDDD had a significantly higher average cultural/ethnic identity scale score at wave 2 and were more likely to ask an elder for advice than control youth who had no BZDDD exposure in adjusted analyses. Findings illustrate the value of measuring and testing for potential effects of diffusion in prevention trials with American Indians.

Effects of adjunctive brexpiprazole on sleep-wake and circadian parameters in youth with depressive disorders: study protocol for a clinical trial

IntroductionSleep-wake and circadian disturbance is a key feature of mood disorders with a potential causal role and particular relevance to young people. Brexpiprazole is a second-generation antipsychotic medication with demonstrated...

Targeting the Proximal Mechanisms of Stress Adaptation in Early Adolescence to Prevent Mental Health Problems in Youth in Poverty

ABSTRACT Objective This study used a randomized clinical trial design to evaluate the success with which The Building a Strong Identity and Coping Skills intervention (BaSICS) engaged the proximal mechanisms of poverty-related stress’s impact on the psychosocial functioning and mental health of young adolescents living in high poverty contexts. Method 129 youth from very low-income families were randomized to receive the 32-hour group-based intervention or no-treatment control – 16 of these families withdrew before the intervention groups began. The remaining 113 youth aged 11–12 (53% assigned to intervention; 54% female; 40% Hispanic, 63% Black, 20% White) participated in the study, which included four assessment waves: pretest, posttest, 6-month follow-up and 12-month follow-up assessments. Primary control, secondary control, and disengagement coping were assessed via a combination of parent and youth reports as well as via interviews and questionnaires. Hypothalamic-pituitary-adrenal axis (HPA) reactivity was assessed via salivary cortisol responses occurring during a lab-based stress induction (Trier Social Stress Test). Results Multilevel regression models with repeated measures nested within subjects revealed that in comparison to controls, intervention youth had sustained significant increases in their knowledge about primary control coping (e.g., problem solving, emotion modulation), knowledge and utilization of secondary control (e.g., cognitive restructuring) coping, as well as decreased reliance on disengagement coping. These were accompanied by decreased cortisol reactivity in intervention versus control youth. Conclusions These findings support that BaSICS engages several proximal mechanisms of poverty-related stress’ impact on early adolescent mental health – coping skills and HPA reactivity – during the neurodevelopmentally plastic pubertal period.

34.1 Improving Equity in Child Mental Health Outcomes

The aim of this study is to investigate the impact of pediatric integrated care, including peer-to-peer family support, on outcomes for children with mental health needs in a multicultural, urban safety-net system. We conducted a prospective, quasi-experimental clinical trial comparing health service utilization and spending between children nonrandomly assigned (at the clinic level) to the intervention or to usual care. We analyzed service-use data in 30-day segments for 12 months pre-post initial evaluation. Outcome variables were mental health, pediatric, and pharmacy utilization. The main explanatory variables were treatment group, time, and their interaction. In addition, we examined within-group changes (pre-post) on standardized measures of clinical functioning. Intervention youths were more likely to: be Black or Hispanic (61% vs 43%; p < 0.001); speak Spanish or Portuguese (52% vs 32%; p < 0.001); and carry multiple mental health diagnoses at baseline (42% vs 30%; p = 0.009). Doubly robust estimation results indicated that the intervention group had a 36% larger pre-post gain in outpatient mental health utilization (+15.6 pts.; standard error [SE] = 6.7) but no difference in outpatient mental health spending compared to controls. Intervention youths had 20% pre-post reductions in ED admissions (–5.6 pts.; SE = 2.2) and outpatient PH utilization (–19.2 pts.; SE = 5.2). The control group experienced no significant changes. Within-group analyses of clinical functioning, including measures of self-harm, revealed statistically significant improvement from baseline to 6 months and again from 6 months to 12 months. Overcoming mental healthcare access barriers for children and families, often mediated by structural racism, requires new models of care. In addition to significant clinical change on longitudinal measures, for the intervention group, evidence from propensity-score–weighted analyses indicate service use changes consistent with reduced health status inequity.

Factors associated with successful mentor matching in an intervention study of youth violence.

One challenge of conducting intervention studies is ensuring that study participants are exposed to the intervention. For example, in our randomized controlled trial of Take Charge!, a mentor-implemented and research-informed violence prevention program that partners with one-on-one community-based mentoring agencies, only 50% of intervention youth with fight-related injuries were successfully matched with a mentor. We examined the differences between matched (n = 49) and unmatched (n = 49) youth with regard to demographics, time from injury to study enrollment, perceived seriousness of injury, belief that future injury can be avoided, and household chaos. Youth who were successfully matched with a mentor were more likely to perceive the injury as very serious or somewhat serious compared with unmatched youth (95.9% vs. 79.6%, p = .028). All other factors were not significantly associated with successful mentor matching. Future violence prevention interventions should consider youth perceptions as a factor that may influence the completion of desired interventions.

Neurocognitive functioning predicts suicidal behaviour in young people with affective disorders

BackgroundNeurocognitive impairment is recognised as a risk factor for suicidal behaviour in adults. The current study aims to determine whether neurocognitive deficits also predict ongoing or emergent suicidal behaviour in young people with affective disorders. MethodsParticipants were aged 12-30 years and presented to early intervention youth mental health clinics between 2008 and 2018. In addition to clinical assessment a standardised neurocognitive assessment was conducted at baseline. Clinical data was extracted from subsequent visits using a standardised proforma. ResultsOf the 635 participants who met inclusion criteria (mean age 19.6 years, 59% female, average follow up 476 days) 104 (16%) reported suicidal behaviour during care. In 5 of the 10 neurocognitive domains tested (cognitive flexibility, processing speed, working memory, verbal memory and visuospatial memory) those with suicidal behaviour during care were superior to clinical controls. Better general neurocognitive function remained a significant predictor (OR=1.94, 95% CI 1.29- 2.94) of suicidal behaviour in care after controlling for other risk factors. LimitationsThe neurocognitive battery used was designed for use with affective and psychotic disorders and may not have detected some deficits more specific to suicidal behaviour. ConclusionContrary to expectations, better neurocognitive functioning predicts suicidal behaviour during care in young people with affective disorders. While other populations with suicidal behaviour, such as adults with affective disorders or young people with psychotic disorders, tend to experience neurocognitive deficits which may limit their capacity to engage in some interventions, this does not appear to be the case for young people with affective disorders.

Inclusive Education for Disabled Refugee Children: A (Re)Conceptualization through Krip-Hop

Inspired by Hip-Hop pedagogy and the Krip-Hop movement, this paper aims to address the limits of inclusive education for disabled migrant students, by drawing on the community event “I am Hip-Hop” that took place in June 2019 in Italy. Through this community intervention, migrant and disabled migrant youth were provided a creative platform to reflect critically about their identity and journey. Ultimately, this paper offers teachers recommendations to anchor disabled migrant culture in educational practices.

Effects of mindfulness training on daily stress response in college students: Ecological momentary assessment of a randomized controlled trial.

Mindfulness training has been shown to reduce rates of depression, anxiety and perceived stress, but its impact on stress and emotion regulation in real-world settings in the college-aged population is unknown. This study examines the effect of an 8-session long mindfulness training on first-year college students' daily experiences of stress and emotion regulation. Fifty-two first-year students were randomized to the mindfulness training or the waitlist-control group during the fall academic semester. Before, during and after the trial, students completed 10-days of ecological momentary assessments (EMA), reporting on family and school or work stress, negative emotion, rumination, and interference by unwanted thoughts and emotions up to four times a day. Multilevel regression analysis compared levels of momentary stress and emotion regulation difficulties, as well as the strength of the moment-level association between stress and emotion regulation, by intervention condition, before, during and after the trial. Controls showed an exacerbation of family stress related negative emotion, rumination and interference, across the fall semester. However, intervention youth showed stable levels of emotion regulation responses to family stress across the semester. Emotion regulation responses to school or work stress did not differ by intervention condition. Mindfulness training helps to prevent the depletion of emotion regulation capacity in this sample of relatively healthy first-year college students. EMAs allow the assessment of emotion regulation in the context of naturally occurring stress, and enhances the specificity and external validity of evaluations of psychological interventions.

Corrigendum: Pilot Randomized Controlled Trial of an Exercise Program Requiring Minimal In-person Visits for Youth With Persistent Sport-Related Concussion

[This corrects the article DOI: 10.3389/fneur.2019.00623.].

Feasibility and acceptability of a future‐oriented empowerment program to prevent substance use and school dropout among school‐disengaged youth

To evaluate the feasibility and acceptability of a health promotion program to prevent school dropout and substance use among middle school-aged youth who display early warning signs of school disengagement. Youth Empowerment Solutions for Positive Futures (YES-PF), an intensive, theoretically driven, 5-week summer enrichment program, aims to prevent school dropout and substance use by promoting youth empowerment, school engagement, and future orientation. Using a pre-post-intervention design, we test feasibility and acceptability with 6th and 7th grade students (n=43) who exhibited early warning signs for school disengagement (e.g., chronic absenteeism) in two school districts. Program evaluation components included: (a) program session forms completed by facilitators; (b) post-program interviews with facilitators; (c) post-intervention program evaluation surveys with youth; (d) attendance; and (e) baseline and post-intervention surveys with youth to assess behavioral and psychosocial outcomes. Facilitators routinely delivered core component lesson activities. Acceptability and program satisfaction were evidenced in strong program attendance by youth. Youth participants reported higher levels of leadership efficacy (p<.05) and a greater sense of control over their lives and potential problems (p<.01). YES-PF was feasible and acceptable to school personnel and youth. Program refinement, based on implementation findings, is discussed.

Crystal Clear with Active Visualization: Understanding Medication Adherence Among Youth Living with HIV.

Adherence to antiretroviral therapy (ART) among youth remains low. We piloted an adapted active visualization device that demonstrates how ART works in the body. Youth living with HIV were randomized to: (1) standard care (n = 14) or the (2) adapted active visualization intervention (n = 14) and 71% of the sample (n = 19) were re-assessed on viral load, adherence behaviors, and illness perceptions 2.5months later. Intervention youth had lower viral loads, reported less difficulty in adhering to ART, and more motivation and control over their HIV than standard care at follow-up. Active visualization may be an acceptable tool to address ART adherence among youth.

Reducing the Biological and Psychological Toxicity of Poverty-related Stress: Initial Efficacy of the BaSICS Intervention for Early Adolescents.

This proof-of-concept study tests the initial efficacy of the Building a Strong Identity and Coping Skills (BaSICS) intervention, a selective prevention of internalizing problems program for early adolescents exposed to high levels of poverty-related stress. Eighty-four early adolescents (Mage =11.36years) residing in very low-income neighborhoods were randomized to receive the 16-session intervention (n=44) or to an assessment-only control condition (n=40). BaSICS teaches coping skills, social identity development, and collective social action to empower youth with the ability to connect with members of their communities and cope with poverty-related stress in positive and collaborative ways. Pretest-posttest analyses showed that intervention adolescents acquired problem-solving and cognitive-restructuring skills and reduced their reliance on avoidant coping. In addition, HPA reactivity was significantly reduced in the intervention youth, but not controls. Finally, intervention youth's internalizing and somatic symptoms as reported by both youth and their parents, showed significant reductions over time, whereas control youth had no such changes. Results provide strong support for this approach to strength-building and symptom reduction in a population of early adolescents exposed to poverty-related stress.

Impact of family-centered tailoring of pediatric diabetes self-management resources.

BackgroundThe American Diabetes Association recommends a family‐centered approach that addresses each family's specific type 1 diabetes self‐management barriers.ObjectiveTo assess an intervention that tailored delivery of self‐management resources to families' specific self‐management barriers.SubjectsAt two sites, 214 children 8‐16 years old with type 1 diabetes and their parent(s) were randomized to receive tailored self‐management resources (intervention, n = 106) or usual care (n = 108).MethodsOur intervention (1) identified families' self‐management barriers with a validated survey, (2) tailored self‐management resources to identified barriers, and (3) delivered the resources as four group sessions coordinated with diabetes visits. Mixed effects models with repeated measures were fit to A1c as well as parent and child QOL during the intervention and 1 year thereafter.ResultsParticipants were 44% youth (8‐12 years) and 56% teens (13‐16 years). No intervention effect on A1c or QOL was shown, combining data from sites and age groups. Analyzing results by site and age group, post‐intervention A1c for teens at one site declined by 0.06 more per month for intervention teens compared to usual care (P < 0.05). In this group, post‐intervention A1c declined significantly when baseline A1c was >8.5 (−0.08, P < 0.05), with an even larger decline when baseline A1c was >10 (−0.19, P < 0.05). In addition, for these teens, the significant improvements in A1c resulted from addressing barriers related to motivation to self‐manage. Also at this site, mean QOL increased by 0.61 points per month more during the intervention for parents of intervention youth than for usual care youth (P < 0.05).ConclusionsTailored self‐management resources may improve outcomes among specific populations, suggesting the need to consider families' self‐management barriers and patient characteristics before implementing self‐management resources.