Youth Compass Plus

Study Overview
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Brief Summary
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The aim of this randomized control trial is to examine the effectiveness of a novel web- and mobile-based Acceptance and Commitment Therapy program (Youth Compass plus) to promote adolescents' psychological flexibility and well-being and subsequently support their successful transition from basic education to upper secondary education. Our aim is also to compare the efficacy of Youth Compass plus using either an eCoach providing automated personal support to the user or an eCoach and a Human Coach providing personal support to the user. Additionally, we will investigate whether the efficacy of the Youth Compass plus varies according to different individual and contextual factors. Using the internet to deliver interventions is assumed to be particularly motivating for youth who enjoy spending time online using different social media. Web-based interventions have several advantages; they can include more information and treatment components than traditionally delivered treatments and they are accessible at any time and place. The five-week structured intervention is delivered using the novel web- and mobile-based program Youth Compass plus. Youth Compass plus has been developed based on the feedback for the Youth COMPASS pilot program (see ClinicalTrials.gov, NCT03274934). The exercises of Youth Compass plus have been modified, visual aspects have been improved and new game-based interactive elements have been developed. In the Youth COMPASS pilot study, psychology students acted as (human) coaches for the users. While interaction with a personal coach increases commitment to the program, the need to train and supervise coaches limits large scale dissemination. To provide an alternative that is less demanding in terms of resources, we have developed a chatbot (eCoach) as a new feature within the new Youth Compass plus program. The automated eCoach provides personal support within the program and via text messages. The eCoach provides support and encouragement, reminds about using Youth Compass plus, sends individualized feedback, and recommends different exercises.

Detailed Description
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The aim of this randomized trial is to examine whether Youth Compass plus enhances adolescents' (a) psychological skills, particularly with respect to finding a purpose, and psychological flexibility and adaptation skills as the ACT process outcomes; (b) career preparation and psychological well-being as the proximal outcomes; and (c) the initiation of upper secondary education studies and engagement in upper secondary education as the distal outcomes. In addition, our aim is to investigate the ACT processes and mediating mechanisms of the Youth Compass plus program, and to explore the extent to which the effectiveness of the Youth Compass plus varies according to the differences in various individual and contextual factors. H1: The study expects that the Youth Compass plus is more effective than no intervention. Youth Compass plus is expected to promote ACT proximal youth outcomes, as well as the youth distal outcomes. H2: In addition, the study expects that the Youth Compass plus will promote the distal outcomes through enhancing the ACT process outcomes and the proximal outcomes. H3: The study expects that Youth Compass plus is more effective for those adolescents who accept the intervention well, take part intensively and diversely in different exercises, as well as among the adolescents who are initially highly emotionally reactive.

Official Title
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The Effectiveness of the Youth Compass Plus: The Novel Five-week Web- and Mobile-based Acceptance- and Commitment Therapy Program to Promote Adolescent Psychological Flexibility and Well-being

Conditions
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Psychological Flexibility, Psychological Well-being

Intervention / Treatment
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* Behavioral: face-to-face support and Chatbot online support group
* Behavioral: only chat-robot online support group
* Behavioral: Control group, no intervention


Participation Criteria
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Eligibility Criteria
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Inclusion and Exclusion Criteria: Approximately 600-1000 Finnish 14-16 year old adolescents from non-clinical school-age population will fill in a pre-questionnaire. Based on this data the participants for the randomized control trial will be selected from the two gender-balanced groups of Finnish adolescents: Adolescents (n = 150) who have heightened (pre-clinical) level of symptoms of stress/anxiety/depression in the screening measures (no diagnosis is required for participation). Randomly chosen adolescents (n=150) who have no symptoms of stress/anxiety/depression in the screening measures Adolescents from both groups are randomly assigned in three conditions: (a) five weeks of Youth Compass plus with support from chatbot + face-to-face support (altogether two face-to-face meetings); b) five-weeks of Youth Compass plus with support from chatbot only; or (c) no intervention. At the baseline (fall 2020) the participants will be ninth-graders facing the transition to upper secondary education.

Ages Eligible for Study
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Minimum Age: 14 Years
Maximum Age: 16 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Efficacy study
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: face-to-face support and Chatbot online support group<br>Experimental, Intervention Group A: face-to-face support and Chatbot online support group: 5-week intervention according to ACT principles with the web- and mobile-based Youth Compass plus program, face-to-face support (2 meetings) and weekly online support and feedback from the Chabot eCoach built within the program (one third of the participants is randomly assigned to this group) | Behavioral: face-to-face support and Chatbot online support group<br>* Behavioral: Structured web- and mobile-based intervention with Youth Compass plus program to support adolescents' psychological flexibility, well-being, and subsequently support successful transition to upper secondary education. The Youth Compass plus is a five-week online program aiming to enhance adolescents' psychological flexibility by guiding adolescents in exploring their values and setting goals and changing behaviors according to their goals (week 1), and learning acceptance, defusion and mindfulness skills (weeks 2-3) and integrating these skills into their personal and social life (weeks 4-5). The participants in this condition receive weekly online support and feedback from the eCoach built within the program. In addition, they meet and get support from their human coach (i.e., psychology student) twice in the face-to-face meetings.<br>|
| Experimental: only chat-robot online support group<br>Experimental, Intervention Group B: only chat-robot online support group: 5-week intervention according to ACT principles with the web-and mobile-based Youth Compass plus program, no face-to-face support, and weekly online support and feedback from the chatbot eCoach built within the program (one third of the participants is randomly assigned to this group) | Behavioral: only chat-robot online support group<br>* Behavioral: Structured web- and mobile-based intervention with Youth Compass plus program to adolescents' psychological flexibility, well-being, and subsequently support successful transition to upper secondary education. The Youth Compass plus is a five-week online program aiming to enhance adolescents' psychological flexibility by guiding adolescents in exploring their values and setting goals and changing behaviors according to their goals (week 1), and learning acceptance, defusion and mindfulness skills (weeks 2-3) and integrating these skills into their personal and social life (weeks 4-5). The participants in this condition receive weekly online support and feedback from the eCoach built within the program.<br>|
| Experimental: Experimental Control<br>Experimental Control: Control group, no intervention (one third of the participants is randomly assigned to this group) | Behavioral: Control group, no intervention<br>* Behavioral: No intervention<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| psychological flexibility | Comprehensive assessment of Acceptance and Commitment Therapy processes, CompACT; Francis et al., 2016 | Change from baseline at 2 and 6 months after the intervention | 
| psychological flexibility | Cognitive Fusion Questionnaire (Gillanders et al., 2014) | Change from baseline at 2 and 6 months after the intervention | 
| life satisfaction | Satisfaction with Life Scale, SWLS, Diener et al., 1985 | Change from baseline at 2 and 6 months after the intervention | 
| mental well-being | Warwick-Edinburgh Mental Well-being Scale WEMWBS; THL 2011 | Change from baseline at 2 and 6 months after the intervention | 
| stress symptoms | Perceived Stress Scale, PSS-10; Cohen et al., 1983 | Change from baseline at 2 and 6 months after the intervention | 
| anxiety symptoms | short-form of the state scale of the Spielberger State-Trait Anxiety Inventory, STAI; Marteau & Becker, 1992 | Change from baseline at 2 and 6 months after the intervention | 
| depressive symptoms | Depression Scale, DEPS; Salokangas et al., 1995 | Change from baseline at 2 and 6 months after the intervention | 
| Career choice preparedness | career choice self-efficacy, career-related insecurity, preparation against setbacks, Koivisto et al., 2011 | Change from baseline at 2 and 6 months after the intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| perfectionism | The Child-Adolescent; Perfectionism Scale, CAPS; Gordon et al., 2016 | Change from baseline at 2 and 6 months after the intervention | 
| self-compassion | Self-Compassion Scale - Short Form; Raes et al., 2011 | Change from baseline at 2 and 6 months after the intervention | 
| prosocial aspirations | short form of the Aspirations Index, Marshall, 2019 | Change from baseline at 2 and 6 months after the intervention | 
| academic buoyancy | short Academic buoyancy scale; Martin & Marsh, 2008 | Change from baseline at 2 and 6 months after the intervention | 
| school well-being | school satisfaction, anti-school attitude, school-related stress, WHO | Change from baseline at 2 and 6 months after the intervention | 
| academic performance | grade point average | Change from baseline at 2 and 6 months after the intervention | 
| truancy and school absences | truancy and school absences, Finnish School Health Questionnaire | Change from baseline at 2 and 6 months after the intervention | 
| educational attainment, information from school registers | initiation of upper secondary education, progress in studies, changes in study field, graduation time, | 2020-2025 (not possible to provide more specitic time frame) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Career preparation, Adolescents, Acceptance Commitment Therapy, Web- and mobile-based intervention, Psychological flexibility, Psychological well-being, Successful educational transitions