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

 说明(申请人提供)：住院治疗中患有物质使用障碍(ASUD)的青少年是最严重的物质使用障碍，心理、动机、行为、法律、环境和职业问题的发生率最高。住院治疗的ASUD患者也有极高的复发风险，后续研究表明 60%的ASUD患者将在出院后的头90天内复发。育儿实践已被确定为对青少年开始和维持药物使用、以及他们的药物使用结果和复发可能性的关键影响。然而，治疗ASUD的治疗师报告说，让父母参与治疗存在无数的系统性障碍。诸如此类的研究结果认为，住院治疗中的ASUD是一个高度优先的人群，并主张在这个关键时期采取容易获得的育儿干预措施的价值。这项拟议的研究评估了一种潜在的低成本、低强度的模式，用于向准备离开住宅药物使用治疗的青少年出院的父母传授育儿技能。具体地说，该项目涉及调整电脑化育儿干预(明智育儿；PW)的交付，初步证据表明，该干预在改善育儿技能和减少青少年行为问题方面有效。这项研究适应了新人群(ASUD的父母准备出院)和新环境(住院治疗)的PW交付，并获得了关于其可行性、可接受性和有效性的初步数据。首先，一项有10名家长参加的公开试验将调整PW的交付方式，以纳入与这一人群相关的适度参与策略。初步参与战略是基于焦点小组和对13名家长、11名ASUD和3名工作人员的访谈制定的，其中包括在离职前开始的最多6次个体化辅导(纳入常设家庭预约时间)，并利用技术(例如短信和在线家长留言板)在离职后保持工作人员与家长之间的联系。其次，一项有60名父母参加的随机试验将比较适应后的PW加常规治疗(TAU)条件(PW+TAU)和仅在住院治疗中心进行的TAU情况。这两种治疗条件都将由硕士级别的社区临床医生提供。使用低成本、低强度的干预措施，结合适度的参与策略，与传统的治疗提供方法相比是一个显著的变化，有可能在出院后延长治疗收益。当前方法的创新方面包括其时机、使用新的参与战略、面对面和计算机提供的内容相结合，以及侧重于假定的调解人。这一方法有可能通过以下方式促进公共卫生：满足高需求人群；针对已被证明影响ASUD结果的育儿做法(被认为是变化的调解人)；在关键治疗关键时刻与父母合作；改善父母的参与度和获得护理的机会，以及增加传播和实施的便利性。

 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.