The First Step is the Hardest: A Mixed Methods Single-Case Experimental Design Study of a VR-Enhanced Training Program in a Forensic Youth Care Setting.

Street Temptations is a virtual reality-enhanced training program developed as an add-on intervention for adolescents with disruptive behavior problems. Using mentalization as a primary treatment mechanism, the program aims to address cognitive distortions and increase motivation for behavior change. This study provides an initial evaluation of Street Temptations in a forensic youth care setting, utilizing both quantitative and qualitative data within an A-B-A' single-case experimental design. Throughout a baseline, intervention, and follow-up phase, adolescents completed daily measurements on cognitive distortions and motivation for behavior change. Secondary outcomes were assessed before baseline, after intervention, and after follow-up, which included mentalization and perspective-taking. Qualitative data were collected after the intervention through separate interviews with adolescents and Street Temptations therapists. A total of 8 adolescents were included in the study, 5 of whom dropped out, leaving 3 who provided sufficient data for visual inspection of the outcomes. The observed patterns suggested an increase in adolescents' awareness of others' perspectives during participation in Street Temptations, potentially indicating a positive effect on cognitive distortions. However, daily assessments did not show an increase in adolescents' motivation for behavior change. Positive effects of Street Temptations and virtual reality, as well as areas for improvement, were highlighted in all interviews. Recommendations for further development and implementation are discussed. Overall, this study provides preliminary support for the use of Street Temptations as an add-on intervention in forensic youth care.