In response to RFA-MH-16-410, this R34 addresses key NIMH priorities, 1) focusing on health disparities, and 2) development and preliminary testing of an innovative services intervention. We propose to refine and test the efficacy of a brief meta-intervention for young adults when they begin treatment at adult mental health clinics (hence, treatment and meta-intervention run concurrently). The meta-intervention is designed to reduce treatment dropout, a documented problem of significant public health concern, by helping young adults put treatment into perspective, better understand the rationale and goals of care, and address barriers to continued treatment as they build attendance routines and relationships with providers. To date, research has focused on `transition interventions,' namely programs within children's systems that serve transitioning youth into young adulthood, some of which have extended services into the early twenties. These programs create temporary additional support for youth while they are still in the children's systems. Our research suggests a complementary strategy that outreaches to youth who have formed tentative and initial engagement in services in the adult system, but who are at high risk of disengaging due to the failure of services to take into account the unique developmental needs and orientations of young adults. Our team developed a mid-level theory to understand the underlying mechanisms of disengagement. The theory integrates theories of service use with theories of decision-making, and suggests a set of factors (individual and contextual) impact disengagement among young adults with serious mental illness. Our intervention uses novel communication strategies to maintain the attention of young adults and impact these factors and thus, overall engagement. We use narrative communication (e.g., strategic storytelling as a means of conveying health information) to keep young adults connected to care and, in turn, improve functioning. We use a recovery role model who is a person who has had similar difficulties that young adults have as they first engage the adult mental health system. S/he leads activities and is a key resource. Although the recovery role model is related to approaches of peer support, it is distinct from and appeals to different mechanisms. One hundred ninety five young adults (3 groups, 65 per group) will be randomly assigned to either the intervention group, an active control group (curriculum on safe relationships), or the treatment as usual control group when they first enroll in services. Assessments are taken at baseline, 2-week posttest, 4-week follow-up and at a three month follow-up. The study aims are (1) to develop and preliminarily test the efficacy of a novel, 2-session engagement meta-intervention aimed at engagement and functioning outcomes for marginalized young adults with serious mental illness, and (2) to preliminarily identify the underlying mechanisms of change for disengagement in mental health care, i.e., mediators and moderators of intervention effectiveness. We will advance theory as well as strengthen the proposed intervention.
The proposed R34 refines the protocols and examines the efficacy of an engagement intervention designed for (and with) low-income young adults, ages 18 to 28, who are largely racial and ethnic minorities. Research has shown that transitioning to young adulthood often includes the discontinuation of mental health care and/or premature termination of services. The proposed study examines a brief (2-session) meta-intervention designed to help young adults understand how mental health services can help them, and addresses barriers to service engagement (i.e., stigma, mistrust, hope), thus improving their engagement in services and their overall mental health and life outcomes, as well as advancing theory on the underlying mechanisms of mental health decision making.
