Understanding Post-Intervention Shifts In Help-Seeking Attitudes, Intentions, and Behaviors Among Young People with Foster Care Experience

Background and Purpose: Young people transitioning from the foster care system have elevated risk for a range of mental health diagnoses that can be exacerbated by coping difficulties, negative help-seeking attitudes, and mental health service disengagement (Brown et al., 2015; Sakai et al., 2014; Sieta et al., 2016). Strengthening Youth Networks and Coping (SYNC) is a group-based psychosocial intervention developed for young people with foster care experience to improve coping self-efficacy and help-seeking attitudes in ways that influence mental health help-seeking intentions and behaviors. This study specifically explores how participants describe the ways in which SYNC may be shifting help-seeking attitudes, intentions, and behaviors after completing the 8-session synchronous remote curriculum.

Methods: Post-intervention semi-structured interviews were conducted with SYNC participants aged 18-23 (n=12) following three cohorts. Interviews focused on participant perceptions of coping patterns and formal and informal help-seeking before and after SYNC, how these may have changed over time, and how participants describe these shifts in relation to the intervention. Participants received a $30 incentive to complete the interview. Deductive thematic analysis (Braun & Clarke, 2006) was used to examine relationships between targeted intervention mechanisms of action and related outcomes by applying and revising a coding framework based on the theory of change.

Results: Participants described expected gains in help-seeking knowledge and skills due to the intervention, and some linked these to new attitudes about the benefits of seeking support. For example, one person noted, “...it made me realize that I can find support, like, anywhere”, and another shared a shift in understanding that they can “depend on some people with certain things now, better than before.” Further, some reflected theorized shifts in help-seeking intentions resulting from more positive beliefs and increased self-efficacy that they attributed to the peer-delivered curriculum. One participant described their shift in self-efficacy after participating in SYNC, saying that they have increased courage to reach out to others, and “that it's okay to ask for help and need help, because everybody needs help." Finally, some specifically linked new help-seeking intentions and behaviors with improved utilization of formal mental health services, which was a key SYNC outcome. One participant described that SYNC enhanced how they used mental health services, saying that “some of the resources I've learned from SYNC has been able to help me dive deeper into that in therapy.” Another participant indicated that SYNC may have alleviated some stigma and barriers to mental health service utilization, stating that it helped them to realize “that I don't have to be all [crazy] in order to have...those mental resources.”

Conclusions and Implications: Overall, qualitative analysis suggests that for many participants, SYNC engages targeted intervention mechanisms related to skills and self-efficacy that are theoretically linked to improved help-seeking intentions and behaviors. Understanding how participants experience the impact of SYNC on the key mechanisms of change meaningfully enhances quantitative pilot testing of these theorized intervention drivers in advance of a future effectiveness trial. Next steps include mixed-methods analysis of additional mechanisms and outcomes in support of this aim.