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

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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.