Background: 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. Method/design: 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, semistructured 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. Discussion: 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-ofhome 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.

Background The Covid-19 pandemic may have had negative effects on youth and parental mental health, especially in high-risk populations such as multi-problem families (i.e., families that experience problems in multiple domains, such as mental health and social network problems). Using one to four assessments during all phases of the Covid-19 pandemic up until January 2022, we examined the associations between pandemic-related stress and mental health (resilience and well-being) of youth and parents from multi-problem families. We also investigated whether experienced informal (i.e., youth informal mentoring) and formal support (i.e., therapist support) served as protective factors in this association. Methods A total of 92 youth aged 10–19 years (46.7% girls; mean age 16.00 years) and 78 parents (79.5% female; mean age 47.17 years) filled in one to four questionnaires between March 2020 and January 2022. Multi-level analyses were conducted to account for the nested structure of the data. Results For youth, pandemic-related stress was associated with lower well-being, but not with resilience. Perceived support from both mentors and therapists was positively associated with youth mental health. Furthermore, high perceived therapist support protected youth from the negative effect of pandemic-related stress on resilience. For parents, pandemic-related stress was not related to mental health, irrespective of therapist support. Yet, therapist support was directly and positively associated with parental mental health. Conclusions Youth from multi-problem families who experience pandemic-related stress are at risk of (elevated) mental health problems during the pandemic, specifically if they have no or weak therapist support. The mental health of parents, however, was minimally affected by pandemic-related stress, indicating strength and flexibility. Youth and parents who experienced support during the pandemic reported higher levels of resilience and well-being, demonstrating the importance of support for individuals’ mental health during stressful times such as a pandemic.

Higher parent-child relationship quality has been associated with less internalizing and externalizing problem behavior. However, it remained less clear whether these associations are universal or depend on the country under investigation. Furthermore, fathers are still understudied, even though there is increasing evidence of their important role in early adolescent development. Our study compared the association of mother-child as well as father-child relationship quality with early adolescents' problem behavior in four culturally different countries, namely Hungary (N = 293; M age = 11.22; 53% boys), the Netherlands (N = 242; M age = 11.20; 48% boys), India (N = 230; M age = 10.68; 61% boys), and Iceland (N = 261; M age = 10.90; 53% boys). Early adolescents filled out questionnaires in their classroom, assessing warmth and conflict with fathers and mothers and internalizing and externalizing problem behavior. Stepwise multi-group path analysis demonstrated no cross-cultural differences in associations between quality of the parent-child relationship and problem behavior. We did not find any effects of maternal or paternal warmth. However, across samples conflict with mothers was associated with more internalizing and externalizing problem behavior, and conflict with fathers was associated with more externalizing problem behavior. Our findings highlight the need to target conflict with both fathers and mothers in interventions across different countries, especially when addressing externalizing problem behavior.

Youth-initiated mentoring is an innovative youth care approach in which youth recruit supportive adults from their social networks as a mentor for youth and a partner for parents and professionals. This qualitative interview study documents what youth ( n = 15) and parents ( n = 13) from multi-problem families look for in a mentor, what mentors ( n = 8) believe they have to offer, and whether what mentors believe to offer matches youth’s and parents’ needs. Youth and parents indicated that a strong connection and trust were most important, or even prerequisites, as youth who were unable to find mentors did not have strong relationships of trust. Youth and parents also voiced preferences for an understanding, sensitive mentor who offered youth perspective by providing support and advice and (according to some) setting rules. What mentors believed to offer matched youth’s and parents’ needs, suggesting that most youth successfully recruited suitable mentors.

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The purpose of this dissertation was to advance our knowledge on the effectiveness of youth interventions that utilize the social network. To this end, we had three aims: 1) to provide insight into the effectiveness of youth care programs that utilize the social network; 2) to zoom in on the effectiveness of one program specifically, which is developed for youth with mental health needs in multi-problem families (i.e., InConnection); and 3) to better understand the links between pandemic-related stress, informal and formal support and mental health in multi-problem families. 1. How effective are interventions that activate the informal network? An overview study with different intervention types showed that youth interventions which activate the informal network are not more effective than interventions in which the network is not engaged. However, under certain circumstances, interventions that activate the social network were more effective. For example, interventions in which youth decide for themselves who to engage from their informal network, interventions in which only one person is involved, and interventions for youth with mental problems, did have significant effects. 2. How effective is InConnection for youth from multi-problem families? InConnection is an outpatient, systemic treatment for multi-problem families, in which a multidisciplinary team of professionals collaborates with an informal mentor according to the youth-initiated mentoring (YIM) approach. Interviews showed that almost all participants were positive about the collaboration with a YIM. The match between the needs of youth and parents and what mentors thought they could offer turned out to be good in most cases. The effectiveness study showed that InConnection showed some positive effects compared to treatment as usual, namely a decrease in the emotional and behavioral problems of youth and an increase in positive parenting behavior from the parents' perspective. No differences in effectiveness were found for the other outcome measures, including youth well-being and resilience. 3. Does support protect against mental health problems in youth and parents from multi-problem families during the Covid-19 pandemic? Due to the measures taken during the Covid-19 pandemic, youth and their parents had fewer opportunities to receive support from their network, while the risk of mental health problems increased, especially among vulnerable groups. Results showed that the pandemic was experienced as stressful by some youth from multi-problem families. Youth who experienced pandemic-related stress had a higher risk of mental health problems, especially if they reported receiving little or no formal support (therapist support). Parents were minimally affected by pandemic-related stress, suggesting strength and flexibility. Youth and parents who experienced support from their informal and/or formal networks during the pandemic had fewer problems, thus showing the importance of providing help and support to people with mental health problems during stressful situations such as a pandemic. These findings illustrate that despite the complex challenges that vulnerable youth (such as youth with mental health problems and youth from multi-problem families) experience, interventions with characteristics of YIM in general and InConnection specifically are as good or even better than other interventions in supporting youth and reducing their problems.