Dr. Michelle R. Munson’s NIH Funded Study of a Metaintervention to Enhance Engagement in Mental Health Care Shows Promise for Young Adults
Professor Michelle R. Munson has made it her mission to help the mental health system better respond to the distinct needs of underserved young adults living with serious mental illnesses who often discontinue treatments that can be beneficial for their lives. Toward that end, for more than a decade, she has been developing and testing a metaintervention (an intervention about evidence-based treatment interventions) called “Just Do You” which was designed to improve mental health treatment engagement among young adults who are experiencing one of their first-contacts with the adult mental health system. Young adults have long been known to be at high risk of disengaging in treatment before it even begins.
As a starting point, Dr. Munson and her team spent over a decade listening to young adults’ narratives, considering their lived experiences with the mental health system and other social service systems. Just Do You was developed based on what her team learned, and it was refined over many years with young adult partners providing feedback on session content and activities. The intervention draws upon communication and decision-making theory and includes expressive activities that young adults prefer to facilitate processing of their mental health. Just Do You was designed to target common barriers young adults discuss, such as the belief that treatment doesn’t work, stigma surrounding the use of professional treatment, and emotional reactions to treatment such as fear.
Delivered during the intake process in two, 90-minute modules, the program orients young adults to their clinics, providers, and typical mental health services using music and visual arts, audio and video celebrity testimonials, psychoeducation, and motivational interviewing principles. Importantly, the modules are co-facilitated by a licensed clinician and a “Recovery Role Model” who has lived experiences similar to that of the participants.
In a paper published online first in the Journal of Adolescent Health (and coming out in the November issue) Dr. Munson and colleagues report on a National Institute of Mental Health funded randomized explanatory trial of the program, which compared treatment as usual (TAU) with TAU plus the Just Do You modules at four Personalized Recovery-Oriented Services (PROS) programs in poverty-impacted communities in New York City. The randomized explanatory trial (RET), which is a framework designed by James Jaccard, Co-Investigator on the study, allowed the research team to assess not only JDY’s effect on young adults’ treatment engagement but also its effect on the presumed mediators of treatment engagement. That is, the study answers both the program change the primary outcome and how the change happens. Importantly, randomized explanatory trial designs also pinpoint areas where the intervention needs to be refined to strengthen its effect prior to a larger trial. The study is one of the first to empirically test whether expressive activities hypothesized to impact barriers to engagement actually do.
The study enrolled 121 young adults 18-34 years old, who were living with a serious mental illness. Participants were randomly assigned to PROS TAU (n=58), which incorporates evidence-based treatments, rehabilitation, and social supports, or PROS TAU plus JDY (n=63). All participants completed assessments at baseline and 3 months after enrollment. Although there was some attrition, there was no evidence for meaningful differential attrition as a function of treatment condition, and all individuals who were randomized were included in the analyses.
JDY has yielded promising results. A significant difference in treatment engagement was observed between TAU + JDY and TAU at 3 months, when examining participants’ level of buy-in or involvement at PROS. There was a near-significant difference in the number of treatment sessions attended in the past two weeks between those in TAU + JDY vs. those in TAU as well, with the Just Do You group reporting higher attendance. In terms of the mechanisms of engagement, significant between group effects were observed for behavioral beliefs about treatment, perceived expertise of providers, trust in providers, and stigma surrounding treatment, favoring the JDY group. Importantly, the program was not found to impact treatment beliefs and stigma associated with medication, emotional reactions to treatment, self-efficacy, and hope. These results provide diagnostic information for future refinements to Just Do You.
Given the promising findings, the next step for Dr. Munson and her team is to widely disseminate the results, revise the intervention to strengthen it, and then embark on a larger trial. The team is currently developing additional technology-based assets for the program to further bolster the impact it has on engagement; in particular, tools to impact the relevant mechanisms that were not changed. These efforts are one more step towards Dr. Munson’s larger goal of keeping young adults who need treatment connected to it long enough for it to have therapeutic effects. “There is a lot more to do to help young adults living with serious mental health conditions both access and maintain quality mental health care,” she said. “We’ll keep doing the work.”
Dr. Munson is presenting these results on Wednesday, October 27th as part of a panel entitled “Peer Supports, Coaching, and Group Interventions to Improve Treatment Engagement and Academic Persistence and Functioning of Transitional-Age Youth” at the 68th Annual Meeting of the American Academy of Child and Adolescent Psychiatry.