Toward Treatment Integrity: Developing an Approach to Measure the Treatment Integrity of a Dialectical Behavior Therapy Intervention With Homeless Youth in the Community.

The current paper discusses an approach to measuring treatment integrity of dialectical behavioral therapy (DBT) when implemented within two programs providing services to street-involved youth in the community. Measuring treatment integrity is a critical component of effective implementation of evidence-based interventions in clinical practice, since sound treatment integrity increases confidence in client outcomes and intervention replicability. Despite being an essential part of implementation science, few studies report on treatment integrity, with limited research addressing either measurement tools or maintenance of treatment integrity. To address the lack of available treatment integrity measures, researchers in the current study developed and piloted a treatment integrity measure which pertain to the individual and group components of DBT. A total of 20 recordings were assessed using the treatment integrity measure. Results indicate that the community agency staff (e.g. youth workers, social workers & nurses) implemented the intervention as intended; increasing confidence in the outcome variables, the staffs' training and the replicability of the intervention. This article offers one approach to addressing treatment integrity when implementing evidence-based interventions, such as DBT in a community setting, and discusses the need for effective and feasible integrity measures that can be adopted in order to strengthen mental health practice in community settings.

Mental health challenges and strengths of street-involved youth: the need for a multi-determined approach.

The social environments and activities of homeless youth frequently create a downward spiral, leading to drug abuse and survival sex as well as self-harm behaviours and suicidality. This study employed a mixed-methods approach to assess the mental health challenges and strengths of street-involved youth. A convenience sample of 70 homeless young people completed a series of standardized questionnaires evaluating mental health symptoms as well as resilience and self-esteem. Two focus groups were also held to capture the perceived mental health needs of street-involved youth. These young people (aged 16-24) were found to have high levels of mental health symptoms compared to other groups of young adults. However, they also exhibited moderately high levels of resilience and self-esteem. Therefore, multi-component mental health programs and interventions that address both strengths and challenges may well help street-involved youth to work towards social re-integration and, ultimately, improved quality of life.

A relationship-based intervention to improve social connectedness in street-involved youth: a pilot study.

PROBLEM: Street-involved youth experience a range of mental health problems with elevated rates of psychiatric disorders compared with non-homeless youth. The overall objective of this pilot study was to evaluate the impact of a relationship-based intervention for homeless youth receiving services from agencies in downtown Toronto. METHODS: The final sample included 15 homeless youth who met the study inclusion criteria. The intervention and comparison groups were compared at baseline and post-treatment on measures of mental health symptoms, hopelessness, self-esteem, resilience, and social connectedness. FINDINGS: Participants receiving the intervention demonstrated a significant improvement in social connectedness, with a trend toward decreased hopelessness. Those participants who did not receive the intervention did not demonstrate any improvements in social connectedness and hopelessness. CONCLUSION: This preliminary pilot study suggests that providing a relationship-based intervention to street-involved youth may offer promise to strengthen social relationships and to mitigate overwhelming hopelessness and despair.