Engagement of Targeted Mechanisms In a Peer-Led Service Enhancement Intervention for Young People Exiting Foster Care

Background: Young people exiting the foster care system have elevated risk for a range of mental health concerns that for many are exacerbated by coping difficulties, sparse support networks, and service disengagement. These young people may be less prepared to effectively cope with mental health challenges and more likely to have negative help-seeking perspectives, increasing the risk of unmet treatment needs. The Strengthening Youth Networks and Coping (SYNC) intervention was iteratively developed in partnership with an advisory group (including young people and service providers) to identify and pre-test intervention aims, target mechanisms, and delivery strategies. The resulting psychosocial curriculum is designed to improve coping and help-seeking cognitions through remotely-delivered sessions facilitated by a trained peer supported by agency staff. We conducted a two-stage pilot trial of SYNC to demonstrate acceptability, feasibility, and target engagement in preparation for a fully-powered RCT.

Methods: SYNC was delivered through weekly 90-minute sessions to cohorts of 6-8 young people with foster care experience and mental health challenges (N=46 intervention participants to date; mean age=20.8 years; 76% female; 46% white, 15% Black; 15% Hispanic/Latino). This paper details initial evidence of engagement of targeted mechanisms (coping and help-seeking cognitions) as well as association with short-term (cognitive control over emotions, help-seeking intentions) and long-term (mental health symptoms and service use) outcomes. We fitted growth curves for each mechanism and short-term outcome using linear mixed models with random effects for study participant (to allow for variation across subjects) and fixed effects for linear time (4 time points: baseline, post-intervention, 3 months post-intervention, 6 months post-intervention). Linear regression models were then used to test whether change in mechanisms at post-intervention predicted change in 3-month post-intervention depression symptoms, controlling for baseline and including participants with complete data at all three time points.

Results: We found initial evidence (p<.10) of growth in one mechanism (appraisal and coping flexibility, t=2.102, p=.038), and two short-term outcomes (cognitive control over emotions, (t=1.776, p=.079; intentions to seek help from formal support sources for suicidal ideation, t=1.662, p=.100). Next, we found an increase in coping self-efficacy was significantly associated with a decrease in depression symptoms at 3-month follow-up (b=-2.494, t=-2.953, p=.014, n=14). Next, a post-intervention increase in cognitive control over emotions was significantly associated with a decrease in depression symptoms at 3-month follow-up (b=-1.683, t=-2.585, p=.016, n=29).

Conclusion: Overall, initial analysis confirms engagement of the target mechanisms, as well as association with clinically-relevant outcomes. We will present more complete findings from the full analysis, focusing specifically on measured change that can be attributed to the intervention. Such findings underscore how iterative and user-informed intervention development results in innovating programming that is considered acceptable to young people, is feasible for providers to deliver as an enhancement to the current service array, and can ultimately improve well-being and thriving among young people involved in systems of care as they transition to young adulthood.