Abstract
BackgroundAdolescents in residential substance use disorder (SUD) treatment have poor outcomes post-discharge, with follow-up studies suggesting that most adolescents relapse within 90 days. Parenting practices directly influence adolescent SUD outcomes, but parents of adolescents with SUDs are difficult to engage in traditional behavioral treatments. The current study adapts and evaluates a technology-assisted intervention for parents of adolescents in residential SUD treatment. Based on pilot qualitative data with parents, adolescents, and residential staff, we augment an existing computerized intervention (Parenting Wisely; PW) with four in-person coaching sessions, personalized text messages, and an expert-moderated online parent message board. We hypothesize that parents will find enhanced PW (PW+) both feasible and acceptable, and that adolescents whose parents receive PW+ will have better post-discharge outcomes than adolescents who receive standard care (SC) only.Methods/designA two phase approach is used to adapt and evaluate PW+. Phase 1 consists of an open trial with 10 parents of adolescents (age 12–17) in residential SUD treatment. Post-discharge qualitative and quantitative data from parents and adolescents will support PW+ refinement. Phase 2 is a randomized pilot trial with 60 parents testing the effectiveness of adding PW+ to SC. Adolescents and parents will complete assessments at baseline, 6-, 12-, and 24-weeks post-discharge. Primary outcomes will be measures of feasibility and acceptability. Secondary outcomes will include adolescent substance use, truancy, high-risk sexual behavior, and criminal involvement. Two parenting processes (monitoring and communication) are examined as potential mediators of change.DiscussionThis study will adapt and evaluate a technology-assisted parenting intervention as a means of improving adolescent outcomes following residential SUD treatment. Results have the potential to advance the field by: addressing a high-risk population, improving parental engagement; targeting parenting practices (putative mediators of change) that have been linked to adolescent outcomes; and developing a highly disseminable approach.
Highlights
Adolescents in residential substance use disorder (SUD) treatment have poor outcomes post-discharge, with follow-up studies suggesting that most adolescents relapse within 90 days
Results have the potential to advance the field by: addressing a high-risk population, improving parental engagement; targeting parenting practices that have been linked to adolescent outcomes; and developing a highly disseminable approach
In order to reinforce usage of Parenting Wisely (PW) and the online parent board, parents will receive two text messages weekly containing links to videos of parenting skills, messages of encouragement, and links to the online message board. Such supports are designed to sustain parental engagement, reinforce important parenting skills, and provide easier access to a treatment provider during a time when adolescents are at high risk of negative outcomes, but parents reported it was especially difficult to attend in-person sessions
Summary
Adolescents in residential substance use disorder (SUD) treatment have poor outcomes post-discharge, with follow-up studies suggesting that most adolescents relapse within 90 days. Despite such high relapse rates, the majority of adolescents in residential treatment either do not link to or only participate minimally in continuing care after discharge [7, 8] In recognition of these challenges, a review of the continuing care literature [9] advised treatment developers to supplement or replace traditional clinic-based approaches with new service delivery approaches that are of lower burden and greater convenience, and that facilitate sustained contact with the patient for an extended period of time. Consistent with these recommendations, this study aims to adapt and evaluate a flexible, low cost, low intensity treatment model for parents preparing for their teen’s discharge from residential treatment. This body of research provides justification for: (1) working with the parents of adolescents in residential treatment for SUDs and (2) for targeting parenting skills as a potential mechanism of change in adolescent SUD treatment outcome
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