Intervention Youth Research Articles

Collaborative care for adolescents with depression in primary care: a randomized clinical trial.

Up to 20% of adolescents experience an episode of major depression by age 18 years yet few receive evidence-based treatments for their depression. To determine whether a collaborative care intervention for adolescents with depression improves depressive outcomes compared with usual care. Randomized trial with blinded outcome assessment conducted between April 2010 and April 2013. Nine primary care clinics in the Group Health system in Washington State. Adolescents (aged 13-17 years) who screened positive for depression (Patient Health Questionnaire 9-item [PHQ-9] score ≥10) on 2 occasions or who screened positive and met criteria for major depression, spoke English, and had telephone access were recruited. Exclusions included alcohol/drug misuse, suicidal plan or recent attempt, bipolar disorder, developmental delay, and seeing a psychiatrist. Twelve-month collaborative care intervention including an initial in-person engagement session and regular follow-up by master's-level clinicians. Usual care control youth received depression screening results and could access mental health services through Group Health. The primary outcome was change in depressive symptoms on a modified version of the Child Depression Rating Scale-Revised (CDRS-R; score range, 14-94) from baseline to 12 months. Secondary outcomes included change in Columbia Impairment Scale score (CIS), depression response (≥50% decrease on the CDRS-R), and remission (PHQ-9 score <5). Intervention youth (n = 50), compared with those randomized to receive usual care (n = 51), had greater decreases in CDRS-R scores such that by 12 months intervention youth had a mean score of 27.5 (95% CI, 23.8-31.1) compared with 34.6 (95% CI, 30.6-38.6) in control youth (overall intervention effect: F2,747.3 = 7.24, P < .001). Both intervention and control youth experienced improvement on the CIS with no significant differences between groups. At 12 months, intervention youth were more likely than control youth to achieve depression response (67.6% vs 38.6%, OR = 3.3, 95% CI, 1.4-8.2; P = .009) and remission (50.4% vs 20.7%, OR = 3.9, 95% CI, 1.5-10.6; P = .007). Among adolescents with depression seen in primary care, a collaborative care intervention resulted in greater improvement in depressive symptoms at 12 months than usual care. These findings suggest that mental health services for adolescents with depression can be integrated into primary care. clinicaltrials.gov Identifier: NCT01140464.

A clinical staging model for early intervention youth mental health services.

Transformational reforms in mental health services are providing more young Australians who experience mental health problems with access to high-quality care. However, the current diagnostic approach has low utility in the early stages of illness, causing uncertainty among clinicians in regard to matching clients' needs with safe and effective interventions. The authors propose a clinical staging model that has the potential to better match illness stage to intervention. The model allows clinicians to provide more personalized and responsive care, especially to young people with attenuated syndromes (subthreshold disorders) who have a clear need for mental health care but who may not otherwise receive it. This approach can also assist clinicians in considering the potential trajectory of illness. Recent research using this framework has demonstrated the model's prospective utility. The authors describe application of the model in an early intervention youth mental health service in Australia.

Effects of a diabetes prevention programme on weight-specific quality of life in Latino youth.

To examine the effects of a diabetes prevention programme on weight-specific Quality of Life (QOL) in obese Latino youth. Fifteen obese Latino adolescents (body mass index % = 96.4 ± 1.2; age = 15.0 ± 1.0) completed a 12-week culturally grounded, community-based intervention designed to improve physical and psychosocial health. Weight-specific QOL was assessed by the Youth Quality of Life-Weight module and compared with age, sex and ethnicity-matched lean youth. At baseline, intervention youth exhibited significantly lower weight-specific QOL compared with lean youth (70.8 ± 5.4 vs. 91.2 ± 2.2, P = 0.002). However, following the intervention, total weight-specific QOL increased by 21.8% among obese youth (70.8 ± 5.4 to 86.2 ± 4.3, P < 0.001) and was no longer different from lean controls. Significant increases in weight-specific QOL were noted across all subdomains including self (45.7%), social (11.9%) and environmental (36.2%) despite the fact that weight did not change (90.6 ± 6.8 to 89.9 ± 7.2, P = 0.44). The improvements in QOL were maintained for up to 12 months after the intervention. Weight-specific QOL among obese Latino youth can be improved through lifestyle interventions to a level similar to lean peers. Further, weight loss may not be necessary to observe improvements in QOL.

Changing a dangerous rural cultural tradition: a randomized control study of youth as extra riders on tractors.

This study used a randomized control design to evaluate the effectiveness of AgTeen, an in-home, family-based farm safety intervention, in decreasing extra riding on tractors by youth. Having children as extra riders on tractors has deep roots in farm culture, but it can result in serious injury or death. The study randomized 151 families into 3 groups: parent-led intervention (fathers taught their families about farm safety), staff-led intervention (staff members who were peer farmers taught families), and a no-treatment control. Mothers, fathers, and all children aged 10-19 participated in the lessons. At study entry, 93% of youth reported that they had been an extra rider on a tractor in the past year. Although they were aware of the injury risk, fathers frequently gave tractor rides to their children. After the intervention, fathers in both AgTeen groups were less likely than control fathers to give youth tractor rides. Intervention youth were less likely than control youth to be extra riders. The intervention positively affected the extra-riding attitudes and injury risk perceptions of mothers and fathers. The parent-led and staff-led groups did not significantly differ across study outcomes. Findings confirm the effectiveness of a family-based intervention in decreasing extra riding on tractors by youth.

Acceptability and feasibility of CyberSenga: an Internet-based HIV-prevention program for adolescents in Mbarara, Uganda

Capitalizing on emerging data suggesting that HIV-preventive behaviors can be positively affected by Internet-based programs, we developed and tested CyberSenga, an Internet-based, comprehensive sexuality education program for adolescents in Mbarara, Uganda. Three hundred and sixty-six secondary school students were randomly assigned to either the five-lesson program (+ booster) or a treatment-as-usual control. At three-month follow-up, intervention participants provided feedback on the program acceptability. Six focus groups with intervention participants were additionally conducted after the final follow-up at 6 months. Data support a hypothesis of feasibility: despite schedule interruptions, 95% of intervention participants completed all the five modules; only 17% deviated from the once-a-week intended delivery schedule. Internet service was uninterrupted during the field period and, in general, the technology performed to specifications. The intervention also appears to be acceptable: 94% of intervention youth somewhat or strongly agreed that they learned a lot and 93% said they were somewhat or very likely to recommend the program. Although more than two in three youth somewhat or strongly agreed that the program talked too much about sex (70%) and condoms (75%), 89% somewhat or strongly disagreed that “I do not think kids like me should do the CyberSenga program.” Feedback from focus group participants further suggested that the content was generally acceptable and did not contradict local norms in most cases. In fact, despite concerns from some local stakeholders to the contrary, information about condoms did not appear to be confusing or contradictory for youth who were abstinent. Nonetheless, some of the sexual topics seemed to be unfamiliar or uncomfortable for some participants – particularly brief references to oral and anal sex. Together, both qualitative and quantitative data suggest that the program is a feasible and acceptable way of delivering HIV preventive information to both sexually experienced and inexperienced adolescents in Mbarara, Uganda.

Prospective neurochemical characterization of child offspring of parents with bipolar disorder

We wished to determine whether decreases in N-acetyl aspartate (NAA) and increases in myoinositol (mI) concentrations as a ratio of creatine (Cr) occurred in the dorsolateral prefrontal cortex (DLPFC) of pediatric offspring of parents with bipolar disorder (BD) and a healthy comparison group (HC) over a 5-year period using proton magnetic resonance spectroscopy (1H-MRS). Paticipants comprised 64 offspring (9–18 years old) of parents with BD (36 with established BD, and 28 offspring with symptoms subsyndromal to mania) and 28 HCs, who were examined for group differences in NAA/Cr and mI/Cr in the DLPFC at baseline and follow-up at either 8, 10, 12, 52, 104, 156, 208, or 260 weeks. No significant group differences were found in metabolite concentrations at baseline or over time. At baseline, BD offspring had trends for higher mI/Cr concentrations in the right DLPFC than the HC group. mI/Cr concentrations increased with age, but no statistically significant group differences were found between groups on follow-up. It may be the case that with intervention youth at risk for BD are normalizing otherwise potentially aberrant neurochemical trajectories in the DLPFC. A longer period of follow-up may be required before observing any group differences.

A SCHOOL‐BASED MINDFULNESS INTERVENTION FOR URBAN YOUTH: EXPLORING MODERATORS OF INTERVENTION EFFECTS

This study examines gender, grade‐level, and baseline depressive symptoms as potential moderators of a school‐based mindfulness intervention's impact on the self‐regulatory outcomes of urban youth. Ninety‐seven participants from four urban public schools were randomly assigned to an intervention or wait‐list control condition. Fourth and fifth graders in the intervention condition received a 12‐week yoga‐inspired mindfulness program. Using methods outlined by Aiken and West (1991), a series of models estimated the interaction effect of moderators of interest on adjusted posttest self‐regulatory outcomes. Results indicate that gender and grade did not moderate intervention impacts. However, baseline depressive symptoms moderated both impulsive action and involuntary engagement stress responses such that intervention youth reporting lower levels of baseline depressive symptoms were more likely to evidence decreases in these problematic stress responses relative to control youth. Findings highlight the need for future studies to examine moderators of mindfulness‐based interventions impacts on youth outcomes.

RCT of a mentoring and skills group program: placement and permanency outcomes for foster youth.

To examine the impact of a mentoring and skills group intervention for preadolescent children in foster care on placement stability and permanence at 1-year postintervention. A randomized controlled trial was conducted with 9- to 11-year-old children who were maltreated and placed in foster care (n = 54 control; n = 56 intervention). State child welfare records provided information on number of placement changes, placement in residential treatment, and case closure (ie, permanency). Rates of adoption and reunification were also examined. Analysis was by intention to treat. After controlling for baseline functioning and preintervention placement history, intervention youth were 71% less likely to be placed in residential treatment (odds ratio [OR] = 0.29, 95% confidence interval [CI] 0.09-0.98). There were no significant treatment differences in predicting placement changes or permanency for the total sample. Among a subsample of children living in nonrelative foster care at baseline, intervention youth had 44% fewer placement changes (incidence ratio = 0.56, 95% CI 0.34-0.93), were 82% less likely to be placed in a residential treatment center (OR = 0.18, 95% CI 0.03-0.96), and were 5 times more likely to have attained permanency at 1 year postintervention (OR = 5.14, 95% CI 1.55-17.07). More intervention youth had reunified 1-year postintervention [χ(2)(1, N = 78) = 3.99; P < .05], and the pattern of findings suggested that intervention youth had higher rates of adoption. A significant interaction [χ(2)(1, N = 110) = 5.43; P = .02] demonstrated that the intervention attenuated the impact of baseline behavior problems on placement changes. The findings suggest that participation in a 9-month mentoring and skills group intervention leads to greater placement stability and permanence, especially for children in nonrelative foster care.

Short-term effects of a smoking prevention website in American Indian youth.

BackgroundThe rate of smoking commercial tobacco products among American Indian youth is double the rate for white youth. Interventions are needed to reduce this disparity.ObjectiveTo test the feasibility of a Web-based intervention to influence attitudes toward and intentions about smoking cigarettes among American Indian youth who attended a Native summer camp in the Northern Plains.MethodsThe study website, the SmokingZine, was originally developed and tested in Canadian youth, then adapted to be appropriate for American Indian youth. We conducted a randomized controlled trial to test the influence of exposure to the adapted SmokingZine website on smoking attitudes and behaviors among American Indian youth 12–18 years of age. Participants assigned to the intervention group were given access to the website for 1 hour per day during their camp experience and asked to sign in to the site and use it. Control group participants were not given access to the site.ResultsA total of 52% of intervention youth signed in to the website at least once. Among nonsmokers, intentions to try a cigarette in the intervention group declined from 16% to 0%, and increased from 8% to 25% in the control group (P < .05). Compared with the control group, youth in the intervention group were more likely to help others quit (21 percentage point change in intervention versus no change in control; P < .05) and had less positive attitudes about the drug effects of smoking (–0.19 change in intervention versus 0.67 in control; P < .05).ConclusionThese data indicate that SmokingZine needs more long-term, rigorous investigation as a way to keep American Indian youth from becoming regular smokers. Because the intervention group could use computers only 1 hour per day, increasing access might result in more visits and a greater effect of the website on smoking behaviors.

Improving the Transition Outcomes of Low-Income Minority Youth with Disabilities

This study describes the results of a program developed to improve the transition outcomes of low-income minority youth with disabilities. The program relies on case management support to facilitate interagency collaboration. The participants included 164 graduates from special education and 26 youth from an equivalent comparison group. Two case managers were responsible for providing support to intervention participants. Results indicate that 82% of the intervention participants enrolled in postsecondary education programs compared to only 50% in the comparison group. In addition, 74% of the intervention youth secured employment compared to 23% in the comparison group. Case managers provided 10 main support functions in three areas: job, college, and family/community. Critical functions included assistance with goal setting, transportation, job/college applications, referrals, emotional support, and family mediation. We discuss the implications of the intervention for transition research and practice with minority youth with disabilities.

When Things Are Not as They Appear: Assessing the Adequacy of Cluster Randomization When Outcome Events Are Rare at Baseline

The present study randomly assigned 15 Bahamian elementary schools to one of three intervention conditions. To assess the adequacy of cluster randomization, we examined two concerns identified by the local research team: inequality of gender distribution and environmental risk among groups. Baseline significant differences in risk and protective behaviors were minimal. There were significantly more males in the intervention group. Males had higher rates of risk behavior at all assessments. Poor school performance was also higher among the intervention condition and was significantly associated with increased rates of many but not all risk behaviors. Prior to adjusting for gender and school performance, several risk behaviors appeared to be higher after intervention among intervention youth. Adjusting for gender and school performance eradicated the group differences in risk behavior rates. Results demonstrate the importance of adequate randomization where outcomes of interest are rare events at baseline or differ by gender and there is an unequal gender distribution and the importance of the local research team's knowledge of potential inequalities in environmental risk (i.e., school performance). Not considering such individual differences could impact the integrity of trial outcomes.

Alcohol and marijuana use outcomes in the Healthy Choices motivational interviewing intervention for HIV-positive youth.

Healthy Choices is a motivational interviewing intervention targeting multiple risk behaviors among HIV-positive youth. This study investigated the effects of this intervention program specifically on alcohol and marijuana use. Youth living with HIV (n = 143, mean age = 20.7, 51.5% male) were recruited from four sites in the United States, and randomly assigned to intervention or control conditions. The four-session intervention focused on two of three possible problem behaviors based on entry screening; this study focused on 143 HIV-positive youth who received the intervention for substance use. At 15-month follow-up past-week alcohol use was significantly lower for intervention youth than control youth (39.7% versus 53.6%, χ2 = 2.81, 0.05 < p < 0.01); developmental trajectory analysis demonstrated significant reductions in alcohol use, but more importantly the intervention was effective over time in significantly reducing the adolescent's probability of being classified into the high-risk trajectory group. The intervention was less effective in reducing marijuana use.

Observations of Adolescent Peer Resistance Skills Following a Classroom-Based Healthy Relationship Program: A Post-intervention Comparison

This study examines peer resistance skills following a 21-lesson classroom-based intervention to build healthy relationships and decrease abusive and health-risk behaviors among adolescents. The Fourth R instructs students in positive relationship skills, such as negotiation and delay, for navigating challenging peer and dating scenarios. Observational data from 196 grade 9 students participating in a larger cluster randomized controlled trial were used to evaluate post-intervention acquisition of peer resistance skills. Pairs of students engaged in a role play paradigm with older student actors, where they were subjected to increasing pressure to comply with peer requests related to drugs and alcohol, bullying, and sexual behavior. Specific and global measures of change in peer resistance responses were obtained from two independent sets of observers, blinded to condition. Specific peer resistance responses (negotiation, delay, yielding to pressure, refusal, and compliance) were coded by research assistants; global peer resistance responses were rated by teachers from other schools (thinking / inquiry, application, communication, and perceived efficacy). Students who received the intervention were more likely to demonstrate negotiation skills and less likely to yield to negative pressure relative to controls. Intervention students were also more likely to use delay than controls; control girls were more likely to use refusal responses; the number of times students complied with peer requests did not differ. Teacher ratings demonstrated significant main effects favoring intervention youth on all measures. Program and research implications are highlighted.

Fast Track intervention effects on youth arrests and delinquency.

This paper examines the effects of the Fast Track preventive intervention on youth arrests and self-reported delinquent behavior through age 19. High-risk youth randomly assigned to receive a long-term, comprehensive preventive intervention from 1st grade through 10th grade at four sites were compared to high-risk control youth. Findings indicated that random assignment to Fast Track reduced court-recorded juvenile arrest activity based on a severity weighted sum of juvenile arrests. Supplementary analyses revealed an intervention effect on the reduction in the number of court-recorded moderate-severity juvenile arrests, relative to control children. In addition, among youth with higher initial behavioral risk, the intervention reduced the number of high-severity adult arrests relative to the control youth. Survival analyses examining the onset of arrests and delinquent behavior revealed a similar pattern of findings. Intervention decreased the probability of any juvenile arrest among intervention youth not previously arrested. In addition, intervention decreased the probability of a self-reported high-severity offense among youth with no previous self-reported high-severity offense. Intervention effects were also evident on the onset of high-severity court-recorded adult arrests among participants, but these effects varied by site. The current findings suggest that comprehensive preventive intervention can prevent juvenile arrest rates, although the presence and nature of intervention effects differs by outcome.

School Success, Possible Selves, and Parent School Involvement*

Abstract:Increased parent school involvement is associated with better academic outcomes; yet, proximal contributors to this effect remain understudied. We focus on one potential proximal contributor, youth’s positive and negative future self‐images or “possible selves,” reasoning that if parent school involvement fosters possible selves, then interventions aimed at enhancing youths’ possible selves should moderate the negative effect of low parent school involvement. We examine a 2‐year follow‐up of a randomized clinical trial of a possible self‐based intervention (N= 239), demonstrating with regression equations that the intervention moderated the association of low parent school involvement with worse grades and less school‐engaged behavior. Low parent school involvement negatively influenced achievement among control, not intervention youth, suggesting that school‐based, possible self‐focused interventions can moderate the undermining effect of low parent school involvement.

Effectiveness of a Theory-Based Risk Reduction HIV Prevention Program for Rural Vietnamese Adolescents

As of April 2003, 64,801 HIV cases have been documented in Vietnam (Policy Project 2003), 53.9 % of which are among individuals 20-29 years of age. Although HIV education efforts have increased, there remains a need for proven effective programs. We present findings from a randomized-controlled effectiveness trial of an HIV prevention program for adolescents 15-20 years. Four hundred eighty adolescents were randomized into control and intervention groups. Evaluation data were collected using the Vietnamese Youth Health Risk Behavior Instrument, including scales based on the protection motivation theory (PMT). Findings presented show significant differences in knowledge of severity and vulnerability of HIV/AIDS ( p < .05), perceptions of self-efficacy ( p < .001), and response efficacy for condom use ( p < .05) between control and intervention youth at immediate and 6-month postintervention. A significant difference was also found for response cost of condom use ( p < .05) at immediate postintervention. No significant difference was found for the construct of response cost at 6 months, and there were no significant differences for the constructs external and internal rewards. Reported engagement in vaginal sex (1.7%), or anal and/or oral sex (3.1%) was extremely low, and therefore changes in actual behaviors could not be accurately measured. However, intention to use condoms in possible future sexual encounters increased significantly ( p < .05) for the intervention youth compared to control youth between baseline (74/240, 30.8%) and both immediate postintervention (132/230, 57.4%), and six month follow-up (123/228: 53.9%). These data suggest the potential applicability of the PMT for HIV program development with non-Western adolescents but also point to the need for further studies on how constructs within behavioral theories might need to be modified in different sociocultural settings.

Programa Shortstop: A Culturally Focused Juvenile Intervention for Hispanic Youth

Culturally sensitive juvenile delinquency and substance abuse interventions are relatively limited and unavailable to many first-time Hispanic juvenile offenders. The purpose of this study was to test the effectiveness of a culturally focused juvenile and substance abuse intervention program for first time Hispanic youth offenders. The intent of the program was to decrease juvenile recidivism and increase substance abuse resistance. Programa Shortstop is a family based intervention designed for Hispanic youth ages 9-17. The intervention was delivered to 352 youth and at least one parent/caregiver over the 5-year study period. For intervention youth, the results of the recidivism study (n = 321) indicated that 89% of youth participating in Programa Shortstop between 1995 to 1997 were not rearrested within one year of completing Programa Shortstop. Additionally, statistical paired t-test analysis found that the intervention model had a positive effect on legal knowledge and school related factors associated with substance abuse and delinquency. Parent participants demonstrated significant increases in knowledge related to substance abuse and the legal system.

Caught in the Crossfire: the effects of a peer-based intervention program for violently injured youth

Purpose To assess the effect of a hospital-based peer intervention program serving youth who have been hospitalized for violent injuries on participant involvement in the criminal justice system and violent reinjury and death after hospital discharge. Methods A total of 112 violently injured youth (ages 12–20 years; 80% male; predominantly African-American [60%] and Latino [26%]) hospitalized in Oakland, California participated in a retrospective case–control study. Clients were matched by age and injury severity. Treatment and control youth were followed for 6 months after their individual dates of injury. The outcome variables of rate of entry/reentry into the criminal justice system, rate of rehospitalization for violent injuries and rate of violence-related deaths were compared for treatment and control groups using an odds ratio analysis. Results Intervention youth were 70% less likely to be arrested for any offense (odds ratio [OR] = 0.257) and 60% less likely to have any criminal involvement (OR = 0.356) when compared with controls. No statistically significant differences were found for rates of reinjury or death. Conclusion A peer-based program that intervenes immediately after, or very soon after, youth are violently injured can directly reduce at-risk youth involvement in the criminal justice system.

Developmentally inspired drug prevention: middle school outcomes in a school-based randomized prevention trial

Prior investigations have linked behavioral competencies in primary school to a reduced risk of later drug involvement. In this randomized prevention trial, we sought to quantify the potential early impact of two developmentally inspired universal preventive interventions on the risk of early-onset alcohol, inhalant, tobacco, and illegal drug use through early adolescence. Participants were recruited as they entered first grade within nine schools of an urban public school system. Approximately, 80% of the sample was followed from first to eighth grades. Two theory-based preventive interventions, (1) a family–school partnership (FSP) intervention and (2) a classroom-centered (CC) intervention, were developed to improve early risk behaviors in primary school. Generalized estimating equations (GEE) multivariate response profile regressions were used to estimate the relative profiles of drug involvement for intervention youths versus controls, i.e. youth in the standard educational setting. Relative to control youths, intervention youths were less likely to use tobacco, with modestly stronger evidence of protection associated with the CC intervention (RR=0.5; P=0.008) as compared to protection associated with the FSP intervention (RR=0.6; P=0.042). Intervention status was not associated with risk of starting alcohol, inhalants, or marijuana use, but assignment to the CC intervention was associated with reduced risk of starting to use other illegal drugs by early adolescence, i.e. heroin, crack, and cocaine powder (RR=0.32, P=0.042). This study adds new evidence on intervention-associated reduced risk of starting illegal drug use. In the context of ‘gateway’ models, the null evidence on marijuana is intriguing and merits attention in future investigations.

A possible selves intervention to enhance school involvement

We developed a 9-week after-school, small group, activities-based intervention focused on enhancing youth's abilities to imagine themselves as successful adults and connecting these future imagines to current school involvement. We describe and evaluate this programme comparing three cohorts of urban African American middle school students ( n=62 experimental, n=146 control), controlling for sex and previous school involvement. By the end of the school year, intervention youth reported more bonding to school, concern about doing well in school, “balanced” possible selves, plausible strategies to attain these possible selves, better school attendance, and for boys, less trouble at school. Copyright 2002 The Association for Professionals in Services for Adolescents. Published by Elsevier Science Ltd. All rights reserved.