Experimental Therapeutics Applied to Young Adult Mental Health Treatment

Background: The combination of rising rates of mental disorders and poor treatment engagement among young adults is a growing public health concern. This paper illustrates how data from a study that applied experimental therapeutics can inform, in nuanced ways, if an intervention to improve engagement is promising, how it is leading to change, and what needs to be addressed to make it more effective. Study data are from an NIMH-funded R34 pilot trial of the Young Adult Engagement Program. The program provides an orientation to mental health treatment during intake. It is facilitated by a social worker and a peer support specialist and it integrates components of psychoeducation, expressive arts and technology, motivational interviewing and narrative expression. This paper answers the following questions: 1) Does the program meaningfully impact the outcome?; 2) Are the mechanisms that the program targeted relevant to the outcome?; and, 3) Does the program meaningfully impact the mechanisms that it targeted? Empirically derived answers to these questions provide feedback to program designers about how to improve the program.

Method: A two-arm pilot randomized control trial was utilized to explore the feasibility, acceptability, and preliminary impact of the intervention on engagement in personalized recovery-oriented services (PROS), a day treatment program for adults (n=109). Baseline and 3-month outcome data were examined for both mechanisms of change (e.g., beliefs about treatment) and the ultimate outcome of treatment engagement. A modified version of the Yatchmenoff (2005) measure was used to examine engagement in mental health services (reliability alpha = .83). Data analysis was conducted using SPSS and Mplus, examining mean differences and regression coefficients. Analysts used robust maximum likelihood estimation with FIML for missing data. Mediational chains of treatment influence on engagement were decomposed for each mechanism, providing answers to questions 1-3 listed above.

Results: Participants were receiving services in PROS programs in an urban city; mean age was 26 (SD=3); 66% of participants were male and 94% identified as racial/ethnic minorities. Most common diagnoses were schizophrenia-spectrum disorders, mood, anxiety and trauma-related disorders, with high levels of comorbidity. The intervention was found to impact engagement (treatment minus control mean difference=3.26, d = .63, p<.01), with young adults in the experimental condition reporting higher levels of engagement at 3-months, compared to the control group. Interestingly, all of the hypothesized mechanisms (i.e., targets) were associated with engagement at 3-months (e.g., hope, regression coefficient =0.18, p<.01). The program itself, however, significantly changed only two of the targeted mechanisms, credibility of providers and behavioral beliefs about treatment, with three additional mechanisms nearing significance (i.e., stigma, hope, trust).

Discussion: Results from this illustrative trial suggest the intervention has promise for changing engagement, and that the program significantly changes young adults’ views on provider credibility and beliefs about treatment. Results reveal needed changes in the program to enhance it relative to mechanisms that were not significantly changed by the program even though they were targeted by the program. Importantly, analyses suggested that these mechanisms are indeed relevant to influencing the ultimate outcome of engagement.