Providing Human Support for the Use of Digital Mental Health Interventions: Systematic Meta-review.

BACKGROUND: Digital mental health interventions (DMHIs) have been increasingly deployed to bridge gaps in mental health care, particularly given their promising efficacy. Nevertheless, attrition among DMHI users remains high. In response, human support has been studied as a means of improving retention to and outcomes of DMHIs. Although a growing number of studies and meta-analyses have investigated the effects of human support for DMHIs on mental health outcomes, systematic empirical evidence of its effectiveness across mental health domains remains scant. OBJECTIVE: We aimed to summarize the results of meta-analyses of human support versus no support for DMHI use across various outcome domains, participant samples, and support providers. METHODS: We conducted a systematic meta-review of meta-analyses, comparing the effects of human support with those of no support for DMHI use, with the goal of qualitatively summarizing data across various outcome domains, participant samples, and support providers. We used MEDLINE, PubMed, and PsycINFO electronic databases. Articles were included if the study had a quantitative meta-analysis study design; the intervention targeted mental health symptoms and was delivered via a technology platform (excluding person-delivered interventions mediated through telehealth, text messages, or social media); the outcome variables included mental health symptoms such as anxiety, depression, stress, posttraumatic stress disorder symptoms, or a number of these symptoms together; and the study included quantitative comparisons of outcomes in which human support versus those when no or minimal human support was provided. RESULTS: The results of 31 meta-analyses (505 unique primary studies) were analyzed. The meta-analyses reported 45 effect sizes; almost half (n=22, 48%) of them showed that human-supported DMHIs were significantly more effective than unsupported DMHIs. A total of 9% (4/45) of effect sizes showed that unsupported DMHIs were significantly more effective. No clear patterns of results emerged regarding the efficacy of human support for the outcomes assessed (including anxiety, depression, posttraumatic stress disorder, stress, and multiple outcomes). Human-supported DMHIs may be more effective than unsupported DMHIs for individuals with elevated mental health symptoms. There were no clear results regarding the type of training for those providing support. CONCLUSIONS: Our findings highlight the potential of human support in improving the effects of DMHIs. Specifically, evidence emerged for stronger effects of human support for individuals with greater symptom severity. There was considerable heterogeneity across meta-analyses in the level of detail regarding the nature of the interventions, population served, and support delivered, making it difficult to draw strong conclusions regarding the circumstances under which human support is most effective. Future research should emphasize reporting detailed descriptions of sample and intervention characteristics and describe the mechanism through which they believe the coach will be most useful for the DMHI.

Striking the Balance: The Relative Benefits of Goal- and Youth-Focused Approaches to Youth Mentoring Relationships.

Targeted, goal-focused approaches to mentoring can improve behavioral and mental health outcomes than more recreational, non-specific approaches. However, a focus on goals needs to be balanced with openness to including mentees' preferences. This study builds on prior work by exploring the benefits of goal- and youth-focused approaches to mentoring relationships from the youth mentee's perspective, including their associations with relationship measures (closeness and tension) and mental health outcomes (i.e., conduct problems, emotional symptoms, and depressive symptoms). This study was a secondary analysis of data from 2165 youth participating in thirty nationally representative mentoring programs in the United States. On average, youth were 12.3-years-old (SD = 1.43, range = 9-16) and the majority were female (55%); 36.7% were Black/African American, 22.4% were White, and 23.5% were Latino/Hispanic. Path analyses revealed 1) youth- and goal-focused approaches were positively associated with closeness, 2) youth-focused approaches were negatively associated with tension, 3) goal-focused approaches were positively associated with tension. At follow-up, a stronger mentoring relationship (less tension and greater closeness) was related to positive youth outcomes. As the field of mentoring corrects for an overemphasis on intuitive approaches and moves towards more targeted directions, it should resist veering too far from what sets the field apart from skills-training models: the role of a caring relationship.

A randomized controlled trial of enhanced mentoring program practices for children of incarcerated caregivers: Assessing impacts on youth and match outcomes.

Parental incarceration is an adverse childhood experience that is associated with heightened risk for negative outcomes in youth. Mentoring programs seek to mitigate this risk by providing children of incarcerated parents (COIP) with a supportive relationship that fosters positive outcomes. The current study presents findings from a longitudinal evaluation of enhanced mentoring program practices designed for supporting COIP. One thousand three hundred and thirty-four COIP mentees, their parents or guardians, and their mentors were randomly assigned to receive either enhanced or business as usual (BAU) mentoring. Mentees who received enhanced mentoring demonstrated improved positive self-cognitions, and reduced internalizing behavior problems, intentions to use substances, and substance use, compared with youth who received BAU mentoring. The enhancements had no impact on the quality of mentoring relationships and the enhanced matches had shorter mentoring relationships compared with BAU matches. This evaluation demonstrates that the enhanced mentoring program practices for COIP had significant, positive impacts on outcomes for this special population of youth and suggests that enhanced practices tailored to COIP should be implemented throughout the duration of the mentoring relationship to be most effective.

Paraprofessional Youth Mentoring: A Framework for Integrating Youth Mentoring with Helping Institutions and Professions.

The demand for child mental health services, including those provided by psychologists, counselors, and social workers, exceeds the supply. This trend is expected to continue or worsen unless there are substantial structural changes in how mental health services are provided. We propose a framework for paraprofessional youth mentors, defined as a subgroup of professionally supervised, non-expert volunteer or paid mentors to whom aspects of professional helping tasks are delegated. Our proposal is aligned with historical and modern solutions to scaling mental health services, and this framework could simultaneously increase the number of youth receiving evidence-based mental health services and reduce the burden on existing systems of care. The framework defines three plausible tasks for paraprofessional mentors: (1) reducing barriers to mental health service, (2) increasing engagement in services, and (3) providing direct services. The safety and effectiveness of these task-shifting efforts will hinge on competency-based training and evaluation, supervision by professionals, and documentation of services rendered, all of which the field of youth mentoring currently lacks. We describe several requisite scientific, institutional, and regulatory advances that will be necessary to realize this variant of youth mentoring for a subgroup of youth who are presenting for assistance with mental health problems.

A Meta-analysis of the Effects of Mentoring on Youth in Foster Care.

Research suggests that mentoring programs may promote a range of positive outcomes in youth populations. Less is known, however, about the extent to which such programs are effective in specialized youth populations, such as youth involved in the foster care system. The current study aimed to investigate the extent to which mentoring interventions promote positive outcomes among youth involved in the foster care system and to systematically explore factors that may moderate the effectiveness of mentoring interventions. Using a multilevel meta-analytic approach, this study estimated the effect size of nine formal mentoring programs in the United States serving youth involved with the foster care system (total n = 55,561). Analyses revealed a small-to-medium-sized overall effect (g = 0.342). Moderator analyses revealed weaker effects for studies containing higher proportions of youth with emotional abuse histories. Programs deploying near-peer mentors were more than twice as effective as intergenerational mentors. The findings highlight the salience of emotional abuse history, suggesting the utility of providing mentor trainings in trauma-informed care for this population.

A Life-Course Model of Trauma Exposure and Mental Health Among Low-Income Survivors of Hurricane Katrina.

Prior research has provided robust evidence that exposure to potentially traumatic events (PTEs) during a disaster is predictive of adverse postdisaster mental health outcomes, including posttraumatic stress symptoms (PTSS) and nonspecific psychological distress (PD). However, few studies have explored the role of exposure to other PTEs over the life-course in shaping postdisaster mental health. Based on the broader literature on trauma exposure and mental health, we hypothesized a path analytic model linking predisaster PTEs to long-term postdisaster PTSS and PD via predisaster PD, short-term postdisaster symptoms, and disaster-related and postdisaster PTEs. We tested this model using data from the Resilience in Survivors of Katrina study, a longitudinal study of low-income, primarily non-Hispanic Black mothers exposed to Hurricane Katrina and assessed before the disaster and at time points 1, 4, and 12 years thereafter. The models evidenced a good fit with the data, RMSEA < .01-.04, CFIs > .99. In addition, 44.1%-67.4% of the effect of predisaster PTEs on long-term postdisaster symptoms was indirect. Descriptive differences were observed across models that included PTSS versus PD, as well as models that included all pre- and postdisaster PTEs versus only those that involved assaultive violence. The results suggest the importance of incorporating disaster preparedness in clinical work with trauma survivors and the value in attending to other lifetime PTEs when working in postdisaster contexts.

Non-Specific versus Targeted Approaches to Youth Mentoring: A Follow-up Meta-analysis.

Despite decades of increased research and funding, youth mentoring programs, overall, yield small effects on youth outcomes. As a result, there are growing calls for programs to utilize the mentoring relationship as context for intentional, targeted skills development, in which mentors employ targeted skills designed to match the presenting concerns of mentees. This targeted approach contrasts with the historically dominant, non-specific friendship model, which holds that a supportive relational bond-alone-promotes positive developmental change. The current study is a follow-up meta-analysis using a comprehensive dataset of all intergenerational, one-on-one mentoring program evaluations published between 1975 and 2018, investigating the comparative impact of targeted, skills-based versus non-specific, relational approaches to mentoring. Analyses of 48 mentoring studies of youth outcomes (average youth age of 12.25 years old) revealed the overall effect size of targeted programs to be more than double that of non-specific relational approaches, with significant moderator effects on academic, psychological, and social functioning. Findings suggest that youth mentoring programs can promote positive outcomes, particularly when mentors employ targeted approaches matched to the needs of their mentees.

The Long-Term Impact of Natural Mentoring Relationships: A Counterfactual Analysis.

Previous research suggests that youth's natural mentoring relationships are associated with better academic, vocational, and psychosocial functioning. However, little is known about the extent to which the impact of mentoring endures beyond adolescence and early adulthood. Furthermore, most natural mentoring research is confounded by selection bias. In this study, we examined the long-term impact of mentoring using the nationally representative, longitudinal Add Health dataset. We conducted counterfactual analysis, a more stringent test of causality than regression-based approaches. Compared to their unmentored counterparts, adults (ages 33-42) who had a natural mentor during adolescence or emerging adulthood reported higher educational attainment, more time spent volunteering, and more close friends, after controlling for a range of confounding factors. However, outcomes differed when mentors were classified as "strong ties" (e.g., grandparents, friends) or "weak ties" (e.g., teachers, coaches, employers). Having a strong-tie mentor was associated with having more close friends and a lower income. In contrast, having a weak-tie mentor was associated with higher educational attainment, higher income, and more time spent volunteering. These findings suggest that natural mentoring relationships can exert lasting influence on young people's developmental trajectories, providing strong rationale for efforts to expand their availability and scope.

How Economic Disadvantage Affects the Availability and Nature of Mentoring Relationships During the Transition to Adulthood.

Supportive nonparental adults, particularly nonfamilial adults, provide critical support during the transition to adulthood, opening doors to educational and career paths. This study examined whether economic disadvantage shapes access to these relationships. Results showed that low-income adolescents had reduced access to naturally occurring mentors, and the relationships they did form tended to be close bonds with family and friends, rather than nonfamilial adults. Their mentors were more likely to focus on practical support, and less likely to serve as role models or provide career advice. These effects of socioeconomic status on natural mentoring relationships remained evident, even when accounting for youth race/ethnicity. Findings suggest that networks of support differ depending on a youth's socioeconomic context in ways that could perpetuate social and economic inequalities.

Mentoring Program Enhancements Supporting Effective Mentoring of Children of Incarcerated Parents.

Children of incarcerated parents (COIP) are at risk for a range of negative outcomes; however, participating in a mentoring relationship can be a promising intervention for these youth. This study examined the impact of mentoring and mentoring program enhancements on COIP. Secondary data analyses were conducted on an archival database consisting of 70,729 matches from 216 Big Brothers Big Sisters (BBBS) local agencies to establish the differential effects of mentoring on COIP. A subset of 45 BBBS agencies, representing 25,252 matches, participated in a telephone interview about program enhancements for better serving COIP. Results revealed that enhanced program practices, including having specific program goals, providing specialized mentor training, and receiving additional funding resulted in better outcomes for COIP matches. Specifically, specialized mentor training and receiving additional funding for serving matches containing COIP were associated with longer and stronger matches. Having specific goals for serving COIP was associated with higher educational expectations in COIP. Results are discussed in terms of benefits of a relationship-based intervention for addressing the needs of COIP and suggestions for program improvements when mentoring programs are serving this unique population of youth.

"I'm Having a Little Struggle With This, Can You Help Me Out?": Examining Impacts and Processes of a Social Capital Intervention for First-Generation College Students.

Social capital plays a key role in college and career success, and research indicates that a dearth of on-campus connections contributes to challenges first-generation college students face in effectively navigating the college environment. This study investigates a novel intervention that focuses on the development of skills and attitudes to empower first-generation college students to cultivate social capital and on-campus connections during the transition to college. A mixed methods, explanatory design was used to evaluate impacts and processes of the intervention among first-generation college students (n = 164) in the context of an ethnically diverse, urban, public university in the Northeast. Results indicated that students who participated in the intervention demonstrated improved attitudes and behaviors around seeking support in college, closer relationships with instructors, and higher GPAs at the end of their first year in college. These results suggest the potential benefits of a relatively scalable approach to supporting the needs of first-generation college students.

Role of health in predicting moves to poor neighborhoods among Hurricane Katrina survivors.

In contrast to a large literature investigating neighborhood effects on health, few studies have examined health as a determinant of neighborhood attainment. However, the sorting of individuals into neighborhoods by health status is a substantively important process for multiple policy sectors. We use prospectively collected data on 569 poor, predominantly African American Hurricane Katrina survivors to examine the extent to which health problems predicted subsequent neighborhood poverty. Our outcome of interest was participants' 2009-2010 census tract poverty rate. Participants were coded as having a health problem at baseline (2003-2004) if they self-reported a diagnosis of asthma, high blood pressure, diabetes, high cholesterol, heart problems, or any other physical health problems not listed, or complained of back pain, migraines, or digestive problems at baseline. Although health problems were not associated with neighborhood poverty at baseline, those with baseline health problems ended up living in higher poverty areas by 2009-2010. Differences persisted after adjustment for personal characteristics, baseline neighborhood poverty, hurricane exposure, and residence in the New Orleans metropolitan area, with baseline health problems predicting a 3.4 percentage point higher neighborhood poverty rate (95% confidence interval: 1.41, 5.47). Results suggest that better health was protective against later neighborhood deprivation in a highly mobile, socially vulnerable population. Researchers should consider reciprocal associations between health and neighborhoods when estimating and interpreting neighborhood effects on health. Understanding whether and how poor health impedes poverty deconcentration efforts may help inform programs and policies designed to help low-income families move to--and stay in--higher opportunity neighborhoods.

Trends in Volunteer Mentoring in the United States: Analysis of a Decade of Census Survey Data.

Over the past decade, considerable resources have been devoted to recruiting volunteer mentors and expanding mentoring programs. It is unclear whether these efforts have helped to counter the broader national trends of declining volunteer rates. The current study uses data from the Volunteering Supplement of the Current Population Survey (CPS), sponsored by the U.S. Census Bureau and U.S. Bureau of Labor Statistics, to explore population-level trends in mentoring over the past decade. Results suggest that mentoring rates have remained relatively stable over the past decade, but that the population of mentors has changed somewhat in terms of age, ethnicity, educational background, and region of the United States. In addition, certain sectors of the mentor population show higher rates of attrition from 1 year to the next. Findings have important implications for the development of recruitment, training, and mentor support practices within mentoring organizations, as well as policies designed to meet the needs of at-risk youth in the U.S.

Predictors of Premature Match Closure in Youth Mentoring Relationships.

Although mentoring is a popular and effective means of intervention with youth, the positive effects of mentoring can be diminished by premature match closure of relationships. Program, mentor, and mentee characteristics were examined as predictors of premature match closure. Secondary data analyses were conducted on a large national database of mentoring programs consisting of match and youth risk information from 170 mentoring programs and 6468 matches from across the U.S. Premature closure was associated with mentee age at match inception and 19 individual mentee characteristics. The set of mentee characteristics were examined as part of a cumulative risk index encompassing seven conceptually combined categories including family background characteristics, school functioning problems, engagement in risky health behaviors, self-regulation difficulties, engagement in illegal or criminal activities, and internalizing and externalizing behavior problems. Both the age of mentees when matched and the cumulative risk index score significantly predicted premature closure. Results are discussed in terms of directions for future research and suggestions for enhancing mentoring program practices.

The Impact of Youth Risk on Mentoring Relationship Quality: Do Mentor Characteristics Matter?

Although mentoring is a widely used intervention strategy, effect sizes for at-risk youth remain modest. Research is therefore needed to maximize the impact of mentoring for at-risk youth who might struggle to benefit from mentoring relationships. This study tested the hypothesis that different types of youth risk would have a negative impact on mentoring relationship quality and duration and explored whether mentor characteristics exacerbated or mitigated these negative effects. Results showed that elevated environmental stress at a youth's home and/or school predicted shorter match duration, and elevated rates of youth behavioral problems, such as poor academic performance or misconduct, predicted greater youth dissatisfaction and less positive mentor perceptions of relationship quality. Mentors with greater self-efficacy and more previous involvement with youth in their communities were able to buffer the negative effects of environmental stress on match duration. Similarly, mentors' previous involvement with youth buffered the negative effects of youth behavioral problems on mentor perceptions of relationship quality. Findings have important implications for the matching of mentors and at-risk youth in a way that improves mentoring outcomes.

From Treatment to Empowerment: New Approaches to Youth Mentoring.

Traditional approaches to formal youth mentoring have focused primarily on improving the lives of "at-risk" youth through the assignment of individual mentors who are typically disconnected from youth's communities. Similarly, research in the field of formal mentoring has emphasized the dyadic relationship between the mentor and the mentee, with less attention paid to the broader relational contexts in which such relationships unfold. The current paper proposes a new framework that expands the scope of mentoring interventions to include approaches that build on and cultivate informal supports and empower youth to identify and reach out to networks of potential supportive adults, thus increasing the reach of youth mentoring.

Understanding Resilience and Other Trajectories of Psychological Distress: a Mixed-Methods Study of Low-Income Mothers Who Survived Hurricane Katrina.

Recent longitudinal studies in the aftermath of natural disasters have shown that resilience, defined as a trajectory of consistently low symptoms, is the modal experience, although other trajectories representing adverse responses, including chronic or delayed symptom elevations, occur in a substantial minority of survivors. Although these studies have provided insight into the prototypical patterns of postdisaster mental health, the factors that account for these patterns remain unclear. In the current analysis, we aimed to fill this gap through a mixed-methods study of female participants in the Resilience in Survivors of Katrina (RISK) study. Latent class growth analysis identified six trajectories of psychological distress in the quantitative sample (n=386). Qualitative analysis of in-depth interviews with 54 participants identified predisaster, disaster-related and postdisaster experiences that could account for the trends in the quantitative data. In particular, preexisting and gains in psychosocial resources (e.g., emotion regulation, religiosity) and positive postdisaster impacts (e.g., greater neighborhood satisfaction, improved employment opportunities) were found to underlie resilience and other positive mental health outcomes. Conversely, experiences of childhood trauma, and pre and postdisaster stressors (e.g., difficulties in intimate partner relationships) were common among participants in trajectories representing adverse psychological responses. Illustrative case studies that exemplify each trajectory are presented. The results demonstrate the utility of mixed-methods analysis to provide a richer picture of processes underlying postdisaster mental health.

Urban sprawl and body mass index among displaced Hurricane Katrina survivors.

OBJECTIVE: Existing research suggests that walkable environments are protective against weight gain, while sprawling neighborhoods may pose health risks. Using prospective data on displaced Hurricane Katrina survivors, we provide the first natural experimental data on sprawl and body mass index (BMI). METHODS: The analysis uses prospectively collected pre- (2003-2005) and post-hurricane (2006-2007) data from the Resilience in Survivors of Katrina (RISK) project on 280 displaced Hurricane Katrina survivors who had little control over their neighborhood placement immediately after the disaster. The county sprawl index, a standardized measure of built environment, was used to predict BMI at follow-up, adjusted for baseline BMI and sprawl; hurricane-related trauma; and demographic and economic characteristics. RESULTS: Respondents from 8 New Orleans-area counties were dispersed to 76 counties post-Katrina. Sprawl increased by an average of 1.5 standard deviations (30 points) on the county sprawl index. Each one point increase in sprawl was associated with approximately .05kg/m(2) higher BMI in unadjusted models (95%CI: .01-.08), and the relationship was not attenuated after covariate adjustment. CONCLUSIONS: We find a robust association between residence in a sprawling county and higher BMI unlikely to be caused by self-selection into neighborhoods, suggesting that the built environment may foster changes in weight.

Association of PTSD symptoms with asthma attacks among hurricane Katrina survivors.

The relationship between posttraumatic stress disorder (PTSD) and asthma in the wake of natural disasters is poorly understood. Using pre- and postdisaster data (N = 405) from the Resilience in Survivors of Katrina (RISK) project, we examined associations between PTSD symptoms, measured by the Impact of Event Scale-Revised (IES-R), and self-reported postdisaster asthma attacks. A 1-point increase in the IES-R avoidance score, which corresponded to one standard deviation change in this sample, was associated with double the odds of reporting an asthma attack or episode since the hurricane, 95% CI Revise spacing among characters: [1.22, 4.16]. Association with hyperarousal and intrusion symptoms was null. Further research using objective measures of asthma morbidity is needed; nevertheless, these findings may help inform postdisaster health services delivery and predisaster mitigation planning.

Supporting the transition to adulthood among high school dropouts: an impact study of the national guard youth challenge program.

Using a multi-year, random assignment design, this study evaluated the effects of the National Guard Youth Challenge Program (NGYCP), an intensive residential intervention program for youth ages 16-18 who have dropped out of high school. The sample included 1,173 youth (predominantly male) of diverse racial and ethnic backgrounds from ten NGYCP sites across the country. Positive impacts on educational and employment outcomes were sustained 3 years after entering the program, with older participants generally showing greater benefits than younger participants. Implications for research and practice are discussed.