A Primary Prevention Intervention for the Promotion of Psycho-social Wellbeing in Adolescent Young Carers:
Condition: Adolescent - Emotional Problem; Mental Health Wellness 1; Caregivers; Primary Prevention; Cognitive Therapy
Study type: Interventional
Phase: Phase 1/Phase 2

Summary: 
      Adolescent young carers (AYCs) are young people aged 15-17 years old, who take on significant
      or substantial caring tasks and assume a level of responsibility that would usually be
      associated with an adult. In Europe, the estimated prevalence rate of YCs is around
      4-8%.Taking on care responsibilities so early in life may have considerable negative
      consequences for YCs' mental and physical health and psychosocial development. Psychosocial
      interventions to support YC worldwide are generally quite limited. The H2020 Me-We project
      (Psychosocial Support for Promoting Mental Health and Well-being among Adolescent Young
      Carers in Europe) aims to develop an innovative framework of primary prevention interventions
      for adolescent YCs (AYCs) aged 15-17 to be tested in six European countries (Italy,
      Netherlands, Slovenia, Sweden, Switzerland, United Kingdom).

      The theoretical framework chosen for the intervention is the DNA-V Model. The DNA-V model is
      a psychological intervention, addressed to adolescents and young people, used in educational
      and clinical settings. This model has its roots in the contextual and functional science and
      it is based on Acceptance and Commitment Therapy, a third-generation cognitive-behavioural
      therapy. The intervention programme designed for the ME-WE project builds on the DNA-V model
      but it was adapted to fit the specific needs of adolescent young carers (AYCs) and the goals
      of the ME-WE project.

      The study aim is to evaluate the efficacy of DNA-V based program for AYCs (so-called ME-WE
      intervention), using a cluster-randomized controlled trial (C-RCT) design. The evaluation of
      the intervention will be carried out using as primary outcome variables: Psychological
      flexibility; Mindfulness skills; Resilience; Subjective mental health; Quality of life;
      Subjective health complaints; Caring-related quality of life; Cognitive and emotional impact
      of caring and Social support. As secondary outcome variables will be included Self-reported
      school, training or work experience, performance, and attendance.

      COVID-19 Amendment: Recruitment, should be moved to a cluster- based online recruitment or
      individual, social media recruitment, face-to-face sessions should be moved to online
      sessions using video-conferencing instruments, allowing for visual presentations of
      participants and session materials (e.g. ZOOM, Microsoft Teams). Four open-ended items were
      added to evaluation questionnaire assessing impact of COVID-19 pandemic.
    

Detailed description: 
      Adolescent young carers (AYCs) are young people aged 15-17 years old, who take on significant
      or substantial caring tasks and assume a level of responsibility that would usually be
      associated with an adult. Often on a regular basis, they look after family member(s) with a
      disability, chronic physical and/or mental health condition or substance use issue and/or
      problems related to old age, who require support or supervision. In Europe, the estimated
      prevalence rate of YCs is around 4-8%.

      Taking on care responsibilities so early in life may have considerable negative consequences
      for YCs' mental and physical health and psychosocial development. Furthermore, YCs likely
      face difficulties in education that negatively impact their future employability and
      socio-economic status and experience constraints in finding and maintaining employment and
      pursuing their career aspirations.

      Psychosocial interventions to support YC worldwide are generally quite limited. In order to
      prevent the entrenched level of caring that results in significant and long-term effects on
      YCs' well-being and hinder transitions to adulthood, it has been suggested that a primary
      prevention model should be adopted. To prevent adverse mental health, social, and educational
      outcomes in YCs, building their resilience would be especially important.

      The H2020 Me-We project (Psychosocial Support for Promoting Mental Health and Well-being
      among Adolescent Young Carers in Europe) aims to develop an innovative framework of primary
      prevention interventions for adolescent YCs (AYCs) aged 15-17 to be tested in six European
      countries (Italy, Netherlands, Slovenia, Sweden, Switzerland, United Kingdom).

      The theoretical framework chosen for the intervention is the DNA-V Model. The DNA-V model is
      a psychological intervention, addressed to adolescents and young people, used in educational
      and clinical settings. This model has its roots in the contextual and functional science and
      it is based on Acceptance and Commitment Therapy, a third-generation cognitive-behavioural
      therapy. The intervention programme designed for the ME-WE project builds on the DNA-V model
      but it was adapted to fit the specific needs of adolescent young carers (AYCs) and the goals
      of the ME-WE project.

      The study aim is to evaluate the efficacy of DNA-V-based program for AYCs, called the ME-WE
      support intervention, using a cluster-randomized controlled trial (C-RCT) design. The
      evaluation of the intervention will be carried out using as primary outcome variables:
      Psychological flexibility; Mindfulness skills; Resilience; Subjective mental health; Quality
      of life; Subjective health complaints; Caring-related quality of life; Cognitive and
      emotional impact of caring and Social support. As secondary outcome variables Self-reported
      school, training or work experience, performance, and attendance will be used. Control
      variable will be caring activities; overall amount of caring and likes and dislikes about
      caring. Results will be compared of the intervention-group participants relative to the
      wait-list control-group participants from baseline (pre-intervention) through
      post-intervention and 3-month follow-up (3MFU).

      Investigators expect that there will be greater improvements in protective factors targeted
      by the ME-WE intervention. Thus, it is hypothesized that, compared to the wait-list control
      group, ME-WE participants will report greater improvements in psychological flexibility,
      mindfulness, resilience, subjective mental health and quality of life as well as in perceived
      emotional impact of caring and social support (primary outcomes), and these effects will be
      maintained at the 3MFU. The impact of ME-WE on self-reported school, training or work
      experience, performance, and attendance of AYCs (secondary outcomes) will be also explored.
      Since the intervention will not address these variables directly, we consider them as
      secondary outcomes.

      COVID-19 Amendment: Recruitment, should be moved to a cluster- based online recruitment or
      individual, social media recruitment, face-to-face sessions should be moved to online
      sessions using video-conferencing instruments, allowing for visual presentations of
      participants and session materials (e.g. ZOOM, Microsoft Teams). All evaluation self-report
      instruments are available online. Five open-ended items were added to evaluation
      questionnaire assessing impact of COVID-19 pandemic (how participants were affected by
      pandemic, what kind of support and services they received, how their mental and/or physical
      health has been affected and how they experience the participation in intervention).
    

Intervention name(s): Psycho-educational sessions
Intervention type(s): Behavioral
Intervention description(s): Participants of clusters allocated to the ME-WE intervention group will complete a programme based on seven weekly sessions of approximately 2 hours each, plus a follow-up meeting after 3 months from the end of the programme. All sessions maintain a similar structure (objectives, ice-breaker, central activity/ies, and final activity). At the end of some sessions, participants will be asked to do some exercises at home, between one meeting and the next one, in order to keep what has been done during the previous session fresh in their minds.
Contents of sessions will be as follows: (1) Getting to know each other; (2) The Advisor: dealing with annoying thoughts; (3) The Noticer: being in connection with our feelings; (4) The Discoverer: growing and thriving; (5) Values: connecting to meaning and vitality; (6) Developing a flexible self-view and self-compassion; (7) Building strong social networks.
Other intervention name(s): Acceptance and Commitment Therapy - Mental Health- Mindfulness
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The study is a prospective C-RCT, with a two (group) by three (time) repeated measures factorial design. Both the intervention and the wait-list control group will be assessed at baseline, immediately post-intervention for the intervention group or after 7 weeks for the wait-list control group - and at the 3MFU.
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Prevention
Keywords: Adolescent; Acceptance and Commitment Therapy, Cognitive therapy; Mindfulness; Europe