Adapting Personality-Targeted Interventions for Reducing Substance Misuse and Related Outcomes in Youth in Youth Protection Services
Condition: Substance Use Disorders; Youth Protection Services; Early Intervention; Prevention; Adolescent Development
MeSH terms: Substance-Related Disorders
Study type: Interventional

Summary: 
      Substance use problems are major concern in adolescents involved in Youth Protection
      Services. However, there is an enormous gap between the needs and availability of
      interventions for youth with substance use problems in the system. The present study will
      examine the feasibility and proof-of-concept of implementing an evidence-based,
      personality-targeted drug and alcohol prevention programme for high-risk adolescents (i.e.,
      Preventure programme) receiving services from Youth Protection Services. Our goal is to
      examine the effects of these interventions on reducing rates of substance use outcomes,
      depression symptoms, and self-reported anxiety sensitivity and impulsivity at 3- and 6-month
      post-intervention. These primary outcomes were selected based on previous Preventure trials
      with the community samples, that indicated these factors largely accounted for the long-term
      intervention effects on improving substance use outcomes. The study will be conducted at
      Batshaw Youth and Family Centres, which provide psychosocial, rehabilitation and social
      integration services and services related to child placement and adoption to English-speaking
      youth from all regions of Quebec. Adolescents receiving services from Batshaw centres (N =
      100, aged 14 and above) will be invited to participate in the study. All interested
      adolescents will be invited to attend one assessment session with the research team.
      Participants who score high on one of subscales of Substance Use Risk Profile Scale (SURPS)
      (i.e., high-risk adolescents) will be invited to participate in two 90-minute group-based
      intervention sessions, which target their dominant personality profile. Sessions will be
      cognitive-behavioural in nature and are designed to help youth understand the target
      personality trait and develop adaptive coping strategies for managing that trait using
      motivational and cognitive restructuring techniques. The primary outcomes will be measured at
      baseline before receiving the interventions and then with 3-month and 6-month intervals after
      receiving the interventions to test whether these outcomes are significantly reduced after
      receiving the interventions. The results of this study will be used to plan the future
      directions of personality-targeted interventions for youth involved in Youth Protection
      Services.
    

Detailed description: 
      Background and aims

      Substance use problems are major concern in adolescents involved in Youth Protection
      Services. Some studies estimated that 1 in 5 adolescents involved in Youth Protection
      Services struggle with a substance use problem. In addition, living in foster homes increases
      the likelihood of substance abuse by five times compared to no history of removal.
      Investigators of this study have conducted a review to identify the gaps in research and
      service delivery for substance use prevention and early interventions among at-risk
      adolescents involved in Youth Protection Services. This review showed that there is an
      enormous gap between the needs and availability of interventions for youth with substance use
      problems with less than 10% of these adolescents and young adults receive such interventions.
      This article also reviewed the evidence that showed targeting personality risk profiles is
      potentially a good strategy for reducing substance use problems and increasing resilience in
      this population.

      The present study examines the feasibility and proof-of-concept of implementing an
      evidence-based, personality-targeted drug and alcohol prevention programme (i.e., Preventure
      programme) for high-risk adolescents receiving services from Youth Protection Services.The
      Preventure programme is a selective substance use prevention programme designed to target
      known personality risk factors for substance misuse based on the evidence from
      cross-sectional and longitudinal studies which connect these personality risk factors to
      early initiation and escalation of substance misuse in adolescents. This selected
      personality-targeted approach targets four personality-specific motivational pathways to
      substance misuse: Hopelessness (Negative Thinking), Anxiety Sensitivity, Impulsivity and
      Sensation Seeking.

      The study is conducted at Batshaw Youth and Family Centres, which provide psychosocial,
      rehabilitation and social integration services and services related to child placement and
      adoption to English-speaking youth from all regions of Quebec.

      A working group consisting of research scientists in the fields of adolescent mental health,
      childhood trauma, and substance use prevention and the coordinator of the residential and
      rehabilitation program of Batshaw Centres, met on February 11, 2019 to discuss details of the
      pilot trial, required changes to the content of personality-targeted interventions (i.e.,
      Preventure Programme), and the study timeline.

      Study Design

      Participants. All adolescents receiving services from the Batshaw Centres, starting October
      2nd, 2019, are invited to participate in this study. Batshaw Centres provide services to an
      average of 100 adolescents aged 14 and above during every 6-month period. This study aims to
      recruit all interested adolescents aged 14 and above for this pilot project.

      Recruitment & Consent. Staff at Batshaw Centres will give a brief description including basic
      information about the study to all adolescents in their units. Interested participants will
      be invited for the pre-intervention screening. Passive consent from parents or legal
      guardians is required. Prior to starting the study, an information letter will be provided to
      all parents notifying them that the study is taking place at Batshaw Centres and explaining
      the study and interventions. They will be asked to sign and return the letter if they do not
      agree to their child participating in this study. An assent form will be provided to
      adolescents and thoroughly explained by the Batshaw staff and research investigator.
      Adolescents are required to sign the assent form prior starting the study.

      Procedure. Adolescents who score high on one of the Substance Use Risk Profile Scale (SURPS)
      (i.e., high-risk individuals) will be invited to participate in brief group-based
      intervention sessions which target their dominant personality profile. The criterion for high
      scores on SURPS personality traits (i.e., high-risk) are determined based on norms from
      high-risk adolescents in the same age range who participated in previous trials of
      personality-targeted interventions. Intervention sessions will be delivered by trained
      educators or counsellors from Batshaw. According to the literature, it is estimated that
      around 80% of recruited youth (N ~ 80) will show high scores in one of the personality risk
      profiles. The rest of participants (N ~ 20; low-risk adolescents) will receive the treatment
      as usual. Adolescents receive an honorarium of $30 in the form of gift card upon completion
      of each assessments for a total of $90.

      Screening. Both groups of participants will be followed for 6 months. Screening will take
      place using a computerized program installed on laptops provided by the research team. The
      screening is completed at baseline and then 3-month and 6-month intervals after receiving the
      interventions and takes 50-60 minutes. The screening procedure includes several
      questionnaires and computerized tasks, which have been validated by the scientific community.
      These questionnaires involve assessing youth's personality traits, cognitive functioning,
      substance use outcomes, and psychiatric symptoms. The research investigator will be present
      during the assessment sessions to ready the participants and materials, give instructions,
      expla study goals and procedure, answer questions and supervise the session.

      Outcome Measures. All participants will be assessed by the same measures 3 and 6 months after
      receiving the interventions.

      For testing the feasibility, this study will compare the following outcomes with the same
      outcomes from the previous successful trials with the community samples: facilitator's score
      on Intervention/implementation fidelity, number of high-risk youth who agree to participate
      in the intervention sessions, and elements of youth's feedback (assessment immediately at the
      end of second intervention session). Preventure Intervention/implementation Fidelity Scale
      (PIFA) was designed by the Preventure team to measure the level of implementation of the
      programme and facilitators' adherence and fidelity to the critical ingredients of the
      Preventure programme. This measure has been used in previous trials of Preventure programme
      with the community samples. Group Experience Questionnaire was also designed by the
      Preventure team to measure youth-generated perspectives and feedback on the intervention. Our
      previous studies using this questionnaire have shown that youth perspectives on the
      intervention independently accounted for up to 12-25% of the variance in changes in alcohol
      consumption and mental health symptoms over 12 months. These findings highlight the positive
      youth experiences of the programme as a significant indicator of its efficacy.

      For the proof-of-concept, this study will examine the rates of depression symptoms,
      self-reported anxiety sensitivity and impulsivity and several substance use outcomes at
      baseline and then 3-month and 6-month intervals after receiving the interventions and test
      whether these outcomes are significantly reduced after receiving the interventions. These
      primary outcomes (i.e., early mechanisms of change) were selected based on previous
      Preventure trials with the community samples, that indicated these factors largely accounted
      for the long-term intervention effects on improving substance use outcomes. According to our
      conversation with the Batshaw centres, around 60% of the adolescents in their care suffer
      from some forms of substance use problems. Therefore, reductions in substance use problems is
      regarded as a significant indicator of the proof-of-concept in this study.

      Additional information on research participants. The rates of childhood
      adversity/maltreatment, involvement in criminal justice system, low academic performance, and
      psychiatric diagnoses are particularly high in this population, which may influence the
      results of the study. In addition, the exact date of the admission and type of other
      interventions received before and during this trial are needed to be considered in the
      analyses. Participants' files will be used to gain this information. A protocol was designed,
      and approved by the Research Ethics Board to access participants' files.

      Interventions. All interventions will be conducted at Batshaw centres by a trained
      facilitator and a co-facilitator. After selection on personality scale (i.e., SURPS),
      high-risk adolescents will be invited to participate in brief group-based intervention
      sessions which target their dominant personality profile (Hopelessness, Anxiety Sensitivity,
      Impulsivity, or Sensation Seeking). Each intervention will involve two 90-minute sessions,
      with an average of 4-6 personality-matched adolescents per group, and will be conducted using
      manuals that incorporate psycho-educational, motivational enhancement therapy (MET), and
      cognitive behavioural therapy (CBT) components which include real life 'scenarios' shared by
      high-risk youth from Montreal with similar personality profiles.

      Analyses. Correlation analyses will be used to examine the patterns of substance use and
      related mental health problem in relation to personality profiles of adolescents in Youth
      Protection Services. For the feasibility analyses, t-test will be used to compare results of
      facilitator's score on Intervention/implementation fidelity scale, number of high-risk youth
      who agree to participate in the interventions, and elements of youth's feedback with results
      from previous trials which were successful in reducing rates of substance use outcomes among
      community samples. For proof-of-concept analyses, a repeated measure ANCOVA will be used to
      examine the change in pre- and post-intervention assessments of substance use outcomes,
      depression symptoms, and scores of anxiety sensitivity and impulsivity while controlling for
      the effects of confounding variables such as histories of childhood maltreatment and
      socio-economic status. This study will also conduct some secondary data analyses with other
      outcomes such as cognitive functioning, and psychiatric symptoms to guide future directions.

      Follow-up survey. After completing the intervention sessions, some of youth who received
      personality-targeted interventions and group facilitators will be invited to participate in
      separate focus groups with the research team to comment on various aspects of their
      experiences of interventions using a qualitative method. This qualitative data and the
      quantitative data from the pre- and post-intervention assessments will be discussed in the
      second working group to plan the future directions for personality-targeted interventions for
      youth involved in Youth Protection Services.
    

Intervention name(s): Personality-targeted Interventions
Intervention type(s): Behavioral
Intervention description(s): The Personality-targeted Interventions (i.e., Preventure programme) are selective substance use prevention programme designed to target known personality risk factors for substance misuse based on the evidence from cross-sectional and longitudinal studies which connect these personality risk factors to early initiation and escalation of substance misuse in adolescents. This selected personality-targeted approach targets four personality-specific motivational pathways to substance misuse: Hopelessness, Anxiety Sensitivity, Impulsivity, and Sensation Seeking. Each intervention will involve two 90-minute sessions, with an average of 6 personality-matched adolescents per group, and will be conducted using manuals that incorporate psycho-educational, motivational enhancement therapy (MET), and cognitive behavioural therapy (CBT) components and include real life 'scenarios' shared by high-risk local youth with similar personality profiles.
Other intervention name(s): Preventure programme
Intervention model: Single Group Assignment
Intervention model description: This study examines the feasibility and proof-of-concept of implementing personality-targeted interventions for high-risk adolescents receiving services from Youth Protection Services. For testing the feasibility, this study compares the following outcomes with the same outcomes from previous Preventure trials with community samples: facilitator's score on Intervention/implementation fidelity, number of high-risk youth who agree to participate in intervention sessions, and elements of youth's feedback. For testing the proof-of-concept, this study examines effects of interventions on change in substance use outcomes, depression symptoms, and self-reported anxiety sensitivity and impulsivity at 3- and 6-month post-intervention. Previous trials with the community samples indicated that these primary outcomes largely accounted for the long-term intervention effects on reduction of substance use outcomes.
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: Substance Use and Misuse; Prevention; Early Intervention; Mental Health; Complex Trauma; Youth Protection Services.; Adolescence; Personality-targeted Interventions