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Braciszewski JM, Colby SM, Franklin MJ, Stout RL, Vose-O'Neal A, Bock BC. Technology-Based Smoking Cessation for Youth Exiting Foster Care: A Pilot Randomized Trial. JOURNAL OF PUBLIC CHILD WELFARE 2022; 18:61-79. [PMID: 38144460 PMCID: PMC10746146 DOI: 10.1080/15548732.2022.2155754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/28/2022] [Indexed: 12/26/2023]
Abstract
Despite high rates of cigarette use, little attention has been paid to screening and cessation services for youth in foster care. Study aims were to test the feasibility, acceptability, and preliminary efficacy of a technology-based smoking cessation intervention. Study enrollment, satisfaction, and engagement were high in the intervention arm, where readiness to change also significantly increased over time. Intervention and control participants significantly reduced cigarette use at 6-month follow up, though groups did not differ. Technology-based interventions appear to be attractive and offer a potentially scalable link to health care that this vulnerable population may not otherwise seek.
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Affiliation(s)
| | | | | | - Robert L Stout
- Pacific Institute for Research and Evaluation, Calverton, MD
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Colonna R, Alvarez L. Characteristics of mobile-based brief interventions targeting substance use among youth: a rapid review. JOURNAL OF SUBSTANCE USE 2022. [DOI: 10.1080/14659891.2022.2051622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Robert Colonna
- Health and Rehabilitation Sciences Graduate Program, Western University, London, Ontario, Canada
| | - Liliana Alvarez
- School of Occupational Therapy, Western University, London, Ontario, Canada
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Long-term benefits of providing transitional services to youth aging-out of the child welfare system: Evidence from a cohort of young people who use drugs in Vancouver, Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 85:102912. [PMID: 32889145 DOI: 10.1016/j.drugpo.2020.102912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 07/30/2020] [Accepted: 08/09/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Youth aging-out of the child welfare system (CWS) experience numerous vulnerabilities including, elevated rates of substance use and substance use disorders. Calls to improve services to transition youth to independence are common; however, evidence of the long-term impacts associated with transitional service utilization is scarce. Further, existing services frequently lack appropriate supports for substance using youth and it is unknown if youth are able to access such services. In the present study, we assess the relationship between transitional service utilization and health and social outcomes among a cohort of people who use drugs (PWUD) that aged-out of the CWS. METHODS Data were obtained from two harmonized cohorts of PWUD in Vancouver, Canada. Those who reported aging-out were asked about service utilization, availability, barriers, and interest across seven categories of transitional services. Multivariable logistic regression analyses were conducted to assess the relationship between having previously utilized transitional services and current health and social outcomes. RESULTS Between December 2014 and November 2017, 217 PWUD reported having previously aged-out of the CWS. Across service categories, reported service utilization prevalence ranged from 16.6-61.8% while unmet demand ranged from 64.8-78.4%. In multivariable analyses, compared to individuals who utilized ≤1 service while aging-out, having utilized 4-7 services was significantly associated with reduced odds of current homelessness (adjusted odds ratio [AOR]=0.29) and engaging in daily drug use (AOR=0.35) (both p<0.05). CONCLUSION Findings suggest that this understudied high-risk population of PWUD and aged-out of the CWS experience long-term benefits associated with transitional service utilization and are interested and willing to engage in these services. However, given high unmet demand, findings also highlight considerable gaps in service delivery and support calls for extending the age of emancipation for all youth in the CWS and in particular, for additional harm reduction and substance use supports embedded into service models.
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Blanco C, Wiley TRA, Lloyd JJ, Lopez MF, Volkow ND. America's opioid crisis: the need for an integrated public health approach. Transl Psychiatry 2020; 10:167. [PMID: 32522999 PMCID: PMC7286889 DOI: 10.1038/s41398-020-0847-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 02/28/2020] [Accepted: 05/13/2020] [Indexed: 12/12/2022] Open
Abstract
Continued increases in overdose deaths and recent declines in life expectancy call for need to adopt comprehensive public health approaches to the United States opioid crisis and to establish an infrastructure to avert future crises. Successfully addressing the challenges posed by the crisis requires a translational, integrated approach that combines the contribution of neuroscience, pharmacology, epidemiology, treatment services and prevention. It also is critical to integrate interventions across settings, including healthcare, justice, education and social service systems. This review highlights four interconnected themes: (1) social determinants of health and disease; (2) person-centered approaches for prevention and treatment; (3) bridging the gap between implementation science and practice; and (4) using data to build learning systems of care, relevant to public health approaches to address the opioid crisis. We discuss how across these four themes taking into account the influence of developmental factors on brain function and sensitivity to environmental stimuli including drugs, addressing the complex interactions between biological and social factors, and promoting an ongoing dialogue across disciplines and settings will help accelerate public health advances that are evidenced based and sustainable to address the current opioid crisis and avert future ones.
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Affiliation(s)
- Carlos Blanco
- National Institute on Drug Abuse, Bethesda, MD, 20892, USA.
| | | | | | - Marsha F Lopez
- National Institute on Drug Abuse, Bethesda, MD, 20892, USA
| | - Nora D Volkow
- National Institute on Drug Abuse, Bethesda, MD, 20892, USA
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Former Foster System Youth: Perspectives on Transitional Supports and Programs. J Behav Health Serv Res 2020; 48:287-305. [PMID: 32095998 DOI: 10.1007/s11414-020-09693-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Youth aging out of the foster care system have well-documented challenges when transitioning to adulthood. Multiple transition services provide support in the transition process; however, limited research is available regarding youth's perceptions of programming. In this pilot study, sixteen youth between ages 18 and 20 participated in semi-structured interviews, support mapping, and resiliency measurements to gather the experiences of the transition from foster care. Comparisons between those who chose initial transition supports and those who did not receive or delayed receiving transition supports were initially explored. Common themes emerged in participants' needs and perceived resiliency regardless of transition support services. All youth reported relationship, trust, and concern for well-being as highly important characteristics in transition team members. A need for earlier transition programming, decision-making opportunities, and life skills courses were important themes in transition programming needs. Implications for policy, research, and practice are presented based upon findings.
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Armstrong-Heimsoth A, Hahn-Floyd M, Williamson HJ, Lockmiller C. Toward a Defined Role for Occupational Therapy in Foster Care Transition Programming. THE OPEN JOURNAL OF OCCUPATIONAL THERAPY 2020; 8:13. [PMID: 33101787 PMCID: PMC7584147 DOI: 10.15453/2168-6408.1726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Youth who age out of the foster care system and transition to adulthood face challenges that are exacerbated by a history of trauma, severed relationships, and instability of living and educational placements. A review of the literature demonstrates poor outcomes overall for this population. Occupational therapists are positioned to meet the needs that arise during this time; however, a review of emerging roles for occupational therapists is necessary to describe how occupational therapists can best fulfill gaps in current programming. Through a review of the literature and a preliminary mixed-methods study, this paper establishes a direction for the inclusion of occupational therapy for youth aging out of foster care using the Person Environment Occupation Performance (PEOP) model as a structure. Federal, state, and local organizations provide resources to assist transitioning foster youth. However, there is a lack of collaborative, individualized, and evidence-based approaches reporting good outcomes. Specific occupational therapy interventions are suggested to delineate our role with this high-risk population during transition to independent living: both novel interventions and additions to current evidence-based programming.
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Deutsch C, Bock BC, Lantini R, Walaska K, Rosen RK, Fava JL, Jennings EG, Foster R, Flanagan W. A text message delivered smoking cessation intervention: Design and rationale of the Text My Quit Study. Contemp Clin Trials 2019; 81:19-27. [PMID: 30999058 PMCID: PMC6550345 DOI: 10.1016/j.cct.2019.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 04/05/2019] [Accepted: 04/13/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Smoking cessation interventions delivered through mobile technologies offer promise as an effective intervention tool. However, most existing programs have not been empirically tested, were not developed with end-user participation, and/or do not address evidence-based cognitive and behavioral variables shown to enhance smoking cessation in clinical trials. In addition, many programs tested in research trials have required users to access the internet and/or a smartphone app to access all program features, limiting the potential reach of those programs. METHODS/DESIGN This study is a randomized controlled trial testing the efficacy of the TMQ intervention for smoking cessation. All participants are randomly assigned to receive 12 weeks of either; (1) a tailored smoking-cessation intervention delivered 100% through text messaging (TMQ), or (2) non-smoking-related text messages serving as a control for contact and subject burden (Mojo). Assessments are conducted at baseline, 3- and 6-month follow-up. The primary outcome is prolonged abstinence using an intent-to-treat approach. To understand why TMQ may be more effective than Mojo, we will test several posited mechanisms of action (i.e., mediators) that may underlie intervention efficacy and will examine use of the TMQ integrated social support (ISS) network. At the end of treatment, semi-structured interviews will be conducted with TMQ participants. CONCLUSIONS This study will provide a rigorous test of an innovative smoking cessation program delivered 100% through text messages. Use of mixed methodologies will provide the opportunity to enhance our understanding of the user's experience with TMQ and identify areas for future enhancement and/or expansion.
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Affiliation(s)
| | - Beth C Bock
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, United States; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States
| | - Ryan Lantini
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, United States.
| | - Kristen Walaska
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, United States
| | - Rochelle K Rosen
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, United States; Department of Behavioral and Social Sciences, School of Public Health of Brown University, Providence, RI, United States
| | - Joseph L Fava
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, United States
| | - Ernestine G Jennings
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, United States; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States
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Braciszewski JM, Tzilos Wernette GK, Moore RS, Bock BC, Stout RL, Chamberlain P. A Pilot Randomized Controlled Trial of a Technology-Based Substance Use Intervention for Youth Exiting Foster Care. CHILDREN AND YOUTH SERVICES REVIEW 2018; 94:466-476. [PMID: 31435121 PMCID: PMC6703817 DOI: 10.1016/j.childyouth.2018.08.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Youth exiting foster care represent a unique, at-risk population in that they receive supportive health services while under the umbrella of the foster care system, but access to care can drop precipitously upon release from foster custody. Traditional means of substance use treatment may not meet the needs of this vulnerable population. Mobile interventions, however, have demonstrated high acceptability and efficacy across a range of mental and physical health issues. The specific advantages to mobile interventions dovetail well with the barriers faced by youth exiting foster care. This study describes the feasibility, acceptability, and initial efficacy of iHeLP, a computer- and mobile phone-based intervention based in Motivational Interviewing for reducing substance use among youth exiting foster care (n = 33). Participants were randomly assigned to either iHeLP or a contact control, each of which lasted six months. Feasibility was evaluated through eligibility and enrollment rates at baseline, and retention and intervention reach rates 3, 6, 9, and 12 months later. Acceptability was measured through a 5-item satisfaction measure and exit interviews. The two groups were then compared on a monthly measure of substance use. Study enrollment, retention, response rate, engagement, and satisfaction were all very good. Participants receiving iHeLP reported higher percent days abstinent than the control group, with effect sizes ranging from 0.32 to 0.62. Technology-based interventions such as iHeLP may be attractive to this population and support efforts towards reductions in substance use.
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Affiliation(s)
- Jordan M Braciszewski
- Center for Health Policy and Health Services Research, Henry Ford Health System, 1 Ford Place, Suite 3A, Detroit, MI, USA 48202,
| | - Golfo K Tzilos Wernette
- Department of Family Medicine, University of Michigan Medical School, 1018 Fuller St., Ann Arbor, MI, USA 48104,
| | - Roland S Moore
- Prevention Research Center, Pacific Institute for Research and Evaluation, 180 Grand Avenue Suite 1200, Oakland, CA 94612,
| | - Beth C Bock
- The Miriam Hospital, 167 Point St., Suite 1B, Providence, RI 02903,
| | - Robert L Stout
- Decision Sciences Institute, Pacific Institute for Research and Evaluation, 1005 Main St., Suite 8210, Pawtucket, RI 02860,
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Abstract
PURPOSE OF REVIEW Mental health clinicians should understand how technologies augment, enhance, and provide alternate means for the delivery of mental healthcare. These technologies can be used asynchronously, in which the patient and the clinician need not be communicating at the same time. This contrasts with synchronous technologies, in which patient and clinician must communicate at the same time. RECENT FINDINGS The review is based on research literature and the authors' clinical and healthcare administration experiences. Asynchronous technologies can exist between a single clinician and a single patient, such as patient portal e-mail and messaging, in-app messaging, asynchronous telepsychiatry via store-and-forward video, and specialty patient-to-provider mobile apps. Asynchronous technologies have already been used in different countries with success, and can alleviate the psychiatric workforce shortage and improve barriers to access. Multiple studies referred to in this review demonstrate good retention and acceptability of asynchronous psychotherapy interventions by patients. Asynchronous technologies can alleviate access barriers, such as geographical, scheduling, administrative, and financial issues. It is important for clinicians to understand the efficacy, assess the ethics, and manage privacy and legal concerns that may arise from using asynchronous technologies.
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