Applying the ADAPT-ITT Framework to Build Charge up!, an Intervention to Support Young Adults Transitioning into Housing

Background and Purpose: The transition from homelessness into a housing program is a critical process. Deploying time limited services could increase mental health treatment engagement and ultimately improve mental health and housing stability. Currently, there are few interventions designed to support young adults in need. Our team applied seven sequential steps of the ADAPT-ITT framework (Wingood & DiClemente, 2008), which has primarily been used in health research, to guide the adaptation of multi-component evidence-informed transition interventions for young adults transitioning into Rapid Rehousing (RRH).

Methods: The ADAPT-ITT framework guided a sequential process that utilized multiple data sources to select interventions for adaptation, draft manuals and iteratively refine them to co-create an intervention. Assessment included interviews with RRH case managers (n=5), and youth in RRH (n=10). A thematic analysis was utilized to identify unmet needs related to mental health. Decision involved agency stakeholders and content experts consulting to identify two interventions for adaptation. Administration involved formal training of case managers and youth. Formal feedback was solicited through focus groups with professionals (n=7) and youth (n=10) following the training. Production involved working groups of youth, professionals, and researchers further refining existing materials and creating new content. Topical experts then provided written feedback. Integration involved the team refining a final set of manuals, which included select perspectives from experts. Training involved using the final manuals to prepare staff for the open trial.

Results: Qualitative interviews revealed that RRH case managers used a variety of approaches in their work and no formal, explicit supports for mental health assessment or referrals to treatment. Based on these gaps the team identified Critical Time Intervention, an evidence-based, phase-based case management intervention and Cornerstone, a psychosocial intervention for transition-age youth. Training and feedback sessions led to the development of a new intervention, Charge Up!, which employed a short term, phase based approach based on CTI that added mental health supports from a mental health professional (healing partner) and a peer role model (transition support specialist). The working groups established guiding principles for Charge Up! and centered youth voice to ensure that the adaptation was culturally relevant for youth in the housing context. Original manuals were simplified following feedback from topical experts and youth and integrated into a visually appealing product that was accessible for training the intervention team.

Conclusions and Implications: ADAPT-ITT was found to be an acceptable and effective intervention adaptation framework for our multidisciplinary team. Importantly, the administration phase was changed to include multiple meetings with working groups who assisted in developing all aspects of the intervention including an important guiding values and principles statement and an overall framework for embedding specific activities and adapted content from the original interventions. Co-creation with youth with lived expertise and RRH staff was central to developing an intervention that was feasible for implementation around an existing program and acceptable and affirming for young adults. This project can act as a model for how to bring this sequential, systematic and flexible approach into social work intervention development research.