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

 描述（由申请人提供）：住院治疗的青少年物质使用障碍（ASUD）具有最严重的物质使用障碍和最高的心理，动机，行为，法律的，环境和职业问题。住院治疗的ASUD也有极高的复发风险，随访研究表明， 60%的ASUD会在出院后的前90天内复发。父母的做法已被确定为对青少年开始和维持药物使用及其药物使用结果和复发可能性的关键影响。然而，治疗ASUD的治疗师报告了无数的系统性障碍，使父母参与治疗。诸如此类的调查结果认为，ASUD在住院治疗的高度优先人群，并主张在这一关键时期容易获得的育儿干预措施的价值。拟议的研究评估一个潜在的低成本，低强度的模式，提供父母的育儿技巧，为他们的青少年的出院准备从住宅物质使用治疗。具体而言，该项目涉及适应提供一个计算机化的育儿干预（育儿明智; PW），有初步证据表明，有效地提高育儿技能，减少青年行为问题。本研究调整了PW在新人群（准备出院的ASUD父母）和新环境（住院治疗）中的应用，并获得了其可行性、可接受性和有效性的初始数据。首先，一项有10名父母的开放试验将调整PW的交付，以包括与该人群相关的适度参与策略。根据焦点小组和对13名家长、11名ASUD和3名工作人员的访谈，制定了初步参与战略，包括在出院前开始的多达6次个性化辅导（纳入长期家庭预约时间）和使用技术（例如，短信和在线家长留言板），以保持员工和家长之间的联系出院后。其次，一项包含60名父母的随机试验将在住院治疗中心比较适应性PW加常规治疗（TAU）条件（PW+TAU）与仅TAU。这两种治疗条件将由硕士级社区临床医生提供。使用低成本、低强度的干预措施与适度的参与策略相结合，代表了传统治疗方法的显著变化，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，使用新颖的参与策略，结合人和计算机交付的内容，并专注于假定的调解人。该方法有可能通过以下方式促进公共卫生：解决高需求人群;针对已被证明会影响ASUD结果的育儿实践（假定的变化媒介）;在关键治疗时刻与父母合作;改善父母的参与和获得护理，并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.