Optimizing residential treatment gains for adolescents through tailored behavioral parent training

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Project Summary Although adolescents (ages 11 to 17) make treatment gains (e.g., reduced internalizing or externalizing behaviors) in psychiatric residential treatment (RT), they experience significant difficulty adapting to the community and often do not sustain treatment gains long term. After RT, 70% of adolescents discharge to their family of origin. However, parents are not provided with the necessary support or behavior management skillset to bridge the gap between RT and home. A new federal mandate will soon require parent training, an evidence-based behavior management intervention, in the RT setting. Parents with adolescents admitted to RT are a difficult-to-reach population, and technology may increase access and uptake of parent training. Parenting Wisely (PW) is a web-based parent training with demonstrated efficacy in increasing effective parenting practices to reduce adolescent behavior problems. We previously found that PW was highly feasible for parents and the skills were perceived as useful. However, parents reported two unmet needs: (1) skill individualization to apply the PW skills and (2) enhanced community to reduce isolation. In collaboration with an advisory board (a partner in the proposed study), we augmented PW with clinician facilitated discussion groups (referred to as PWRT). The discussion groups in PWRT supports program completion and parent engagement, provides a venue to discuss individualizing PW strategies, reduces isolation, and support parents by engaging in conversation about parenting in the RT context. The proposed study aims to: (1) establish feasibility and acceptability of PWRT, (2) evaluate whether PWRT engages target mechanisms (parental self- efficacy, parenting behaviors, social support, family function), and (3) determine the effects of PWRT on adolescent outcomes (internalizing and externalizing behaviors, placement restrictiveness). Sixty parents (30 per condition) will be randomly assigned to PWRT or treatment-as-usual (TAU). Each week for six weeks, parents will complete two PW modules (20 minutes each) and attend one discussion group via Zoom (90- minutes). PWRT will be initiated towards the end of the RT admission and continue post-discharge to bridge the transition from RT to the community. Adolescents (n=60) will not receive intervention; however, we will evaluate the feasibility of adolescent data collection for future studies. Data from parents and adolescents will be collected at baseline, 6-weeks, and 6-months post-baseline to allow for a robust understanding of the longer-term effects of PWRT on treatment gain maintenance. Consistent with PAR-21-211, our team of researchers and community partners is collecting the requisite data for a larger-scale effectiveness trial by testing the feasibility, acceptability, and preliminary effects of PWRT vs. TAU. PWRT is among the first web- based parent training augmented with supportive elements designed to engage parents with adolescents in RT. By providing parents with tailored education and support in PWRT, parents will be equipped with the behavior management skillset to provide structure in the home and ultimately maintain RT treatment gains.