Improving Outcomes of Adolescents in Residential Substance use Treatment via a Technology-Assisted Parenting Intervention

项目描述 青少年在住宅物质使用（SU）治疗有最严重的SU障碍和最高的 心理、行为、法律的、环境和职业问题的发生率。寄宿家庭中的青少年 SU治疗也有很高的复发风险，随访研究表明，60%的出院患者 青少年在90天内复发。养育子女的做法，包括父母监督和父母-青少年 沟通，已被确定为青少年SU结果和复发可能性的关键预测因素， 但父母们很难参与青少年SU治疗。因此，显然需要 为接受寄宿SU治疗的青少年的父母提供有效、可获得和可扩展的干预措施。 在我们成功的NIDA资助的R34的基础上，这项研究评估了一种技术辅助的养育方式。 一项名为“父母智能”（Parent SMART）的干预措施， 具有高度可行性和可接受性的证据，以及有效性的初步证据， 短期住院治疗（TAU）。家长智能中心围绕一个现成的 计算机化干预，明智的父母（PW），这已经证明了强有力的证据，改善 育儿技巧和减少青少年行为问题的多项临床试验。我们进行了广泛的 与家长，青少年和住宅工作人员进行形成性研究，以指导开发和交付 两项高度可扩展的增强功能：1）访问最先进的移动的网络应用程序; 2）最多四个 远程保健辅导课程，以定制PW内容。我们的网络应用程序允许家长提交问题， 一个SU专家，并与其他青少年的父母在住宅SU治疗实时连接，而 通过“每日小贴士”加强育儿技巧推送通知。在我们的试点试验中，家长智能是高度 可行和可接受，并有证据表明在改善父母监督方面的有效性， 交流，减少青少年酗酒和所有其他药物使用的天数，并减少与学校有关的 问题，在短期住宿治疗的父母。本R 01提出了一个完全有效的评估， 家长智能。青少年-父母二人组（n = 220对二人组;共440对）将随机接受以下任一治疗 仅TAU或父SMART + TAU。多方法后续评估（即，自我报告的父母和 青少年测量，父母-青少年体内相互作用任务，8-板尿液筛查）将进行6-， 出院后12周和24周，检查父母养育技能，青少年SU和青少年问题 行为。探索性分析将检验养育技能的提高是否部分介导了减少 在青少年SU。拟议的研究有可能通过以下方式推进该领域：满足高需求， 在治疗的关键时刻，服务不足的人群;针对父母的做法（假定的调解人）， 已被证明可以预测青少年SU的结果;解决获得持续护理的障碍;以及 测试一个高度可扩展的干预模型，该模型由广泛的形成性研究提供信息。

Project Description Adolescents in residential substance use (SU) treatment have the most serious SU disorders and the highest rates of psychological, behavioral, legal, environmental, and vocational problems. Adolescents in residential SU treatment are also at high risk of relapse, with follow-up studies demonstrating that 60% of discharged adolescents relapse within 90 days. Parenting practices, including parental monitoring and parent-adolescent communication, have been established as key predictors of adolescent SU outcomes and likelihood of relapse, but parents are notoriously difficult to engage in adolescent SU treatment. Accordingly, there is a clear need for effective, accessible, and scalable interventions for parents of adolescents receiving residential SU treatment. Building upon our successful NIDA-funded R34, this study evaluates a technology-assisted parenting intervention called Parent SMART (Substance Misuse among Adolescents in Residential Treatment), which has evidence of high feasibility and acceptability, as well as preliminary evidence of effectiveness, as an adjunct to short-term residential treatment as usual (TAU). Parent SMART centers around an off-the-shelf computerized intervention, Parenting Wisely (PW), which has demonstrated robust evidence of improving parenting skills and reducing youth behavior problems in multiple clinical trials. We conducted extensive formative research with parents, adolescents, and residential staff to guide the development and delivery of two highly scalable enhancements: 1) access to a state-of-the-art mobile networking app; and 2) up to four telehealth coaching sessions to tailor PW content. Our networking app allows parents to submit questions to an SU expert and connect with other parents of adolescents in residential SU treatment in real-time, while reinforcing parenting skills via “Tip of the Day!” push notifications. In our pilot trial, Parent SMART was highly feasible and acceptable, and demonstrated evidence of effectiveness in improving parental monitoring and communication, reducing days of adolescent binge drinking and all other drug use, and reducing school-related problems, among parents in short-term residential treatment. This R01 proposes a fully powered evaluation of Parent SMART. Adolescent-parent dyads (n = 220 dyads; 440 in total) will be randomized to receive either TAU only or Parent SMART + TAU. Multi-method follow-up assessments (i.e., self-report parent and adolescent measures, parent-adolescent in vivo interaction task, 8-panel urine screens) will be conducted 6-, 12-, and 24-weeks post-discharge, to examine parenting skills, adolescent SU, and adolescent problem behaviors. Exploratory analyses will test whether improvements in parenting skills partially mediate reductions in adolescent SU. The proposed research has the potential to advance the field by: serving a high-need, underserved population during a vital treatment juncture; targeting parenting practices (putative mediators) that have been shown to predict adolescent SU outcomes; addressing barriers to accessing continuing care; and testing a highly scalable intervention model informed by extensive formative research.