Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.
Peer mentoring (PM) is an evidence-based approach that may support young adults with intellectual and developmental disabilities and co-occurring mental health conditions (YA-IDD-MH) to cope with MH challenges. Feasibility testing of PM suggested that YA-IDD-MH learned, enjoyed PM, and had increased self-efficacy for managing emotions, but smaller changes in MH symptoms, suggesting a longer intervention period, may be needed. OTs may utilize peer-delivered interventions as a client-centered approach to support YA-IDD-MH.
Primary Author and Speaker: Ariel E. Schwartz
Additional Authors and Speakers: Tara Loeper
Contributing Authors: Melissa Levin
PURPOSE: There is a lack of evidence-based interventions to support young adults with intellectual/developmental disabilities and co-occurring mental health conditions (YA-IDD-MH). Peer mentoring (PM) is an evidence-based approach for adults with chronic mental health (MH) conditions (Chinman et al., 2014) that may support YA-IDD-MH to cope with MH challenges, thereby decreasing symptoms, and increasing health and participation. We collaborated with a team of YA-IDD-MH to develop a PM intervention (Schwartz et al., 2020). To evaluate intervention feasibility, we explored: RQ1: Is the intervention acceptable to YA-IDD-MH? RQ2: Does the intervention demonstrate potential promise to decrease MH symptoms for YA-IDD-MH?
DESIGN: Observational-single group feasibility study Inclusion criteria: 1) Ages 16-23; 2) diagnosis of IDD; 3) Diagnosis of MH condition and/or receiving treatment for MH symptoms. Exclusion criteria: 1) Current self-harm or suicidality; 2) psychosis symptoms within the past 3 months. Participants: 5 YA-IDD-MH: 2M/3F; ages 16-22; mean age: 20.0 (sd = 2.3), diagnoses included IDD, autism, PTSD, depression, and anxiety. Mentors: 4 YA-IDD-MH, 2M/2F, ages 19-23; diagnoses included IDD, spina bifida, autism, anxiety, depression, and OCD. PM occurred in the community (e.g., libraries, homes). PM incorporated social learning, regulatory flexibility, and metacognitive theories. Mentees met weekly with their mentor for 10 weeks. Mentors received weekly supervision and utilized a theory-driven manual and activities to provide psychoeducation, teach mentees how to self-monitor emotions and to select and utilize strategies to cope with MH symptoms. Hypothesized proximal outcome: self-efficacy for managing emotions; distal outcomes: MH symptoms.
METHOD: RQ1: Percent attendance and mentee satisfaction (youth mentoring questionnaire, range: 15-60; high scores indicate satisfaction). RQ2: Effect sizes, using T scores from PROMIS short forms completed pre and post mentoring. Mentee reports: Anxiety, physical stress, self-efficacy for managing emotions. Parent reports: Anxiety, depression, physical stress, psychological stress. We conducted post-intervention interviews with mentees and their parents to address both RQs. We used content analysis to code interview data for: RQ1 positive and negative feedback about intervention components; RQ2: mentee- and parent-reported changes in MH symptoms and coping strategy use.
RESULTS: RQ1: Mentees attended 98% of sessions. Mentees reported a high satisfaction with mentoring on the mentoring questionnaire (mean: 49.4; sd = 8.26; range 40-57). Mentees reported enjoying the activities and the mentoring relationship; parents endorsed the mentee-centered nature of the intervention and the value of peer socialization and modeling. Mentees preferred when mentors did not read from their script. RQ2: Effect sizes for mentee-reported PROMIS measures: self-efficacy for managing emotions: d = 2.253; anxiety: d = .524; physical stress: d = .309; proxy-reported measures: anxiety: d = .486; physical stress: d = .239; psychological stress: d = .382; depression: d = .582. Parents reported increased help seeking for self-regulation and interest in coping strategies; mentees reported learning.
CONCLUSION: The intervention was acceptable to YA-IDD-MH and may support increases in YA-IDD-MH's self-efficacy for managing emotions. Larger effects for the proximal outcome suggest a longer intervention period may be necessary to address distal outcomes (MH symptoms).
IMPACT: OTs may utilize peer-delivered interventions as a client-centered approach to support YA-IDD-MH. OTs may incorporate regulatory flexibility, metacognitive, and social learning theories to support YA-IDD-MH's self-efficacy for managing MH symptoms.
References
Schwartz, A. E., Young Adult Mental Health/Peer Mentoring Research Team, Kramer, J. M., Rogers, E. S., McDonald, K. E., & Cohn, E. S. (2020). Stakeholder-driven approach to developing a peer-mentoring intervention for young adults with intellectual/developmental disabilities and co-occurring mental health conditions. Journal of Applied Research in Intellectual Disabilities. https://doi.org/10.1111/jar.12721
Chinman, M., George, P., Dougherty, R. H., Daniels, A. S., Ghose, S. S., Swift, A., & Delphin-Rittmon, M. E. (2014). Peer support services for individuals with serious mental illnesses: Assessing the evidence. Psychiatric Services, 65(4), 429–441. https://doi.org/10.1176/appi.ps.201300244
Bonanno, G. A., & Burton, C. L. (2013). Regulatory flexibility: An individual differences perspective on coping and emotion regulation. Perspectives on Psychological Science, 8(6), 591–612. https://doi.org/10.1177/1745691613504116
