18 August 2026

Promoting Resilience in Residential Youth Care: Web-Based Intervention Showed No Additional Effects

A randomized study conducted by Prof. Christina Stadler’s DKF research group examined the implementation and effectiveness of the web-based START NOW intervention among adolescents and young adults in swiss residential youth care facilities.

Adolescents in residential youth care facilities are often confronted with stressful life events, trauma, and mental health issues. At the same time, they often have to pass through barriers to access evidence-based psychological support services. Against this backdrop, a research team from the University Psychiatric Clinics of Basel and the University of Basel developed the digital version of the START NOW skills training program, which is designed to promote skills in emotion regulation, stress management, and resilience.

In the cluster-randomized study, now published in Child and Adolescent Psychiatry and Mental Health, 164 adolescents and young adults (ages 14–24) from 27 youth care facilities in German- and French-speaking Switzerland participated. The facilities were assigned to one of three conditions: a web-based group version of START NOW led by trained professionals, a self-help-only version of the web app, or treatment as usual (TAU). Over a nine-week period, changes in psychological flexibility, resilience, well-being, self-efficacy, and psychological distress were examined.

Significant Barriers to Program Use and Study Participation

The results show significant differences in program usage. While adolescents in the guided group completed a median of ten of the twelve modules, more than half of the participants in the self-help group did not complete a single session. Participation in the follow-up surveys also posed a challenge: Three months after the end of the intervention, data were available for only about 38 percent of the participants. The decline was particularly pronounced in the self-help group. Both the low participation rate in the self-help group and the high rate of missing questionnaire data significantly complicated the analysis.

The available statistical results indicate that there are no significant differences between the three study arms. Neither psychological flexibility—the primary endpoint of the study—nor resilience, well-being, self-efficacy, or symptoms of anxiety or depression improved more significantly with the web app than with standard care. These results were observed both immediately after the intervention and at three and six months.

Digital offerings require active support

The results indicate that the newly developed START NOW app is not effective in its current implementation. However, a complementary qualitative study suggests that the digital infrastructure and institutional framework were not optimal, which—along with other limitations—restricts the final assessment.

At the same time, the researchers involved in the study emphasize that purely digital self-help programs appear to be only of limited suitability for this target group. To achieve sustainable effects through START NOW and enable the transfer of skills into everyday life, both in-person training and supervision of staff and a more intensive intervention format are important—as has already been shown in previous studies.

Hybrid approaches that combine digital tools with in-person support from trained professionals may be promising and should be further explored.

“Achieving lasting results from interventions is only possible if young people are supported in applying the skills they’ve learned in their daily lives—digital tools are no substitute for in-person, real-world coaching.”

Prof. Christina Stadler