Self-management and recovery training (SMARTStart) to help young people make healthy choices: Pilot trial of feasibility and acceptability

We aim to run a maximum of three weekly groups that run for up to 2 hours per session. In practice (i.e., out of the research setting), these groups are likely to continue running throughout the year, however for research purposes we will be assessing change over 8 weeks. Group size is likely to vary based on interest, physical capacity of program site, and participant commitments. It will be a minimum of 2 participants and capped at 20 participants. If more than 10 participants, additional peer workers and/or psychologists will be present to help manage group dynamics. Groups may be run online using videoconferencing or face to face. We have chosen to provide the upper limits of groups (i.e., 3), session running time (i.e., 2 hours), and number of participants (i.e., 20) to account for the unpredictability of interest in the study and pandemic lockdown restrictions. Participants from both eligible pathways (from headspace or other pathways) will be grouped together. No distinction will be made based on the pathway. Group participants may be grouped by age range if sufficient number of participants in these age ranges are recruited (e.g. 12-17 years olds in one group and 18-25 years old in another group). The program will be based on SMART Recovery principles, a mutual aid group originally designed to help people with addictive behaviours, such as drug or alcohol use, or gambling. SMART Recovery is facilitated by a trained professional using Cognitive Behavioural Therapy and Motivational Interviewing techniques with a mutual aid approach where group members share experiences and ideas to support other group members. SMART Recovery is a well-established, evidence-based organisation that runs over 200 groups nationwide. The primary modifications that have been made are to establish the program as a space where young people help other young people; design the program as a social space, not a program targeting addictive behaviours or wellbeing; account for the importance of identity development and social connection in adolescent and young adult years; modify language and resources to be youth-targeted and youth-friendly; and to allow social, emotional, personal, and environmental stressors to be raised as important contributors to the health choices young people make. Examples of topics that might be raised during the weekly sessions would be related to drugs and alcohol, mental health, physical health, social relationships, managing school or work stress, and quality of life. The study setting would be headspace Newcastle (and affiliated sites) and online using Zoom videoconference software. Due to pandemic lockdown restrictions, we are unable to identify the final setting in which we will run the groups. It is anticipated that we will deliver at least 1 face-to-face group and one videoconference group. Headspace Newcastle will have settings available on-site for small groups and has developed relationships with other sites (e.g., Newcastle Library) that may be required for larger groups. Online groups will be made available to account for possible difficulties accessing a group in Newcastle or pandemic lockdown restrictions. The program will be delivered by one of three research psychologists (all with at least 18 months experience as a psychologist) and one of two peer workers (both with more than 5 years experience with mental health problems and the mental health service). All research psychologists and peer workers will have completed SMART training. Attendance will be taken at each session as a measure of retention and completion of the intervention. No further fidelity assessments will be completed due to this being outside the scope of this study.