An online intervention for vulnerable young adults: identifying mechanisms of change using a grounded theory approach.

PURPOSE: The purpose of this study is to qualitatively identify the mechanisms of change as young adults, whose parents have a mental illness and/or substance use issue, navigate their way through a 6-week, moderated online intervention. METHODS: Using a qualitative, grounded theory approach, data were collected and triangulated for analysis from participants before, during, and after engaging in the intervention. First, 31 young people's motivations for enrolling in the intervention were identified from one open ended question on an online survey. Second, online chat sessions were analysed to identify those topics the 31 participants engaged in throughout the intervention. Finally, 19 interviews were conducted 2 weeks post-intervention, to ascertain participants' perceptions of the impacts of the intervention and how the intervention promoted changes. RESULTS: The main storyline was that of participants "making sense" of their parents, themselves and other relationships, in collaboration with peers, in a safe online space. This storyline of "making sense" drove their motivation to join the intervention and was the focus of the online chats. After the intervention, some were closer to having "made sense" of their families while others struggled differentiating themselves away from their families. An anonymous, professionally moderated online site afforded participants opportunities to think about who they were and for some, who they wanted to be. CONCLUSION: Generating an explanatory theory of how vulnerable young people navigate their way through an online intervention provides important information that can be used to inform future services, interventions, and research.

Web-Based Health Intervention for Young People Who Have a Parent with a Mental Illness: Delphi Study Among Potential Future Users.

BACKGROUND: Young people who have a parent with a mental illness face elevated risks to their mental health and well-being. However, they may not have access to appropriate interventions. Web-based interventions may reach and meet the needs of this at-risk group, yet their preferences regarding the features of this medium are unknown. OBJECTIVE: This study sought to determine the utility of a Web-based intervention to meet the needs of young people who have a parent with a mental illness and their perspectives regarding the types of features of such a website. METHODS: A systematic, 2-round Delphi study was employed to solicit the views of 282 young people aged 16 to 21 years (Round 1, n=14; Round 2, n=268) from urban and regional settings in Australia who self-reported that their parent has a mental illness. "Regional" was used to refer to nonurban participants in the study. After ascertaining whether a Web-based intervention was warranted, Web-based intervention features were identified, including how the site might be facilitated, topics, duration and frequency, and the nature of the professional contact. The extent to which young people agreed on the importance of these factors was assessed. Differences and similarities across gender and location were investigated. A mixed method analytic framework was employed using thematic analysis as well as 2-way between-groups analysis of covariance (ANCOVA) controlling for age and chi-square test of independence analysis. RESULTS: Both rounds highlighted a strong preference for a Web-based intervention. Consensus was reached for a professionally monitored site, young people and professionals having equal input into the weekly facilitated sessions (eg, sharing the lead role in discussions or deciding on relevant session content), unlimited time access, 1-hour, open discussion, weekly sessions over 6 weeks, psychoeducation about mental illness, and considerations for the management of safety violations. There were significant main effects of location type and several of the preferred features for a Web-based intervention for young people who have a parent with a mental illness. However, effect sizes were small to moderate, limiting practical application. CONCLUSIONS: Young people aged 16 to 21 years indicated a need for a professionally monitored, psychoeducational, Web-based intervention, with input from professional facilitators and other young people who have a parent with a mental illness, in addition to recommendations to external resources. These findings may inform the development of future Web-based interventions for this highly vulnerable group.

The Acceptability and Effectiveness of an Online Intervention for Youth With Parents With a Mental Illness and/or Substance Use Issue.

PURPOSE: There is a paucity of interventions for young adults who have parents with a mental health or substance use issue. The 6-week mi.spot (supportive, preventive, online, and targeted) professionally moderated, online intervention fills this gap. The purpose of this study was to present evidence of the acceptability, safety, and preliminary effectiveness of this intervention. METHODS: In response to social media advertising, 31 young people aged 18-25 years participated in mi.spot. Intervention effectiveness was examined via a single-group pre, post, and 6-week follow-up study design, measuring primary changes in depression, anxiety, stress, and psychological well-being and secondary changes in coping, self-efficacy, social connectedness, attribution of responsibility, help-seeking, and mental health literacy. Acceptability and safety were determined by system use and participants' self-reports. RESULTS: Over the 6 weeks of the intervention, 28 (90.3%) of 31 participants used one or more components of the mi.spot intervention. Significant improvements were reported in depression and stress from preintervention to 6-week postintervention. Trend improvements were evident in well-being, social connection, and coping. No change was reported in general help-seeking, social connectedness, mental health literacy, self-efficacy, or attribution. No safety violations were reported. Participants reported mi.spot to be safe and acceptable. CONCLUSIONS: mi.spot appears to be safe and acceptable and shows promise as an effective online intervention to improve the mental health and well-being of young adults with parents with mental health and/or substance use issues.

A Web-Based Intervention for Young Adults Whose Parents Have a Mental Illness or Substance Use Concern: Protocol for a Randomized Controlled Trial.

BACKGROUND: One in 5 young people grow up in a family where one parent has experienced a mental health problem or substance use concern. Compared with their same-aged peers, these youth are at a higher risk of academic failure and acquiring a substance abuse and/or mental health issue. There is a paucity of accessible, age-appropriate interventions that address their needs. OBJECTIVE: A 6-week, web-based intervention, "mental illness: supported, preventative, online, targeted" (mi.spot), was developed based on previous research and the competence enhancement model. This paper describes the protocol for a randomized controlled trial and details how the usage, safety, acceptability, and feasibility of the intervention will be determined. METHODS: Participants will be recruited through social media and clinician referral. A total of 70 Australians, aged 18 to 25 years, who grew up with parents with a mental illness or substance use concern will participate in a 2-arm parallel randomized controlled trial. The assessment will consist of a baseline measurement and 2 follow-up periods, posttest and 6-week follow-up, using the Mental Health Continuum short form; the Depression, Anxiety, and Stress Scale; the Coping Orientation to Problems Experienced inventory; the General Help Seeking Questionnaire; the Social Connectedness Scale; the Mental Health Literacy Scale; the General Self-Efficacy Scale; and the Attribution of Responsibility for Parental Mental Illness Measure. Impact will be examined at pre, post, and follow-up time periods using analyses of variance that will include a within-subjects factor (time) and a between-subjects factor (intervention/control). Facilitator interviews will ascertain intervention feasibility. Participant interviews will ascertain intervention acceptability. Interview data will be analyzed within a qualitative framework. Usage (data analytics) across site features and several indicators of clinical safety will also be reported. RESULTS: The impact of mi.spot will be examined at pre, post, and follow-up time periods using analyses of variance on each of the measures outlined above. There will be a within-subjects factor (time) and a between-subjects factor (intervention/control). Data analysis will employ the intention-to-treat principle by including all participants in the analyses. Qualitative interview data will be analyzed using interpretative phenomenological analysis along with respondent validation. The Monash University Human Research Ethics Committee (reference number: 2019-18660-30434) approved the trial on April 17, 2019. As of October 2, 2019, 30 participants were enrolled in the control group and 34 participants were enrolled in the intervention group. Result are expected to be submitted for publication in December 2020. CONCLUSIONS: Study results will provide reliable evidence on a web-based intervention that has the potential to make a difference to the lives of many vulnerable young adults. Implementation guidelines are needed to embed the intervention in different service sectors. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12619000335190; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12619000335190. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/15626.

An Online Intervention to Promote Mental Health and Wellbeing for Young Adults Whose Parents Have Mental Illness and/or Substance Use Problems: Theoretical Basis and Intervention Description.

The transition to adulthood can be a vulnerable period for certain population groups. In particular, young adults aged 18-25 years who have a parent with mental illness and/or substance use problems face increased risks to their mental health compared to same aged peers. Yet these young adults may not have access to age-appropriate, targeted interventions, nor engage with traditional face-to-face health services. To support this vulnerable group, services need to engage with them in environments where they are likely to seek help, such as the Internet. This paper describes the risk mechanisms for this group of young adults, and the theoretical and empirical basis, aims, features and content of a tailored online group intervention; mi.spot (mental illness: supportive, preventative, online, targeted). The participatory approach employed to design the intervention is described. This involved working collaboratively with stakeholders (i.e., young adults, clinicians, researchers and website developers). Implementation considerations and future research priorities for an online approach targeting this group of young adults conclude the paper.