Addressing the Mental Health Consequences of Being Reared in Poverty for Youth Who Rely On Public Safety Net Service Systems: The 4Rs and 2Ss for Strengthening Families

Purpose and Background: Rates of behavioral difficulties are elevated in poverty-impacted communities, where associated stressors can impede positive youth mental health.  At the same time, youth in the most need of mental health treatment are often least likely to receive care due to challenges related to engagement, as well as the limited capacity and resources of oHowe public child mental health systems.  In response, the 4Rs and 2Ss for strengthening families intervention protocol was designed in collaboration with public mental health officials, adult caregivers and youth representing low-income communities, and service providers from public sector service organizations.  The resulting family-focused, group delivered, evidence-informed, time-limited service was designed to maximize family engagement and reduce child behavior difficulties, as well as align with competencies of the existing workforce practicing in low-resource and capacity-constrained settings. Longitudinal outcomes from a recently completed NIMH-funded effectiveness study (R01 MH072649) will be presented for the purpose of guiding public policy makers and publicly-funded mental health systems to address child behavior difficulties.  This study tests the hypothesis that, over time, youth and their families participating in the 4Rs and 2Ss intervention, in comparison to those receiving child mental health services as usual (SAU), will manifest (1) significantly decreased behavioral difficulties and improved social skills;  and (2) significantly enhanced family processes related to child behavior problems.

Methods:  The 4Rs and 2Ss intervention was examined via a randomized effectiveness study involving 320 low-income youth (ages 7-11) and their families approaching 13 urban child mental health clinics. Participants were randomly assigned to one of two study conditions:  1) 4Rs/2Ss or; 2) SAU.  Outcomes related to youth behavior and social skills functioning, as well as parent/family-level domains were captured via a set of standardized assessments at four time points: baseline, mid-test (8 weeks), post-intervention (16 weeks) and 6 month follow-up (10 months from baseline). Random regression modeling was used to examine multi-level outcomes across time.

Results: Participants in the 4Rs/2Ss multiple family group intervention sessions reported significant improvements in child behavioral difficulties at post-test (16 weeks) and at 6 month follow-up relative to those youth/families assigned to SAU.  In addition, 4Rs/2Ss group participants manifested significant improvements over those in SAU at both post-test and 6 month on the following outcomes:  youth social skills, perceptions of parental stress related to managing difficult child behaviors, and overall impairment in functioning.

Implications: Each year, billions of dollars are spent on addressing child mental health needs or the consequences of failing to provide high quality, evidence-based services to children and their families when difficulties emerge in childhood. Medicaid Redesign efforts across states necessitate the use of efficient, evidence-informed service models that align with needs of youth, families, and can easily be delivered by the existing workforce.  This presentation highlights both a process to develop services to meet the complex needs of youth, families, providers and systems, as well as rigorous research evidence for positive, long-term child and family-level outcomes obtained within “real world” public clinics.