Adolescents with Substance Use Disorders Transitioning from Residential Treatment to the Community: Improving Outcomes via a Computer Assisted Parenting Program

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 DESCRIPTION (provided by applicant): Adolescents with substance use disorders (ASUD) in residential treatment have the most serious substance use disorders and the highest rates of psychological, motivational, behavioral, legal, environmental, and vocational problems. ASUD in residential treatment are also at extremely high risk of relapse, with follow-up studies suggesting that 60% of ASUD will relapse within the first 90 days of discharge. Parenting practices have been established as a key influence on adolescents' initiation and maintenance of substance use, as well as their substance use outcomes and likelihood of relapse. However, therapists who treat ASUD have reported a myriad of systemic barriers to engaging parents in treatment. Findings such as these deem ASUD in residential treatment a high priority population and argue for the value of easily accessible parenting interventions during this critical time. The proposed study evaluates one potential low cost, low intensity model for delivering parenting skills to parents preparing for their adolescent's discharge from residential substance use treatment. Specifically, this project involves adapting the delivery of a computerized parenting intervention (Parenting Wisely; PW) that has preliminary evidence of efficacy in improving parenting skills and reducing youth behavior problems. This study adapts the delivery of PW for a new population (parents of ASUD preparing for discharge) and new setting (residential treatment), and obtains initial data on its feasibility, acceptability, and effectiveness. First, an open trialwith 10 parents will adapt the delivery of PW to include moderate engagement strategies relevant to this population. Initial engagement strategies have been developed based on focus groups and interviews with 13 parents, 11 ASUD, and three staff members and include up to six sessions of individualized coaching that begin prior to discharge (incorporated into standing family appointment times) and the use of technology (e.g., text messaging and an online parent message board) to maintain contact between staff and parents post-discharge. Second, a randomized trial with 60 parents will compare an adapted PW plus treatment as usual (TAU) condition (PW+TAU) versus TAU only in a residential treatment center. Both treatment conditions will be delivered by Master's-level community clinicians. Use of a low-cost, low-intensity intervention paired with moderate engagement strategies represents a marked change from traditional treatment delivery methods, with potential for extending treatment gains after discharge. Innovative aspects of the current approach include its timing, use of novel engagement strategies, combination of in-person and computer-delivered content, and focus on putative mediators. The approach has the potential to advance public health by: addressing a high-needs population; targeting parenting practices (putative mediators of change) that have been shown to influence ASUD outcomes; working with parents during a critical treatment juncture; improving parental engagement and access to care, and increasing ease of dissemination and implementation.