Presenter Disclosures Using Layout PNG Title Engaging delinquent - - PDF document

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Engaging delinquent adolescents in fam ily- based interventions: Challenges and lessons

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Challenges and lessons learned

Norw eeta G. Milburn, Ph.D. Marguerita Lightfoot, Ph.D.

Presenter Disclosures

The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:

• No relationships to disclose

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Affiliations & Support

UCLA Department of Psychiatry and Biobehavioral Sciences Semel Institute for Neuroscience and Human Behavior Nathanson Family Resilience Center milburn@mednet.ucla.edu Department of Medicine University of California San Francisco University of California, San Francisco Supported by NIMH grants MH61185 , MH70322, and MH080664, and NIMHD P20MD000182 Presentation at the annual meeting of the American Public Health Association, San Francisco, CA October 31, 2012

Overview

• Challenges
• Strategies
• Lessons Learned
• Implications

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“ Delinquent” Adolescents

• < 18 years old

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• Ethnic/racial minority
• At-risk

Fam ily-based interventions

• Social context  Family system
• “Relatively unexplored” (Tolou-Shams et al., 2010)

⬇Participation

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Participation

• Recruitment
• Engagement
• Retention

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Characteristics  recruitm ent, engagem ent & retention

• Demographics (e.g., SES)
• Child (e.g., GPA)
• Family (e.g., stress)
• Intervention (e.g., goals)

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Strategies  Participation

• Motivational interviewing
• Culture
• Incentives

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Family Characteristics Family size Ethnicity Education level Income level Marital status Parental monitoring Environmental Transportation Stress Expectancy of Success Perceived competence at task Perceived difficulty of task Value of Task/Activity Enjoyment/intrinsic value Utility in reaching future goals Perceived importance of doing well Perceived negative aspects/costs Recruitment # agree to participate # complete baseline # attend one session Engagement Enthusiasm Involvement Retention

Theoretical Model (m odified Wigfield Eccles, expectancy-value theory of m otivation)

Background Motivation Outcomes

Retention

• Increased motivation and

engagement Engagement

• Pre-session for family to

tell their story (feel heard) & articulate current family goals

• End each session with a

positive

• In home sessions
• Racial/ethnic match of

staff Recruitment

• Motivational DVD
• Motivational recruitment

session Child Mental Health Depression Hyperactivity # sessions attended Proposed Enhanced Strategy Formative Research

• Interviews
• Focus groups

Enhanced Strategy

• DVD development
• Staff training

Phase 1

Overview of Research

C: Standard Strategy T: Enhanced Strategy Pilot Testing

Phase 2

Schools Youth Parents/guardians Schools Youth Parents/guardians Baseline 3 months assessment Baseline 3 months assessment

Developm ent of Inspirational/ Motivational DVD

• Key informant interviews / Focus groups
• Media developer

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Modification of Enhanced Strategy

Recruitment

• Motivational DVD
• Motivational recruitment

session Engagement

• End each session with a

positive

• Racial/ethnic match of staff

session Racial/ethnic match of staff

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Prelim inary Findings

⬆ Recruitment

• 100% baseline enhanced, 71% standard

⬆ Retention

• 100% 3 months enhanced, 50% standard

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Lessons Learned

• Fewer sessions
• Need to include other race/ethnicity
• School sites, not home

Fl ibilit

• Flexibility

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Im plications

• Contextual barriers

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• Engagement