Identifying Mechanistic Pathways of Family Peer Support Effectiveness - Family Peers (FPs) have lived experience of parenting a child with mental health needs and specialized training to support caregivers in navigating mental health care. FP support is promising for engaging families in treatment, even those skeptical of its benefits. FP support is widely used across the United States in a range of formats and settings and is reimbursable by Medicaid in 33 states. Trials of FP support have shown positive results across a range of child and caregiver outcomes. Despite these initial promising results and the widespread use of this model, little is known about the mechanisms through which FP support impacts families. Building these models is essential to increasing efficiency and effectiveness of these efforts and better meeting the needs of families. One barrier to delineating mechanisms of change for FP support is the absence of acceptable and ecologically valid tools to capture the content of FP support. This K23 proposes to 1) develop a comprehensive list of common FP intervention components, and 3) delineate target mechanisms for discrete common FP intervention components, and 3) develop and validate a tool to measure delivery of these components. I will use an Intervention Mapping approach in collaboration with an Advisory Board of FPs, those who have received FP support, and FP trainer/supervisors. This K23 will focus on one-to-one FP support for caregivers of children ages 5-15 in ambulatory settings. In Aim 1, I will survey 50 FPs and 50 caregivers who have received FP support about FP intervention components provided or received, the perceived utility of each component, and their link to target mechanisms. I will then gather more in-depth information on intervention components and target mechanisms through interviews with a subset of 16 FPs, 16 caregivers, and 16 FP trainer/supervisors. In Aim 2, I will work with my Advisory Board to synthesize Aim 1 data into a refined logic model that indexes common FP intervention components tied to target mechanisms, and a fidelity tool to capture adherence to common FP intervention components. In Aim 3, I will validate the fidelity tool with 200 FPs reporting on a selected session with a representative caregiver alongside a survey about target mechanisms, and measure acceptability and feasibility. Forty caregivers will be selected to complete a parallel fidelity tool and survey for the selected session to inform mechanistic understanding. Another subset of forty FPs will be sampled to complete two walk throughs with a standardized patient and accompanying fidelity tools for convergent validity. I will assess initial psychometric properties of the fidelity tool and examine links between intervention components and target mechanisms. This project will result in 1) the first comprehensive list of common FP intervention components across FP programs, 2) a tool to capture fidelity to FP intervention components, and 3) a mechanistic model of how FP intervention components target mechanisms to be tested in a subsequent R01.
