A multimodal day treatment program for multi-problem young adults: study protocol for a randomized controlled trial

Abstract

BackgroundEffective interventions for young adults with severe, multiple problems – such as psychosocial and psychiatric problems, delinquency, unemployment and substance use – are scarce but urgently needed in order to support an adequate transition to adulthood. A multimodal day treatment program called “New Opportunities” (in Dutch: “De Nieuwe Kans”; DNK) was specifically developed to target multi-problem young adults in The Netherlands. The aim of this study protocol is to describe the design of a randomized controlled trial (RCT) in clinical practice to examine the effectiveness of DNK in comparison with care as usual (CAU).Methods/designMulti-problem young adults in Rotterdam, The Netherlands, will be assigned randomly to DNK (expected N = 150) and CAU (expected N = 150). Primary outcome measures are recidivism and self-sufficiency. Secondary outcome measures include quality of life, attending school/work, psychological functioning, cognitive distortions and substance use. Participant and program characteristics will be examined as potential moderators of effectiveness. Additionally, cost-effectiveness will be measured. During 14 months, data from multiple resources will be collected at four time points.DiscussionThis study is one of the first RCTs on the effectiveness of interventions developed for multi-problem young adults. The results will contribute to the currently scant knowledge about what works for various multi-problem young adults in their transition to adulthood. In addition, the study protocol will provide insight into implementing an RCT in a dynamic setting of clinical practice.Trial registrationDutch Trial Register, identifier: NTR5163. Registered on 17 April 2015; retrospectively registered during the recruitment phase.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-017-1950-3) contains supplementary material, which is available to authorized users.

The role of adverse childhood experiences and mental health care use in psychological dysfunction of male multi-problem young adults

“…In 2014–2016, a total of 647 multi-problem young adult men were recruited in Rotterdam, The Netherlands, as part of a larger study [54, 81]. Recruitment for this study took place at two sites.…”

“…He is referred to an intervention such as DNK when he does not meet these aims and meets the conditions for acquiring social welfare. Participants were eligible when they were male, were between 18 and 27 years old (mean age 22.1; SD = 2.4), and adhered to the following definition of multi-problems: (a) a score of 1 or 2 on the domains Income and Daytime Activities; (b) a maximum score of 3 on at least one of the following domains: Addiction, Mental Health, Social Network, and Justice; and (c) a minimum score of 3 on the domain Physical Health [81]. This definition was based on the self-sufficiency scores in the prior year of all young adult males who were referred to DNK.…”

“…Furthermore, the mental health care use of ethnic minorities tends to be lower than that of ethnic majority groups [80]. Most multi-problem young adults belong to ethnic minority groups, and due to their various family and income problems, we expect their residential mobility to be relatively high [81]. Therefore, the influence of residential mobility and ethnicity is taken into account when exploring the associations between ACEs, mental health care use and current mental health problems.…”

Neurocognitive predictors of treatment completion and daytime activities at follow-up in multiproblem young adults

“…One explanation for the difference in results on error processing might be the difference in patient population. The current heterogeneous population suffered from a plethora of problems of varying severity, including, but not limited to, history of delinquency, behavioral and psychological problems, no daytime activities, frequent substance use, and no or low income (Luijks et al, 2017 ; van Duin et al, 2017 ; van Duin et al, 2018 ; Zijlmans et al, 2019 ; Zijlmans et al, 2018 ). It is possible that aberrant error processing reflects a deficit in substance users and thus efficiently discriminates between substance abusers and nonabusers in treatment outcome, but this effect does not apply to heterogeneous populations such as the current sample.…”

“…A sample of male multiproblem young adults is included at the start of multimodal (that is, involving a combination of approaches) day treatment program De Nieuwe Kans (DNK; translated as “New Opportunities”). DNK provides a multimodal day treatment program for young adults facing a range of problems—for example, a history of delinquency, behavioral and psychological problems, no daytime activities (e.g., no work, education, other full-time activities), frequent substance use, and no or low income (Luijks et al, 2017 ; van Duin et al, 2017 ; van Duin et al, 2018 ; Zijlmans et al, 2019 ). The main goal of DNK is to reintegrate participants into society by facilitating and retaining successful integration into education or employment and to increase self-sufficiency, and to subsequently reduce delinquency.…”