GRIP: Examining the effectiveness of care for youth of multi-problem families

BACKGROUND: Multi-problem families experience chronic and intergenerational problems in multiple domains, placing the children’s development at risk. Despite the frequency and intensity of care offered to these families, there is no convincing evidence for the effectiveness of care for youth of multi-problem families. An innovative outpatient integrated care approach has been developed: the InConnection approach, in which youth position a youth initiated mentor (YIM) from among the supportive adults in their social networks. These YIMs provide the youth with support and advise the parents and the formal youth care professionals, thus combining informal and formal care. METHOD: GRIP examines the effectiveness and working mechanisms of the InConnection approach, through two studies: 1) a semi-structured multi-informant interview study to deepen our understanding of why families do or do not position a YIM; and 2) a prospective, quasi-experimental study to examine the positioning of a YIM, the effectiveness of the YIM approach in terms of resilience and mental health of youth, number and duration of out-of-home placements, and parental functioning, and to assess moderators and mediators of effectiveness. Participants are recruited through four youth care organizations in the Netherlands and are estimated to be 300 in total, of which 225 families in the intervention group (InConnection approach) and 75 families in the control group (care as usual). All families face multiple problems and include a youth between the age of 10 and 23. Data will be collected through questionnaires from multiple perspectives, namely youth, parents, YIMs, and case workers. Questionnaires will be administered four times over a period of 15 months. Ten to 20 families will also be interviewed to investigate which families position a YIM and why. Statistical analyses will be conducted in HLM 6.0, which is a statistical package specifically for analysing multilevel data. A multilevel t-test will be used to compare families who appointed a YIM to those who did not. Three-level growth models are examined to analyse the effectiveness and working mechanisms of the YIM approach. Thematic analyses of interview data are done using NVivo 12.0.

With data from this study, the following hypotheses will be tested:
H1: Youth who nominate a YIM do so based on the relationship and similarities with the YIM. We have no expectations as to why some youth do not nominate a YIM.
H2: Youth with fewer problems and higher levels of social resourcefulness are more likely to nominate a YIM.
H3: The InConnection approach is more effective than care as usual in promoting resilience (primary outcome) and mental health in youth and parenting functioning, and reducing the number and duration of out-of-home placements (secondary outcomes).
H4: The effects of the InConnection approach are mediated by social resourcefulness, treatment motivation, and shared decision making; moderated by socio-demographic factors and treatment characteristics; and predicted by youth-YIM relationship quality, alliance between case manager and YIM, and adherence to the approach.

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