Improving Psychological Wellbeing and Decreasing Psychological Distress among Youth in the Legal System: Multi-Site Feasibility Trial of a Mindfulness Meditation App - Youth brought into the legal system face diminished psychological wellbeing and heightened psychological distress compared with peers who have not been arrested, on average, impairing current quality of life and long-term whole person health. Emotion dysregulation appears to contribute to low wellbeing and high distress on the individual level, and it can be improved via mindfulness meditation. Meditation can be taught by smartphone app, reaching youth on probation in their daily lives. In a prior study (K99/R00DA047890), we collaborated with a range of stakeholders in Chicago Cook County, the 2nd largest juvenile legal system in the U.S., to identify determinants (i.e., barriers and facilitators) of implementing a 1-month mindfulness meditation app with youth on probation, create a multi-component implementation plan, and run a fully remote feasibility clinical trial. Preliminary mixed-methods data strongly supported feasibility, including successful recruitment, enrollment, and randomization of n=50 youth on probation; high objective app usage (i.e., adherence); and high retention at 1 (86%) and 6 (81%) months. Study activities included adapting an app comprised of evidence-based meditation practices for relevance to youth on probation, creating a control app matched for time and structure, and automating systems to identify and re-engage non-users of both apps. Now, our team faces critical barriers to building on these successes and running a fully-powered trial that can produce effectiveness and implementation data generalizable beyond a single site. On the individual level, youths’ backgrounds differ across legal systems; determining if youth from diverse backgrounds will adequately adhere to the meditation app is a key concern. Organizationally, marked heterogeneity across legal systems precludes uniform approaches to recruiting, enrolling, and retaining youth, and can impact health and implementation outcomes. The proposed study will thus expand feasibility testing into 4 rural and urban counties (i.e., sites) in 2 new states: Oregon and New York. Our team will form relationships in each county and conduct theoretically-guided interviews to (a) identify determinants of implementing the meditation app and running the trial at each site, and (b) guide corresponding refinements to our recruitment, retention, and other procedures. Youth on probation (n=120; 30/site) will then be individually randomized to use the meditation or control app for 30 days. Youth will report on health outcomes (wellbeing and distress) at baseline, 1, and 6 months, and complete “bursts” of ecological momentary assessment at baseline and 1 month to capture the mechanistic target (emotion dysregulation) in real time. Also at 1 month, youth, officers, and leadership at each site will interview on feasibility. These mixed-methods data will inform the development of a hybrid type 2 effectiveness-implementation trial spanning diverse counties in Oregon, Illinois, and New York. The present study is thus a carefully-designed step toward promoting scalable programming that holds the potential to improve whole person health and help address health disparities among legal-involved youth.
