Young people transitioning from the foster care system have elevated risk for a range of
mental health diagnoses that for many are exacerbated by psychosocial coping
difficulties, sparse support networks, and service disengagement. This population is less
prepared to cope with mental health challenges and more likely to have negative
perspectives on help- seeking, increasing the risk of unmet treatment needs as service
use rapidly declines following the exit from foster care. Our long-term goal is to deploy
a scalable secondary prevention program that leverages existing foster youth transition
services to improve mental health functioning and service use before and after exiting
foster care. Our short-term objective is to remotely test a group intervention called
Stronger Youth Networks and Coping (SYNC) that targets cognitive schemas influencing
stress responses, including mental health help-seeking and service engagement, among
foster youth with behavioral health risk. SYNC aims to increase youth capacity to
appraise stress and regulate emotional responses, to flexibly select adaptive coping
strategies, and to promote informal and formal help-seeking as an effective coping
strategy. SYNC results from intervention development to design a novel program using
evidence- based cognitive change methods, including adapting the Coping Effectiveness
Training (CET) curriculum for foster youth. SYNC is designed for delivery by service
providers in federally-funded Independent Living Programs (ILPs) accessed by most foster
youth in the US. Initial feedback from foster youth, service providers, and our advisory
panel confirmed the acceptability of SYNC curriculum topics (e.g., stress and coping,
navigating services) and program strategy (e.g., groups co-facilitated by "near-peer"
young adults with foster care and mental health care experience). The proposed aims will
establish whether the 10-module program engages the targeted proximal mechanisms with a
signal of efficacy on clinically-relevant outcomes, and whether a fully-powered RCT of
SYNC is feasible in the intended service context. Our first specific aim is to refine our
SYNC curriculum and training materials, prior to testing SYNC in a remote single-arm
trial with two cohorts of 8-10 Oregon foster youth aged 16-20 (N=26). Our second aim is
to conduct a remote two-arm individually-randomized group treatment trial with Oregon
foster youth aged 16-20 with indicated behavioral health risk (N=80) to examine: (a)
intervention group change on proximal mechanisms of coping self-efficacy and help-seeking
attitudes, compared to services-as-usual at post-intervention and 6-month follow-up: and
(b) association between the mechanisms and targeted outcomes, including emotional
regulation, coping behaviors, mental health service use, and symptoms of depression,
anxiety, and PTSD. Our third aim is to refine and standardize the intervention and
research protocol for an effectiveness trial, including confirming transferability with
national stakeholders. The demonstration of target engagement with initial evidence of
efficacy, plus standardized intervention materials and a feasible research protocol, will
prepare us for an effectiveness trial (R01) of a model that is expected to be widely
transferable for implementation across the country, and one that can ultimately be
adapted for other youth service settings (e.g., juvenile justice) and subgroups (e.g.,
lesbian, gay, bisexual, transgender, queer [LGBTQ], youth of color), expanding long-term
public health impact.