Koper, N., Creemers, H. E., Branje, S., Stams, G. J., & van Dam, L. (2020). Effectiveness and working mechanisms of the InConnection approach in multi-problem families: Study protocol of a mixed-methods study. BMC Health Services Research, 20(692), https://doi.org/10.1186/s12913-020-05553-3
Summarized by Harry Bayly
Notes of Interest:
- Study focused on the effectiveness of the InConnection approach vs care as usual in improving youth resilience and mental health in multi-problem families.
- InConnection is based on a youth-initiated mentor approach.
- Mixed methods study found that InConnection was empirically successful in improving youth outcomes but more research is needed to compare the two approaches and how significant the difference is.
Introduction (Reprinted from the Abstract)
Multi-problem families face problems in several domains that are often found to be chronic and intergenerational. Effective mental health care for youth from these families is currently lacking, urging research on new methods. The InConnection approach is an integrated care program to improve resilience in multi-problem families by connecting the professional expertise from multiple disciplines with the informal social network of the youth. Specifically, youth are asked to nominate a youth initiated mentor (YIM) from among the supportive adults in their network. The aim of this protocol is to describe the design of a mixed-methods study to examine the effectiveness and working mechanisms of the InConnection approach. The effectiveness of the InConnection approach is studied in a quasi-experimental questionnaire study using propensity score matching, with N = 300 families with youth aged 10–23 years receiving treatment in either the intervention group (InConnection approach) or the control group (care as usual). The main outcome variables include youth resilience (primary), youth mental health, parental functioning, and the number, duration and types of out-of-home placements. Mediators, moderators, and predictors of effectiveness are examined. Assessments take place at the start of the care program and after three, nine and 15 months. Additionally, semi-structured interviews are conducted with families who have and have not nominated a YIM to understand why some families successfully nominate a YIM, whereas others do not. Effective care for youth in multi-problem families is urgently needed. Given its flexibility and accessibility to suit all youth aged 10–23 years from multi-problem families, and its low costs compared to out-of-home placements, the InConnection approach seems an appealing approach to support these families. The current study will provide information on the effectiveness of the InConnection approach. Strengths of this study include its robust design, the ecological validity, and the inclusion of possible mediators, predictors, and moderators of treatment effects.
Implications (Reprinted from the Discussion)
Giving the lack of convincing evidence for an effective treatment for children of multi-problem families [4, 5], evidence-based approaches are urgently needed. In this article we have presented the protocol of the GRIP study designed to investigate the effectiveness of the InConnection approach, an individualized treatment program for multi-problem families with specific focus on collaboration with the social network. By conducting a prospective quasi-experimental study with propensity score matching, the GRIP study aims to examine the effectiveness of the InConnection approach as well as mediators, moderators and predictors of this effectiveness among multi-problem families. Furthermore, the GRIP study aims to examine the selection process of a YIM in families who have succeeded to find a YIM within 6 weeks and families who have not. With this study, we hope to contribute to the treatment of multi-problem families as well as generate knowledge on mediators, moderators and predictors of treatment effectiveness. This study has several strengths. First, the study is conducted under real-life circumstances, thus testing the effectiveness, rather than the efficacy, of the InConnection approach, which optimizes the ecological validity and improves the generalizability into other real-life settings. Furthermore, this study compares two different active treatment conditions that are similar in most aspects, such as the systemic and individualized approach and the intensity and duration of the treatment. This makes it possible to disentangle the effects of the unique components of the InConnection approach, that is, the integrated care offered by a multidisciplinary team and the YIM. Additionally, by also examining mechanisms that can explain these effects (i.e., mediators) and circumstances under which the effects may be weaker or stronger (i.e., moderators), we gain better insight into what works for whom. A second strength is the use of validated measures and a mixed-methods approach, as the GRIP research project consists of a quantitative questionnaire study and a qualitative interview study. This ‘methodological triangulation’ enhances our understanding, helps interpretation and contributes to the strength of the research . A third strength is the use of multiple informants in both the quantitative and qualitative study, as youth, parents, YIMs and case managers are invited to participate. By collecting information from multiple informants the risk of biases is reduced and contextual variations in behaviors, for example between the home and in proximity of the YIM, can be identified .
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