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Wells M, Kelly PJ, Robson D, Haynes C, Hatton E, Larance B. Systematic review of treatment completion rates and correlates among young people accessing alcohol and other drug treatment. Drug Alcohol Depend 2024; 262:111376. [PMID: 38971027 DOI: 10.1016/j.drugalcdep.2024.111376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 06/16/2024] [Accepted: 06/18/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND AND AIMS Treatment completion is associated with improved alcohol and other drug (AOD) treatment outcomes. Unfortunately, treatment disengagement is common, particularly among young people. We reviewed and synthesised research on AOD treatment completion and/or early disengagement among young people. METHODS We conducted a systematic review and meta-analysis of studies reporting on completion rates and/or early disengagement from psychosocial AOD treatment among adolescents and young adults. An overall estimated treatment completion rate was calculated using inverse-variance random effects meta-analysis, and random-effects meta-regression was used to identify between-study level moderators of completion rate. We completed a narrative review summarising literature on early treatment disengagement and within-study level correlates of treatment completion. Study quality was assessed using the EPHPP. RESULTS Of the 6158 studies screened, we retained 410 for full text review and included 98 studies in the review. Treatment completion rates were reported in 88 studies, and early disengagement rates were reported in 13. The estimated overall treatment completion rate was 59 % (95 % CI=57-61 %), with experimental studies reporting higher rates of completion than observational studies. There was limited evidence for demographic or substance-related correlates of treatment completion. Contingency management was associated with increased completion rates, as was family-based intervention. CONCLUSIONS Disengagement from AOD treatment among youth populations is common and contributes to poor treatment outcomes. Existing research has yielded little consensus on the factors associated with treatment completion. The use of contingency management strategies and involving family/social supports in treatment were identified as potential avenues for promoting ongoing treatment engagement.
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Affiliation(s)
- Megan Wells
- School of Psychology, University of Wollongong, Australia.
| | - Peter J Kelly
- School of Psychology, University of Wollongong, Australia
| | - Davina Robson
- School of Psychology, University of Wollongong, Australia; School of Education, Faculty of Arts, Design and Architecture, University of New South Wales, Australia
| | - Chloe Haynes
- School of Psychology, University of Wollongong, Australia
| | - Emma Hatton
- School of Psychology, University of Wollongong, Australia
| | - Briony Larance
- School of Psychology, University of Wollongong, Australia; National Drug and Alcohol Research Centre, University of New South Wales, Australia
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Meisel SN, Pielech M, Magill M, Sawyer K, Miranda R. Mechanisms of Behavior Change in Adolescent Substance Use Treatment: A Systematic Review of Treatment Mediators and Recommendations for Advancing Future Research. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2024; 31:154-173. [PMID: 38883554 PMCID: PMC11178260 DOI: 10.1037/cps0000089] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Substance use disorders commonly onset during adolescence, yet the best available treatments yield only modest and transient effects. Elucidating treatment mediators is essential for improving treatment options. This review summarizes over 20 years of research on mediators of adolescent substance use treatment; k = 17 studies assessing both treatment or treatment ingredient to mediator (a path) and mediator to treatment outcome (b path) paths were included. Mediators were categorized using the Science of Behavior Change target class framework. Overall, mediation tests supported four of eight self-regulation, two of 10 stress resilience and reactivity, six of 19 interpersonal and social process, and two of four treatment engagement and adherence mediators. To enhance the capacity of this work to inform clinical practice, we recommend future research examine theoretically informed mechanisms using temporally sequenced data among other methodological guidelines.
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Affiliation(s)
- Samuel N. Meisel
- Center for Alcohol and Addiction Studies, Brown University
- E. P. Bradley Hospital, Riverside, Rhode Island, United States
| | | | - Molly Magill
- Center for Alcohol and Addiction Studies, Brown University
| | - Kelsey Sawyer
- Center for Alcohol and Addiction Studies, Brown University
| | - Robert Miranda
- Center for Alcohol and Addiction Studies, Brown University
- E. P. Bradley Hospital, Riverside, Rhode Island, United States
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3
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Pielech M, Modrowski C, Yeh J, Clark MA, Marshall BDL, Beaudoin FL, Becker SJ, Miranda R. Provider perceptions of systems-level barriers and facilitators to utilizing family-based treatment approaches in adolescent and young adult opioid use disorder treatment. Addict Sci Clin Pract 2024; 19:20. [PMID: 38515214 PMCID: PMC10958911 DOI: 10.1186/s13722-024-00437-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 01/05/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Amidst increasing opioid-related fatalities in adolescents and young adults (AYA), there is an urgent need to enhance the quality and availability of developmentally appropriate, evidence-based treatments for opioid use disorder (OUD) and improve youth engagement in treatment. Involving families in treatment planning and therapy augments medication-based OUD treatment for AYA by increasing treatment engagement and retention. Yet, uptake of family-involved treatment for OUD remains low. This study examined systems-level barriers and facilitators to integrating families in AYA OUD treatment in Rhode Island. METHODS An online survey was administered to clinic leaders and direct care providers who work with AYA in programs that provide medication and psychosocial treatments for OUD. The survey assessed attitudes towards and experiences with family-based treatment, barriers and facilitators to family-based treatment utilization, as well as other available treatment services for AYA and family members. Findings were summarized using descriptive statistics. RESULTS A total of 104 respondents from 14 distinct treatment programs completed the survey. Most identified as White (72.5%), female (72.7%), and between 25 and 44 years of age (59.4%). Over half (54.1%) of respondents reported no experience with family based treatment and limited current opportunities to involve families. Barriers perceived as most impactful to adopting family-based treatment were related to limited available resources (i.e. for staff training, program expansion) and lack of prioritization of family-based treatment in staff productivity requirements. Barriers perceived as least impactful were respondent beliefs and attitudes about family-based treatment (e.g., perception of the evidence strength and quality of family-based treatment, interest in implementing family-based treatment) as well as leadership support of family-based treatment approaches. Respondents identified several other gaps in availability of comprehensive treatment services, especially for adolescents (e.g. services that increase social recovery capital). CONCLUSIONS Family-based treatment opportunities for AYA with OUD in Rhode Island are limited. Affordable and accessible training programs are needed to increase provider familiarity and competency with family-based treatment. Implementation of programming to increase family involvement in treatment (i.e. psychoeducational and skills-based groups for family members) rather than adopting a family-based treatment model may be a more feasible step to better meet the needs of AYA with OUD. TRIAL REGISTRATION not applicable.
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Affiliation(s)
- Melissa Pielech
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, 02912, USA.
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA.
| | - Crosby Modrowski
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, 02912, USA
- Bradley Hasbro Children's Research Center, Providence, RI, USA
| | - Jasper Yeh
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA
| | - Melissa A Clark
- Department of Health Services Policy & Practice, Brown University School of Public Health, Providence, RI, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Francesca L Beaudoin
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Sara J Becker
- Center for Dissemination and Implementation Science, Feinberg School of Medicine of Northwestern University, Chicago, IL, USA
| | - Robert Miranda
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, 02912, USA
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA
- E. P. Bradley Hospital, Riverside, RI, USA
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Beckmann EA, Pielech M, Parent J. Clinical considerations for adolescents with eating disorders who use nicotine. BROWN UNIVERSITY CHILD AND ADOLESCENT BEHAVIOR LETTER 2024; 40:1-6. [PMID: 38831916 PMCID: PMC11146581 DOI: 10.1002/cbl.30764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
Adolescence is a developmental period in which individuals demonstrate increased likelihood of engaging in disordered eating and risk‐taking behaviors, such as substance use. Nicotine use, in particular, (e.g., via vaping, combustible cigarettes, smokeless tobacco) is pervasive among middle and high school students. In 2022, 17.4% of middle school and high school students reported current nicotine vaping. Daily use of nicotine was reported among 27.6% of current users (Cooper et al., 2022). Research posits that eating disorders and nicotine use are highly comorbid. A recent study by Ganson and Nagata (2021) found that nearly 20% of participating adolescents with an eating disorder also used nicotine within the past 30 days. This is problematic, as nicotine use increases the mortality rate for eating disorders, which already has the second highest rate of all mental health disorders. Nicotine use may also exacerbate many of the medical complications associated with eating disorders (e.g., neuroendocrinal, dental, nutritional) and negatively impact eating disorder recovery (Ganson & Nagata, 2021).
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Affiliation(s)
| | - Melissa Pielech
- departments of Psychiatry and Human Behavior (Warren Alpert Medical School) and Behavioral and Social Sciences (School of Public Health) at Brown University
| | - Justin Parent
- University of Rhode Island; Warren Alpert Medical School of Brown University
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Meisel SN, Boness CL, Miranda R, Witkiewitz K. Beyond mediators: A critical review and methodological path forward for studying mechanisms in alcohol use treatment research. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:215-229. [PMID: 38099412 PMCID: PMC10922633 DOI: 10.1111/acer.15242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/14/2023] [Accepted: 12/05/2023] [Indexed: 12/29/2023]
Abstract
Understanding how treatments for alcohol use disorder (AUD) facilitate behavior change has long been recognized as an important area of research for advancing clinical care. However, despite decades of research, the specific mechanisms of change for most AUD treatments remain largely unknown because most prior work in the field has focused only on statistical mediation. Statistical mediation is a necessary but not sufficient condition to establish evidence for a mechanism of change. Mediators are intermediate variables that account statistically for the relationship between independent and dependent variables, whereas mechanisms provide more detailed explanations of how an intervention leads to a desired outcome. Thus, mediators and mechanisms are not equivalent. To advance mechanisms of behavior change research, in this critical review we provide an overview of methodological shortfalls of existing AUD treatment mechanism research and introduce an etiologically informed precision medicine approach that facilitates the testing of mechanisms of behavior change rather than treatment mediators. We propose a framework for studying mechanisms in alcohol treatment research that promises to facilitate our understanding of behavior change and precision medicine (i.e., for whom a given mechanism of behavior change operates and under what conditions). The framework presented in this review has several overarching goals, one of which is to provide a methodological roadmap for testing AUD recovery mechanisms. We provide two examples of our framework, one pharmacological and one behavioral, to facilitate future efforts to implement this methodological approach to mechanism research. The framework proposed in this critical review facilitates the alignment of AUD treatment mechanism research with current theories of etiologic mechanisms, precision medicine efforts, and cross-disciplinary approaches to testing mechanisms. Although no framework can address all the challenges related to mechanisms research, our goal is to help facilitate a shift toward more rigorous and falsifiable behavior change research.
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Affiliation(s)
| | | | - Robert Miranda
- E. P. Bradley Hospital, Riverside, RI USA
- Department of Psychiatry & Human Behavior, Brown University, Providence, RI USA
| | - Katie Witkiewitz
- Center on Alcohol, Substance use, And Addictions, University of New Mexico
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Hogue A, Bobek M, MacLean A, Schumm JA, Wenzel K, Fishman M. Relationship-Oriented Recovery System for Youth (RORSY): Clinical Protocol for Transition-Age Youth with Opioid Use Disorders. HSOA JOURNAL OF ADDICTION & ADDICTIVE DISORDERS 2023; 10:144. [PMID: 38707487 PMCID: PMC11068080 DOI: 10.24966/aad-7276/100144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
This article introduces the Relationship-Oriented Recovery System for Youth (RORSY) protocol, which is designed to increase uptake of Medications for Opioid Use Disorder (MOUD) and related services among adolescents and young adults. Youth exhibit alarmingly poor rates of MOUD initiation and adherence, OUD services involvement and long-term recovery success. RORSY attends to three developmentally unique recovery needs of this age group: assess and bolster youth recovery capital, prioritize involvement of concerned significant others, and use digital direct-to-consumer recovery supports. RORSY contains five evidence-informed intervention modules that can be flexibly tailored to meet the individual and relationship needs of a given youth: Relational Orientation, Youth Recovery Management Planning, Relational Recovery Management Planning, Relationship Skills Building, and Digital Recovery Support Planning. The article concludes with practice and policy recommendations for making relationship-building a top clinical priority for addressing youth OUD.
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Affiliation(s)
| | | | | | - Jeremiah A Schumm
- OneFifteen, Inc./Samaritan Behavioral Health, Inc., Wright
State University, Dayton, USA
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Metz K, Lewis J, Mitchell J, Chakraborty S, McLeod BD, Bjørndal L, Mildon R, Shlonsky A. Problem-solving interventions and depression among adolescents and young adults: A systematic review of the effectiveness of problem-solving interventions in preventing or treating depression. PLoS One 2023; 18:e0285949. [PMID: 37643196 PMCID: PMC10464969 DOI: 10.1371/journal.pone.0285949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 05/04/2023] [Indexed: 08/31/2023] Open
Abstract
Problem-solving (PS) has been identified as a therapeutic technique found in multiple evidence-based treatments for depression. To further understand for whom and how this intervention works, we undertook a systematic review of the evidence for PS's effectiveness in preventing and treating depression among adolescents and young adults. We searched electronic databases (PsycINFO, Medline, and Cochrane Library) for studies published between 2000 and 2022. Studies meeting the following criteria were included: (a) the intervention was described by authors as a PS intervention or including PS; (b) the intervention was used to treat or prevent depression; (c) mean or median age between 13-25 years; (d) at least one depression outcome was reported. Risk of bias of included studies was assessed using the Cochrane Risk of Bias 2.0 tool. A narrative synthesis was undertaken given the high level of heterogeneity in study variables. Twenty-five out of 874 studies met inclusion criteria. The interventions studied were heterogeneous in population, intervention, modality, comparison condition, study design, and outcome. Twelve studies focused purely on PS; 13 used PS as part of a more comprehensive intervention. Eleven studies found positive effects in reducing depressive symptoms and two in reducing suicidality. There was little evidence that the intervention impacted PS skills or that PS skills acted as a mediator or moderator of effects on depression. There is mixed evidence about the effectiveness of PS as a prevention and treatment of depression among AYA. Our findings indicate that pure PS interventions to treat clinical depression have the strongest evidence, while pure PS interventions used to prevent or treat sub-clinical depression and PS as part of a more comprehensive intervention show mixed results. Possible explanations for limited effectiveness are discussed, including missing outcome bias, variability in quality, dosage, and fidelity monitoring; small sample sizes and short follow-up periods.
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Affiliation(s)
- Kristina Metz
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
| | - Jane Lewis
- Centre for Evidence and Implementation, London, United Kingdom
| | - Jade Mitchell
- Centre for Evidence and Implementation, London, United Kingdom
| | | | - Bryce D. McLeod
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Ludvig Bjørndal
- Centre for Evidence and Implementation, London, United Kingdom
| | - Robyn Mildon
- Centre for Evidence and Implementation, Melbourne, Victoria, Australia
| | - Aron Shlonsky
- Department of Social Work, Monash University, Melbourne, Victoria, Australia
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8
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Hogue A, Bobek M, Porter N, Dauber S, Southam-Gerow MA, McLeod BD, Henderson CE. Core Elements of Family Therapy for Adolescent Behavioral Health Problems: Validity Generalization in Community Settings. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023; 52:490-502. [PMID: 34519608 PMCID: PMC8918434 DOI: 10.1080/15374416.2021.1969939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The core elements of family therapy for adolescent mental health and substance use problems, originally distilled from high-fidelity sessions conducted by expert clinicians, were tested for validity generalization when delivered by community therapists in routine settings. METHOD The study sampled recorded sessions from 161 cases participating in one of three treatment pools: implementation trial of Functional Family Therapy (98 sessions/50 cases/22 therapists), adaptation trial of Multisystemic Therapy (115 sessions/59 cases/2 therapists), and naturalistic trial of non-manualized family therapy in usual care (107 sessions/52 cases/21 therapists). Adolescents were identified as 60% male and 40% female with an average age of 15.4 years; 49% were Latinx, 27% White Non-Latinx, 15% African American, 3% another race/ethnicity, 6% race/ethnicity unknown. Session recordings (n = 320) were randomly selected for each case and coded for 21 discrete family therapy techniques. Archived data of one-year clinical outcomes were gathered. RESULTS Confirmatory factor analyses replicated the factor structure from the original distillation study, retaining all four clinically coherent treatment modules comprised of all 21 techniques: Interactional Change (ICC = .77, Cronbach's α = .81); Relational Reframe (ICC = .75, α = .81); Adolescent Engagement (ICC = .72, α = .78); Relational Emphasis (ICC = .76, α = .80). Exploratory analyses found that greater use of core techniques predicted symptom improvements in one treatment pool. CONCLUSIONS Core techniques of family therapy distilled from manualized treatments for adolescent behavioral health problems showed strong evidence of validity generalization, and initial evidence of links to client outcomes, in community settings.
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Affiliation(s)
- Aaron Hogue
- Partnership to End Addiction, 485 Lexington Avenue, 3 floor, New York, NY 10017, USA
| | - Molly Bobek
- Partnership to End Addiction, 485 Lexington Avenue, 3 floor, New York, NY 10017, USA
| | - Nicole Porter
- Partnership to End Addiction, 485 Lexington Avenue, 3 floor, New York, NY 10017, USA
| | - Sarah Dauber
- Partnership to End Addiction, 485 Lexington Avenue, 3 floor, New York, NY 10017, USA
| | | | | | - Craig E. Henderson
- Department of Psychology, Sam Houston State University, Huntsville, TX, USA
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9
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Porter NP, Hogue A, Bobek M, Henderson CE. Caregiver Engagement in Outpatient Treatment for Adolescents in Community Settings: Construct and Predictive Validity of Family Therapy Techniques. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023:10.1007/s10488-023-01272-z. [PMID: 37178423 DOI: 10.1007/s10488-023-01272-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2023] [Indexed: 05/15/2023]
Abstract
Caregiver engagement and participation in community-based outpatient treatment services for adolescents is generally poor, which is problematic given the integral role of caregivers prescribed by evidence-based treatments across orientations. The current study explores the psychometric and predictive properties of a set of caregiver engagement techniques distilled from family therapy, used by community clinicians in routine care. It highlights relational engagement interventions and adds to growing work distilling core elements of family therapy. The study examined caregiver engagement techniques observed in 320 recorded sessions and outcome data from 152 cases treated by 45 therapists participating in one of three randomized trials investigating delivery of family therapy for adolescent behavior problems in community settings. Construct and predictive validity of caregiver engagement coding items were analyzed to understand the degree to which they cohered as a single factor and predicted outcomes in predictable ways. Results demonstrated item reliability and construct validity of a Caregiver Engagement Techniques factor. Greater use of these techniques was associated with decreased adolescent substance use. Unexpected results suggested greater use of techniques was associated with worsening internalizing symptoms and family cohesion per youth-report only. Post-hoc analyses revealed additional complexities in the association between engagement techniques and outcomes. Caregiver engagement practices tested in the current study represent a unified treatment factor that may contribute to positive therapeutic outcomes for adolescents in some clinical domains. Further research is needed to understand predictive effects.
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Affiliation(s)
- Nicole P Porter
- Family and Adolescent Clinical Technology and Science, Partnership to End Addiction, New York, NY, USA.
- McLean Hospital and Department of Psychiatry, Harvard Medical School, 115 Mill Street, Belmont, MA, 02478, USA.
| | - Aaron Hogue
- Family and Adolescent Clinical Technology and Science, Partnership to End Addiction, New York, NY, USA
| | - Molly Bobek
- Family and Adolescent Clinical Technology and Science, Partnership to End Addiction, New York, NY, USA
| | - Craig E Henderson
- Department of Psychology, Sam Houston State University, Huntsville, TX, USA
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10
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Pavlov RO, Andreescu V. Gender-based differences in abstention and desistance from drug use among American Indian adolescents. J Ethn Subst Abuse 2023:1-39. [PMID: 36877014 DOI: 10.1080/15332640.2023.2185335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
Informed by the social control theoretical perspective, this study intends to identify the factors more likely to differentiate American Indian (AI) adolescents who never used illicit drugs (abstainers) and those who used drugs in the past but did not report recent drug usage (desisters) from their peers who reported lifetime and recent drug usage (persisters). This secondary analysis is based on data from a multi-site study conducted between 2009 and 2013. It is based on a gender-balanced sample (N = 3,380) of AI adolescents (50.50% male; Mean age = 14.75; SD = 1.69) representing the major AI languages and cultural groups in the U.S. Half of the AI adolescents reported lifetime drug use (50.40%), 37.50% never used drugs, and 12.10% stopped using drugs. When controlling for the variables included in the analysis, AI boys were significantly more likely than AI girls to desist from drug use. Both boys and girls who never used drugs tended to be younger, were less likely to have delinquent friends and a lower level of self-control, had stronger bonds to school, but lower levels of family attachment, and reported increased parental supervision. Compared to drug users, desisters associated significantly less with delinquent peers. While school attachment, self-control, and parental monitoring did not differentiate female desisters from female drug users, adolescent boys who desisted from drug use were more likely to report higher levels of school attachment and parental monitoring and their level of self-control was less likely to be low.
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Affiliation(s)
- Ruben O Pavlov
- Department of Criminal Justice, University of Louisville, Louisville, Kentucky
| | - Viviana Andreescu
- Department of Criminal Justice, University of Louisville, Louisville, Kentucky
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11
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Hogue A, Bobek M, Porter N, MacLean A, Wenzel K, Fishman M, Coatsworth JD, Langer DA. Launching Relationship-Oriented Behavioral Services for Youth Opioid Use Disorder: Innovations in Medication Decision-Making and Adherence Planning. CHILD & FAMILY BEHAVIOR THERAPY 2023; 45:199-225. [PMID: 37767113 PMCID: PMC10531035 DOI: 10.1080/07317107.2023.2172704] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/18/2023] [Accepted: 01/22/2023] [Indexed: 09/29/2023]
Abstract
This article presents behavioral interventions designed to enhance uptake and retention on medication for opioid use disorder (MOUD) among transition-age youth (16-25 years) enrolled in treatment services. The article describes three relationship-oriented interventions designed to address barriers to MOUD uptake, enhance MOUD adherence planning, and strengthen OUD recovery among youth: Relational Orientation; Medication Education and Decision-making Support, and Family Leadership and Ownership of Adherence to Treatment. These interventions are inter-connected can be delivered flexibly. The article concludes with three case examples that illustrate how these modular interventions can be tailored to meet the needs of diverse client profiles.
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Affiliation(s)
- Aaron Hogue
- Family & Adolescent Clinical Technology & Science, Partnership to End Addiction, New York, USA
| | - Molly Bobek
- Family & Adolescent Clinical Technology & Science, Partnership to End Addiction, New York, USA
| | - Nicole Porter
- Family & Adolescent Clinical Technology & Science, Partnership to End Addiction, New York, USA
| | - Alexandra MacLean
- Family & Adolescent Clinical Technology & Science, Partnership to End Addiction, New York, USA
| | - Kevin Wenzel
- Department of Psychiatry, Maryland Treatment Centers, Baltimore, Maryland, USA
| | - Marc Fishman
- Department of Psychiatry, Maryland Treatment Centers, Baltimore, Maryland, USA
| | - J. Douglas Coatsworth
- Knoxville Boyd Center for Business and Economic Research, Social Work, University of Tennessee, Knoxville, Tennessee, USA
| | - David. A. Langer
- Department of Psychology, Suffolk University, Boston, Massachusetts, USA
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Dorhout BG, de Groot LCPGM, van Dongen EJI, Doets EL, Haveman-Nies A. Effects and contextual factors of a diet and resistance exercise intervention vary across settings: an overview of three successive ProMuscle interventions. BMC Geriatr 2022; 22:189. [PMID: 35264105 PMCID: PMC8905865 DOI: 10.1186/s12877-021-02733-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 12/09/2021] [Indexed: 11/26/2022] Open
Abstract
Background Although many effective interventions have been developed, limited interventions have successfully been implemented. An intervention that was translated across settings is ProMuscle: a diet and resistance exercise intervention for older adults. However, varying contexts often lead to varying effects due to contextual factors (characteristics of individuals, organizations, communities or society). The current study aimed to gain insights into effects and contextual factors of ProMuscle in the controlled setting (ProMuscle: PM), real-life setting (ProMuscle in Practice: PiP), and real-life setting of the implementation pilots (ProMuscle Implementation Pilots: IP). Methods Data from the intervention arms of PM (N = 31) and PiP (N = 82), and from IP (N = 35) were used. Physical functioning (chair-rise test) and leg strength (1-10 repetition maximum) were measured at baseline and after 12-weeks intervention. Paired t-tests and General Linear Models were used to study changes after 12 weeks and differences between interventions. To explore contextual factors, researchers of PM and physiotherapists and dietitians of PiP and IP were interviewed. Factors were categorized according to the five domains and its underlying constructs of the Consolidated Framework for Implementation Research (CFIR). Results Improvements on chair-rise performance were found in PM (-2.0 ± 7.0 s, p = 0.186), PiP (-0.8 ± 2.9 s, p = 0.019) and IP (-3.3 ± 4.2 s, p = 0.001). Similar results were found for leg strength in PM (32.6 ± 24.8 kg, p < 0.001), PiP (17.0 ± 23.2 kg, p < 0.001), and IP (47.8 ± 46.8 kg, p < 0.001). Contextual factors that contribute to explaining the relatively high effects in IP included room for adapting and tailoring the intervention, involvement of experienced professionals, availability of and access to facilities, and participants characteristics. Conclusions Effects of the intervention appeared to be strongest in the real-life setting of the implementation pilots. Specific contextual factors contributed to explaining the different findings across settings. Future studies should investigate crucial factors that determine successful implementation of interventions in the real-life setting, to ensure that effective interventions are put into action and reach a broad population. Trial registration The ProMuscle intervention was registered in the Trial Registration (clinicaltrials.gov identifier: NCT01110369) on February 12th, 2010. The ProMuscle in Practice intervention was registered in the Netherlands Trial Register (NTR6038) on August 30th, 2016. Trial registration was not needed for the ProMuscle Implementation Pilots as this research did not fall within the remit of the Dutch ‘Medical Research Involving Human Subjects Act’.
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Affiliation(s)
- Berber G Dorhout
- Division of Human Nutrition and Health, Wageningen University and Research, Stippeneng 4, PO Box 17, 6700 AA, Wageningen, the Netherlands.
| | - Lisette C P G M de Groot
- Division of Human Nutrition and Health, Wageningen University and Research, Stippeneng 4, PO Box 17, 6700 AA, Wageningen, the Netherlands
| | - Ellen J I van Dongen
- Food, Health and Consumer Research, Wageningen Food and Biobased Research, Wageningen, the Netherlands
| | - Esmée L Doets
- Food, Health and Consumer Research, Wageningen Food and Biobased Research, Wageningen, the Netherlands
| | - Annemien Haveman-Nies
- Chair group Consumption and Healthy Lifestyles, Wageningen University and Research, Wageningen, The Netherlands.,GGD Noord- en Oost-Gelderland, Academic Collaborative Center AGORA, Zutphen, the Netherlands
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Therapist Self-Report of Fidelity to Core Elements of Family Therapy for Adolescent Behavior Problems: Psychometrics of a Pragmatic Quality Indicator Tool. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2022; 49:298-311. [PMID: 34476623 PMCID: PMC8854349 DOI: 10.1007/s10488-021-01164-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2021] [Indexed: 10/20/2022]
Abstract
Therapist-report measures of evidence-based interventions have enormous potential utility as quality indicators in routine care; yet, few such tools have shown strong psychometric properties. This study describes reliability and validity characteristics of a therapist-report measure of family therapy techniques for treating adolescent conduct and substance use problems: Inventory of Therapy Techniques for Core Elements of Family Therapy (ITT-CEFT). Study participants included 31 staff therapists treating 68 adolescent clients in eight community-based mental health and substance use clinics. Therapists submitted ITT-CEFT checklists and companion audio recordings for 189 sessions. The ITT-CEFT contains 13 techniques identified as core elements of three manualized family therapy models that are empirically supported for the target group. Therapists also reported on their use of three motivational interventions, and independent observers coded the submitted recordings. ITT-CEFT factor validity was shown via confirmatory factor analyses of the tool's theoretical structure. Derived modules were: Family Engagement (four items; Cronbach's α = .72); Relational Orientation (five items; α = .74); and Interactional Change (four items; α = .66). Concurrent validity analyses showed fair-to-excellent therapist reliability compared to observer ratings (ICCs range .64-.75); they showed moderate therapist accuracy compared to observer mean scores, reflecting a tendency to overestimate delivery of the techniques. Discriminant validity analyses showed tool differentiation from motivational interventions. Results offer provisional evidence for the feasibility of using the therapist-report ITT-CEFT to anchor quality procedures for family therapy interventions in real-world settings.Trial Registration: The parent clinical trial is registered at www.ClinicalTrials.gov , ID: NCT03342872 (registration date: 11.10.17).
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14
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Ibrahim M, Levy S, Gallop B, Krauthamer Ewing S, Hogue A, Chou J, Diamond G. Therapist Adherence to Two Treatments for Adolescent Suicide Risk: Association to Outcomes and Role of Therapeutic Alliance. FAMILY PROCESS 2022; 61:183-197. [PMID: 33904589 DOI: 10.1111/famp.12660] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
In psychotherapy research, adherence refers to the extent to which therapists deliver a treatment as intended. This study examined whether therapist adherence to two different manualized treatments was associated with improved client outcomes and whether the association was moderated by therapeutic alliance. The study sample included 320 video recordings of therapy sessions from 118 cases in a randomized controlled trial (RCT) comparing attachment-based family therapy (ABFT) with family-enhanced nondirective supportive therapy (FE-NST). Recordings were selected from early, middle, and late stages of treatment. The adherence measure consisted of 24 items representing essential therapist interventions from both treatments. Trained raters coded tapes from both therapies. Adolescent self-report of alliance was measured at session 4. Adherence to ABFT was associated with a significant increase in family cohesion at mid-treatment but not at posttreatment. Adherence to FE-NST was significantly associated with an increase in suicide ideation posttreatment. Using therapeutic alliance as a moderator, adherence to ABFT was significantly associated with a reduction in suicide ideation, family conflict, and higher client satisfaction posttreatment. Alliance did not positively affect the association of FE-NST adherence to outcomes. Findings suggest that adherence to ABFT interventions may be better linked to treatment outcomes when adolescents feel a strong alliance with their therapist. Implications for future research and therapist training are explored.
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Affiliation(s)
| | - Suzanne Levy
- Center for Family Intervention Science, Drexel University, Philadelphia, PA, USA
| | - Bob Gallop
- University of West Chester, Philadelphia, PA, USA
| | - Stephanie Krauthamer Ewing
- Counseling and Family Therapy Program, College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
| | | | - Jessica Chou
- Counseling and Family Therapy Program, College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
| | - Guy Diamond
- Center for Family Intervention Science, Drexel University, Philadelphia, PA, USA
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15
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Hogue A, Schumm JA, MacLean A, Bobek M. Couple and family therapy for substance use disorders: Evidence-based update 2010-2019. JOURNAL OF MARITAL AND FAMILY THERAPY 2022; 48:178-203. [PMID: 34435387 DOI: 10.1111/jmft.12546] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 06/24/2021] [Accepted: 08/04/2021] [Indexed: 06/13/2023]
Abstract
This article updates the evidence-based on couple and family therapy interventions for substance use disorders (SUD) since publication of the previous JMFT reviews in 2012. It first summarizes previous reviews along with findings from more recent reviews and meta-analytic studies. It then presents study design and methods criteria used to select 13 studies of couple and family therapy for level of support evaluation. Cumulative level of support designations are then determined for identified treatment approaches. Findings indicate that systemic family therapy is well-established as a standalone treatment, and behavioral family therapy and behavioral couple therapy are probably efficacious as standalone treatments and well-established as part of a multicomponent treatment. The article then suggests practice guidelines with regard to treatment modality considerations and implementation challenges. It concludes with future directions for delivering couple and family interventions in routine systems of care for SUD.
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Affiliation(s)
- Aaron Hogue
- Partnership to End Addiction, Suite, New York, USA
| | - Jeremiah A Schumm
- School of Professional Psychology, Wright State University and OneFifteen, Inc./Samaritan Behavioral Health, Inc., Dayton, Ohio, USA
| | | | - Molly Bobek
- Partnership to End Addiction, Suite, New York, USA
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16
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Frey LM, Hunt QA, Russon JM, Diamond G. Review of family-based treatments from 2010 to 2019 for suicidal ideation and behavior. JOURNAL OF MARITAL AND FAMILY THERAPY 2022; 48:154-177. [PMID: 34710242 DOI: 10.1111/jmft.12568] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 10/15/2021] [Indexed: 06/13/2023]
Abstract
Suicide ideation and behavior are pervasive public health issues. Given that positive interpersonal relationships can be a protective factor against suicide risk, we conducted a systematic review to examine peer-reviewed publications from 2010 to 2019 that included empirical data, tested an intervention with at least some family component, and included a suicide-related outcome measure. We reviewed and synthesized findings from 22 articles covering 7 intervention categories with 12 interventions to examine the treatment components and the quality of evidence to support them. Using Southam-Gerow and Prinstein's (Child Adolesc Psychol 43:16, 2014) guidelines, we identified two well-established intervention categories that met the highest standards for interventions and three probably efficacious intervention categories. All interventions found focused solely on suicide risk in adolescent populations. More studies are needed for adult populations and to explore the role of family moderators and mediators to test whether suicide outcomes are reduced by improvement in the family environment.
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Affiliation(s)
- Laura M Frey
- Couple and Family Therapy Program, University of Louisville, Louisville, Kentucky, USA
| | - Quintin A Hunt
- Marriage and Family Therapy Program, Brigham Young University, Provo, Utah, USA
| | - Jody M Russon
- Department of Human Development and Family Science, Marriage and Family Therapy Doctoral Program Area, Virginia Tech, Virginia, USA
- Counseling and Family Therapy Department, Drexel University, Philadelphia, Pennsylvania, USA
| | - Guy Diamond
- Counseling and Family Therapy Department, Drexel University, Philadelphia, Pennsylvania, USA
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17
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Walker SC, Gubner N, Iztguttinov A, Rodriguez F, Davis P, Lyon A, Kerns S, Bruns E, Qian J, Sedlar G. The implementation potential of a method to monitor empirically-supported children's mental health treatment through claims data. BMC Health Serv Res 2021; 21:1349. [PMID: 34922540 PMCID: PMC8684062 DOI: 10.1186/s12913-021-07317-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 11/22/2021] [Indexed: 11/16/2022] Open
Abstract
Background The delivery of evidence-supported treatments (EST) in children’s mental health could be a valuable measure for monitoring mental healthcare quality; however, efforts to monitor the use of EST in real world systems are hindered by the lack of pragmatic methods. This mixed methods study examined the implementation and agency response rate of a pragmatic, claims-based measure of EST designed to be applied as a universal quality measure for child psychotherapy encounters in a state Medicaid system. Methods Implementation potential of the EST measure was assessed with healthcare leader rankings of the reporting method’s acceptability, appropriateness and feasibility (n = 53), and post-implementation ratings of EST rate accuracy. Ability of the healthcare system to monitor EST through claims was measured by examining the agency responsivity in using the claims-based measure across 98 Medicaid-contracted community mental health (CMH) agencies in Washington State. Results The analysis found the reporting method had high implementation potential. The method was able to measure the use of an EST for 83% of children covered by Medicaid with 58% CMH agencies reporting > 0 ESTs in one quarter. Qualitative analyses revealed that the most significant barrier to reporting ESTs was the operability of electronic health record systems and agencies’ mixed views regarding the accuracy and benefits of reporting. Conclusions Measurement of child mental health ESTs through Medicaid claims reporting has acceptable implementation potential and promising real world responsiveness from CMH agencies in one state. Variation in reporting by agency site and low to moderate perceived value by agency leaders suggests the need for additional implementation supports for wider uptake.
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Affiliation(s)
- Sarah Cusworth Walker
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, USA.
| | - Noah Gubner
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Aniyar Iztguttinov
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Felix Rodriguez
- Washington State Health Care Authority, P.O. Box 45330, Olympia, WA, 98504-5330, USA
| | - Paul Davis
- Washington State Health Care Authority, P.O. Box 45330, Olympia, WA, 98504-5330, USA
| | - Aaron Lyon
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 2012 Skagit Lane, Miller Sall, Box 353600, Seattle, WA, 98195, USA
| | - Suzanne Kerns
- School of Social Work, University of Denver, Craig Hall, 2148 South High, St. Denver, CO, 80210, USA
| | - Eric Bruns
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 6200 NE 74th Street, Building 29, Suite 110, Seattle, WA, 98115, USA
| | - Jiage Qian
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Georganna Sedlar
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, USA
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18
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Nguyen TT, Dinh TTT, Busse A, Kashino W, Suhartono S, Le MG. Family-based intervention for adolescents with substance use disorders in Vietnam. Addict Behav Rep 2021; 14:100382. [PMID: 34938840 PMCID: PMC8664868 DOI: 10.1016/j.abrep.2021.100382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/16/2021] [Accepted: 09/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adolescent substance use is a leading risk factor of medical and social problems in adults. However, evidence-based interventions for substance use disorders (SUD) among youth in resource-limited countries are lacking. Treatnet Family (TF), developed by United Nations Office on Drugs and Crime (UNODC), aims to make youth SUD care more affordable and accessible in low- and middle-income countries. This study explores the suitability of TF in Vietnam. METHOD Twenty interviews were conducted with eight adolescents and their family members who participated in TF, and four practitioners who delivered TF. Questions centred on their experiences with the intervention and suggestions for improvement. Thematic analysis was used to evaluate the data. RESULTS All adolescents were male with an average age of 19.3. Seven of them had left school. Most caregivers were female. Both family members and adolescents expressed a great demand for support, and both groups appreciated the immediate improvement in parent-child communication. However, the impact of TF could be compromised due challenges in recruiting families, possibly arising from the novelty of a family-based intervention in Vietnam and drug-related stigma. The perception of drug use as an acute condition instead of a chronic disorder, and the lack of a continuing care system, also made it difficult to retain participants. CONCLUSION Vietnamese adolescents with SUD and their family members were in great need of support and access to evidence-based interventions. Building a comprehensive, health-centred substance use disorder treatment and care system would enhance treatment impact.
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Affiliation(s)
- Thu Trang Nguyen
- Centre for Training and Research on Substance Use and HIV, Hanoi Medical University, Viet Nam
| | - Thi Thanh Thuy Dinh
- Centre for Training and Research on Substance Use and HIV, Hanoi Medical University, Viet Nam
| | - Anja Busse
- Prevention, Treatment and Rehabilitation Section, Drug Prevention and Health Branch, United Nations Office on Drugs and Crime, Vienna, Austria
| | - Wataru Kashino
- Prevention, Treatment and Rehabilitation Section, Drug Prevention and Health Branch, United Nations Office on Drugs and Crime, Vienna, Austria
| | - Sanita Suhartono
- Prevention, Treatment and Rehabilitation Section, Drug Prevention and Health Branch, United Nations Office on Drugs and Crime, Vienna, Austria
| | - Minh Giang Le
- Centre for Training and Research on Substance Use and HIV, Hanoi Medical University, Viet Nam
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Hogue A, Bobek M, Levy S, Henderson CE, Fishman M, Becker SJ, Dauber S, Porter N, Wenzel K. Conceptual framework for telehealth strategies to increase family involvement in treatment and recovery for youth opioid use disorder. JOURNAL OF MARITAL AND FAMILY THERAPY 2021; 47:501-514. [PMID: 33760249 PMCID: PMC9830952 DOI: 10.1111/jmft.12499] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 01/29/2021] [Accepted: 02/02/2021] [Indexed: 06/12/2023]
Abstract
With opioid use at crisis levels, it is imperative to support youth ages with opioid use disorders (OUD) in taking medication and accessing behavioral services over long periods. This article presents a conceptual framework for telehealth strategies that can be adopted to increase family involvement across a four-stage continuum of youth OUD treatment and recovery: Treatment Preparation, Treatment Initiation, Treatment Stabilization, OUD Recovery. It first identifies provider-delivered tele-interventions that can enhance OUD services in each of the four stages, including family outreach, family engagement, family-focused intervention, and family-focused recovery maintenance. It then introduces several types of direct-to-family tele-supports that can be used to supplement provider-delivered interventions. These include both synchronous tele-supports (remote interactions that occur in real time) such as helplines, peer-to-peer coaching, and online support groups; and asynchronous tele-supports (communications that occur without participants being simultaneously present) such as automated text messaging, self-directed internet-based courses, and digital web support.
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Affiliation(s)
- Aaron Hogue
- Family and Adolescent Clinical Technology & Science, Partnership to End Addiction, New York, NY, USA
| | - Molly Bobek
- Family and Adolescent Clinical Technology & Science, Partnership to End Addiction, New York, NY, USA
| | - Sharon Levy
- Adolescent Substance Use and Addiction Program, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Craig E. Henderson
- Department of Psychology, Sam Houston, State University, Huntsville, TX, USA
| | | | - Sara J. Becker
- Center for Alcohol and Addictions, Studies, Brown University School of Public, Health, Providence, RI, USA
| | - Sarah Dauber
- Family and Adolescent Clinical Technology & Science, Partnership to End Addiction, New York, NY, USA
| | - Nicole Porter
- Family and Adolescent Clinical Technology & Science, Partnership to End Addiction, New York, NY, USA
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20
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Examining the Correspondence Between Teacher- and Observer-Report Treatment Integrity Measures. SCHOOL MENTAL HEALTH 2021. [DOI: 10.1007/s12310-021-09437-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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21
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A Theory-Informed Approach to Locally Managed Learning School Systems: Integrating Treatment Integrity and Youth Mental Health Outcome Data to Promote Youth Mental Health. SCHOOL MENTAL HEALTH 2021. [DOI: 10.1007/s12310-021-09413-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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22
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Hogue A, Bobek M, MacLean A. Core Elements of CBT for Adolescent Conduct and Substance Use Problems: Comorbidity, Clinical Techniques, and Case Examples. COGNITIVE AND BEHAVIORAL PRACTICE 2020; 27:426-441. [PMID: 34103883 PMCID: PMC8184115 DOI: 10.1016/j.cbpra.2019.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Adolescent externalizing problems (AEPs), including serious conduct problems, delinquency, and substance misuse, are the most common adolescent behavioral issues in specialty care. High rates of comorbidity between conduct and substance use problems necessitate multidomain treatment strategies that can effectively address the AEP spectrum. One strategy to increase delivery of evidence-based interventions for multiproblem youth in usual care is to focus on core elements of empirically supported treatments that can be judiciously applied to clients presenting with diverse clinical profiles. This article describes six core practice elements of the cognitive-behavioral treatment (CBT) approach for AEPs: (1) Functional Analysis of Behavior Problems; (2) Prosocial Activity Sampling; (3) Cognitive Monitoring and Restructuring; (4) Emotion Regulation Training; (5) Problem-solving Training; (6) Communication Training. Integrated delivery of these core CBT elements is illustrated in two case examples, and implications for treatment planning for youth with AEPs are discussed.
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Affiliation(s)
- Aaron Hogue
- Center on Addiction, Robert Miranda and Jennifer C. Wolff, Brown University, Amanda Jensen-Doss, University of Miami
| | - Molly Bobek
- Center on Addiction, Robert Miranda and Jennifer C. Wolff, Brown University, Amanda Jensen-Doss, University of Miami
| | - Alexandra MacLean
- Center on Addiction, Robert Miranda and Jennifer C. Wolff, Brown University, Amanda Jensen-Doss, University of Miami
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23
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D'Aniello C, Fife ST. A 20-Year Review of Common Factors Research in Marriage and Family Therapy: A Mixed Methods Content Analysis. JOURNAL OF MARITAL AND FAMILY THERAPY 2020; 46:701-718. [PMID: 32237170 DOI: 10.1111/jmft.12427] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 02/09/2020] [Accepted: 02/18/2020] [Indexed: 06/11/2023]
Abstract
Introduced by Sprenkle, Blow & Dickey (1999), common factors in marriage and family therapy (MFT) have been discussed over the past two decades. Although the MFT common factors literature has grown, there are misconceptions and disagreements about their role in theory, practice, research, and training. This content analysis examined the contributions of the common factors paradigm to MFT theory, practice, research, and training over the past 20 years. We identified 37 scholarly works including peer-reviewed journal articles, books, and chapters. Using mixed methods content analysis, we analyze and synthesize the contributions of this literature in terms of theoretical development about therapeutic effectiveness in MFT, MFT training, research, and practice. We provide commentary on the substantive contributions that the common factors paradigm has made to these areas, and we discuss the implications and limitations of the common factors literature, and provide recommendations for moving common factors research forward.
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Common Elements of Practice, Process and Implementation in Out-of-School-Time Academic Interventions for At-risk Children: a Systematic Review. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2020; 21:545-556. [PMID: 32020489 PMCID: PMC7162823 DOI: 10.1007/s11121-020-01091-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Academic achievement is a strong preventive factor against marginalization. Children at risk of academic failure and drop out can benefit from out-of-school-time academic (OSTA) interventions. Wide-scaled implementation and sustainment of effective interventions remain a struggle across education, welfare, and health. The need for approaches to increase implementability, effectiveness, and efficiency of interventions is pressing. Advancements in the field of education and mental health suggest identifying and studying discrete elements that are common across interventions for the purpose of hypothesis generation, intervention optimization, design improvement, and implementation. This review identified OSTA interventions for primary school children at risk of academic failure. Common elements methodology was used to code practice elements (n = 62), process elements (n = 49), and implementation elements (n = 36) in 30 effective and six ineffective OSTA interventions in matrices. Based on frequency counts, common practice, process, and implementation elements across the interventions were identified, and given frequency count values (FV) reflecting how often elements were included in effective studies as opposed to in ineffective studies. The five common practice elements with the highest FVs were homework support, training in positive parental school involvement, positive reinforcement, structured tutoring, and psychoeducation. The most common process element was regular support to intervention receiver, and the most common implementation element was quality monitoring. Common combinations of elements were also identified and given FVs. Results from this review can inform efforts to design or optimize OSTA interventions, and inform education, implementation, and practice to improve academic achievement for children at risk.
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25
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Hogue A, Dauber S, Bobek M, Jensen-Doss A, Henderson CE. Measurement Training and Feedback System for Implementation of family-based services for adolescent substance use: protocol for a cluster randomized trial of two implementation strategies. Implement Sci 2019; 14:25. [PMID: 30866967 PMCID: PMC6416843 DOI: 10.1186/s13012-019-0874-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 02/21/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This article describes a study protocol for testing the Measurement Training and Feedback System for Implementation (MTFS-I) and comparing two implementation strategies for MTFS-I delivery. MTFS-I is a web-based treatment quality improvement system designed to increase the delivery of evidence-based interventions for behavioral health problems in routine care settings. This version of MTFS-I focuses on family-based services (FBS) for adolescent substance use. FBS, comprising both family participation in treatment and family therapy technique use, have achieved the strongest evidence base for adolescent substance use and are a prime candidate for upgrading treatment quality in outpatient care. For FBS to fulfill their potential for widespread dissemination, FBS implementation must be bolstered by effective quality procedures that support sustainable delivery in usual care. METHODS/DESIGN Adapted from measurement feedback systems for client outcomes, MTFS-I contains three synergistic components: (a) weekly reporter training modules to instruct therapists in reliable post-session self-reporting on FBS utilization; (b) weekly mock session videos of FBS interventions (5-8 min) for supportive training in, and practice coding of, high-quality FBS; and (c) monthly feedback reports to therapists and supervisors displaying aggregated data on therapist-reported FBS use. MTFS-I is hosted online and requires approximately 20 min per week to complete. The study will experimentally compare two well-established implementation strategies designed to foster ongoing MTFS-I usage: Core Training, consisting of two 3-h training sessions focused on FBS site mapping, selecting FBS improvement goals, and sustaining MTFS-I, followed by routine remote technical assistance; and Core + Facilitation, which boosts Core Training sessions with collaborative phone-based clinical consultation and on-site facilitation meetings for 1 year to promote FBS goal achievement. The study design is a cluster randomized trial testing Core Training versus Core + Facilitation in ten substance use treatment clinics. Study aims will compare conditions on MTFS-I uptake, FBS delivery (based on therapist-report and observational data), and 1-year client outcomes. DISCUSSION Study contributions to implementation science and considerations of MTFS-I sustainability are discussed. TRIAL REGISTRATION ClinicalTrials.gov NCT03342872 . Registered 10 November 2017.
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Affiliation(s)
| | | | | | | | - Craig E. Henderson
- Department of Psychology, Sam Houston State University, Huntsville, TX USA
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26
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Smith JD, Rudo-Stern J, Dishion TJ, Stormshak EA, Montag S, Brown K, Ramos K, Shaw DS, Wilson MN. Effectiveness and Efficiency of Observationally Assessing Fidelity to a Family-Centered Child Intervention: A Quasi-Experimental Study. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2019; 48:16-28. [PMID: 30702355 DOI: 10.1080/15374416.2018.1561295] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Assessment of fidelity that is effective, efficient, and differentiates from usual practices is critical for effectively implementing evidence-based programs for families. This quasi-experiemntal study sought to determine whether observational ratings of fidelity to the Family Check-Up (FCU) could differentiate between levels of clinician training in the model, and from services as usual, and whether rating segments of sessions could be equivalent to rating complete sessions. Coders rated 75 videotaped sessions-complete and 20-min segments-for fidelity, using a valid and reliable rating system across three groups: (a) highly trained in FCU with universal, routine monitoring; (b) minimally trained in FCU with optional, variable monitoring; and (c) services as usual with no training in the FCU. We hypothesized that certain dimensions of fidelity would differ by training, whereas others would not. The results indicated that, as expected, one dimension of fidelity to the FCU, Conceptually accurate to the FCU, was reliably different between the groups (χ2 = 44.63, p < .001). The differences observed were in the expected direction, showing higher scores for therapists with more training. The rating magnitude of session segments largely did not differ from those of complete session ratings; however, interrater reliabilities were low for the segments. Although observational ratings were shown to be sensitive to the degree of training in the FCU on a unique and theoretically critical dimension, observational coding of complete sessions is resource intensive and limits scalability. Additional work is needed to reduce the burden of assessing fidelity to family-centered programs.
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Affiliation(s)
- Justin D Smith
- a Center for Prevention Implementation Methodology for Drug Abuse and HIV, Department of Psychiatry and Behavioral Sciences , Northwestern University Feinberg School of Medicine
| | - Jenna Rudo-Stern
- b REACH Institute, Department of Psychology , Arizona State University
| | - Thomas J Dishion
- c REACH Institute, Department of Psychology , Arizona State University & Oregon Research Institute
| | - Elizabeth A Stormshak
- d Prevention Science Institute and Department of Counseling Psychology , University of Oregon
| | - Samantha Montag
- a Center for Prevention Implementation Methodology for Drug Abuse and HIV, Department of Psychiatry and Behavioral Sciences , Northwestern University Feinberg School of Medicine
| | | | - Karina Ramos
- f University of California Irvine Counseling Center
| | - Daniel S Shaw
- g Department of Psychology , University of Pittsburgh
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Hogue A, Bobek M, Dauber S, Henderson CE, McLeod BD, Southam-Gerow MA. Core Elements of Family Therapy for Adolescent Behavior Problems: Empirical Distillation of Three Manualized Treatments. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2019; 48:29-41. [PMID: 30657722 DOI: 10.1080/15374416.2018.1555762] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Family therapy has the strongest evidence base for treating adolescent conduct and substance use problems, yet there remain substantial barriers to widespread delivery of this approach in community settings. This study aimed to promote the feasibility of implementing family-based interventions in usual care by empirically distilling the core practice elements of three manualized treatments. The study sampled 302 high-fidelity treatment sessions from 196 cases enrolled in 1 of 3 manualized family therapy models: multidimensional family therapy (102 sessions/56 cases), brief strategic family therapy (100 sessions/94 cases), or functional family therapy (100 sessions/46 cases). Adolescents were 57% male; 41% were African American, 31% White non-Hispanic, 9% Hispanic American, 6% another race/ethnicity, and 13% unknown. The observational fidelity measures of all three models were used to code all 302 sessions. Fidelity ratings were analyzed to derive model-shared treatment techniques via exploratory factor analyses on half the sample; the derived factors were then validated via confirmatory factor analyses supplemented by Bayesian structural equation modeling on the remaining half. Factor analyses distilled 4 clinically coherent practice elements with strong internal consistency: Interactional Change (6 treatment techniques; Cronbach's α = .93), Relational Reframe (7 techniques; α = .79), Adolescent Engagement (4 techniques; α = .68), and Relational Emphasis (4 techniques; α = .67). The 4 empirically derived factors represent the core elements of 3 manualized family therapy models for adolescent behavior problems, setting the foundation of a more sustainable option for delivering evidence-based family interventions in routine practice settings. Public Health Significance: Increasing implementation of high-fidelity family-based interventions would improve the quality of treatment services for adolescent conduct and substance use problems.
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Affiliation(s)
| | | | | | | | - Bryce D McLeod
- c Department of Psychology , Virginia Commonwealth University
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Hogue A, Henderson CE, Becker SJ, Knight DK. Evidence Base on Outpatient Behavioral Treatments for Adolescent Substance Use, 2014-2017: Outcomes, Treatment Delivery, and Promising Horizons. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2018; 47:499-526. [PMID: 29893607 PMCID: PMC7192024 DOI: 10.1080/15374416.2018.1466307] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
This article updates the evidence base on outpatient behavioral treatments for adolescent substance use (ASU) since publication of the previous review completed for this journal by Hogue, Henderson, Ozechowski, and Robbins (2014). It first summarizes the Hogue et al. findings along with those from recent literature reviews and meta-analytic studies of ASU treatments. It then presents study design and methods criteria used to select 11 comparative studies subjected to Journal of Clinical Child and Adolescent Psychology level of support evaluation. These 11 studies are detailed in terms of their sample characteristics, methodological quality, and substance use outcomes. Cumulative level of support designations are then made for each identified treatment approach. These cumulative designations are virtually identical to those of the previous review: ecological family-based treatment, individual cognitive-behavioral therapy, and group cognitive-behavioral therapy remain well-established; behavioral family-based treatment and motivational interviewing remain probably efficacious; drug counseling remains possibly efficacious; and an updated total of 5 multicomponent treatments combining more than 1 approach (3 of which include contingency management) are deemed well-established or probably efficacious. Treatment delivery issues associated with evidence-based approaches are then reviewed, focusing on client engagement, fidelity and mediator, and predictor and moderator effects. Finally, to help accelerate innovation in ASU treatment science and practice, the article outlines promising horizons in improving youth identification and access, specifying and implementing pragmatic treatment in community settings, and leveraging emerging lessons from implementation science.
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Affiliation(s)
| | | | - Sara J Becker
- c Center for Alcohol and Addictions Studies , Brown University School of Public Health
| | - Danica K Knight
- d Institute of Behavioral Research , Texas Christian University
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