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Gadbois EA, Meehan A, Uth R, Baier RR, Gravenstein S, Zullo AR, Kabler H, Loiacono MM, Bardenheier BH. Identifying strategies that promote staff and resident influenza and COVID-19 vaccination in nursing homes: Perspectives from nursing home staff. Geriatr Nurs 2023; 54:205-210. [PMID: 37844537 DOI: 10.1016/j.gerinurse.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 09/04/2023] [Accepted: 09/05/2023] [Indexed: 10/18/2023]
Abstract
Resident and staff influenza and COVID-19 vaccination are critical components of infection prevention in nursing homes. Our study sought to characterize strategies that nursing home staff use to promote vaccination. Twenty-six telephone/videoconference interviews were conducted with administrators, directors of nursing, infection preventionists, and Minimum Data Set coordinators at 14 nursing homes across the US. Transcripts were analyzed using content analysis and a detailed audit trail was maintained. Staff described resident and staff influenza and COVID-19 vaccine hesitancy and confidence as well as varying approaches to promote vaccination. These included incentives, education efforts, and having a "vaccine champion" responsible for vaccine promotion. While many strategies had been in place prior to COVID-19 in support of improving influenza vaccination, participants reported implementing additional approaches to promote COVID-19 vaccination. Findings may inform future efforts to promote vaccination, which will be critical to mitigate the burden of influenza and COVID-19 in nursing homes.
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Affiliation(s)
- Emily A Gadbois
- Brown University School of Public Health, 121 S. Main St., Providence, RI 02903, United States.
| | - Amy Meehan
- Brown University School of Public Health, 121 S. Main St., Providence, RI 02903, United States
| | - Rebecca Uth
- Brown University School of Public Health, 121 S. Main St., Providence, RI 02903, United States
| | - Rosa R Baier
- Brown University School of Public Health, 121 S. Main St., Providence, RI 02903, United States
| | - Stefan Gravenstein
- Brown University School of Public Health, 121 S. Main St., Providence, RI 02903, United States; Warren Alpert Medical School of Brown University, 222 Richmond St., Providence, RI 02903, United States; Providence Veterans Affairs Medical Center, 830 Chalkstone Ave., Providence, RI 02908, United States
| | - Andrew R Zullo
- Brown University School of Public Health, 121 S. Main St., Providence, RI 02903, United States; Providence Veterans Affairs Medical Center, 830 Chalkstone Ave., Providence, RI 02908, United States; Department of Pharmacy, Rhode Island Hospital, 593 Eddy St., Providence, RI 02903, United States
| | - Heidi Kabler
- Medical Affairs, Sanofi, 1 Discovery Dr., Swiftwater, PA 18370, United States
| | - Matthew M Loiacono
- Global Medical Evidence Generation, Sanofi, 1 Discovery Dr., Swiftwater, PA 18370, United States
| | - Barbara H Bardenheier
- Brown University School of Public Health, 121 S. Main St., Providence, RI 02903, United States; Westat, Inc., 1600 Research Blvd., Rockville, MD 20850, United States
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Meehan A, Uth R, Gadbois EA, Baier RR, Gravenstein S, Zullo AR, Kabler H, Loiacono MM, Bardenheier BH. Impact of COVID-19 on influenza and infection control practices in nursing homes. J Am Geriatr Soc 2022; 71:661-665. [PMID: 36146903 PMCID: PMC9538598 DOI: 10.1111/jgs.18061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/31/2022] [Accepted: 09/05/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Amy Meehan
- Brown University School of Public HealthProvidenceRhode IslandUSA
| | - Rebecca Uth
- Brown University School of Public HealthProvidenceRhode IslandUSA
| | - Emily A. Gadbois
- Brown University School of Public HealthProvidenceRhode IslandUSA
| | - Rosa R. Baier
- Brown University School of Public HealthProvidenceRhode IslandUSA
| | - Stefan Gravenstein
- Brown University School of Public HealthProvidenceRhode IslandUSA,Warren Alpert Medical School of Brown UniversityProvidenceRhode IslandUSA,Providence Veterans Affairs Medical CenterProvidenceRhode IslandUSA
| | - Andrew R. Zullo
- Brown University School of Public HealthProvidenceRhode IslandUSA,Providence Veterans Affairs Medical CenterProvidenceRhode IslandUSA,Rhode Island HospitalProvidenceRhode IslandUSA
| | | | | | - Barbara H. Bardenheier
- Brown University School of Public HealthProvidenceRhode IslandUSA,Westat, Inc.RockvilleMarylandUSA
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Meehan A, Meehan A, Gadbois E, Uth R, Baier R, Gravenstein S, Zullo A, Kabler H, Loiacono M, Bardenheier B. Strategies to Promote Staff and Resident Flu and COVID-19 Vaccination in Skilled Nursing Facilities. J Am Med Dir Assoc 2022. [PMCID: PMC9159938 DOI: 10.1016/j.jamda.2022.04.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Olson MB, McCreedy EM, Baier RR, Shield RR, Zediker EE, Uth R, Thomas KS, Mor V, Gutman R, Rudolph JL. Measuring implementation fidelity in a cluster-randomized pragmatic trial: development and use of a quantitative multi-component approach. Trials 2022; 23:43. [PMID: 35033176 PMCID: PMC8761354 DOI: 10.1186/s13063-022-06002-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 01/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In pragmatic trials, on-site partners, rather than researchers, lead intervention delivery, which may result in implementation variation. There is a need to quantitatively measure this variation. Applying the Framework for Implementation Fidelity (FIF), we develop an approach for measuring variability in site-level implementation fidelity. This approach is then applied to measure site-level fidelity in a cluster-randomized pragmatic trial of Music & MemorySM (M&M), a personalized music intervention targeting agitated behaviors in residents living with dementia, in US nursing homes (NHs). METHODS Intervention NHs (N = 27) implemented M&M using a standardized manual, utilizing provided staff trainings and iPods for participating residents. Quantitative implementation data, including iPod metadata (i.e., song title, duration, number of plays), were collected during baseline, 4-month, and 8-month site visits. Three researchers developed four FIF adherence dimension scores. For Details of Content, we independently reviewed the implementation manual and reached consensus on six core M&M components. Coverage was the total number of residents exposed to the music at each NH. Frequency was the percent of participating residents in each NH exposed to M&M at least weekly. Duration was the median minutes of music received per resident day exposed. Data elements were scaled and summed to generate dimension-level NH scores, which were then summed to create a Composite adherence score. NHs were grouped by tercile (low-, medium-, high-fidelity). RESULTS The 27 NHs differed in size, resident composition, and publicly reported quality rating. The Composite score demonstrated significant variation across NHs, ranging from 4.0 to 12.0 [8.0, standard deviation (SD) 2.1]. Scaled dimension scores were significantly correlated with the Composite score. However, dimension scores were not highly correlated with each other; for example, the correlation of the Details of Content score with Coverage was τb = 0.11 (p = 0.59) and with Duration was τb = - 0.05 (p = 0.78). The Composite score correlated with CMS quality star rating and presence of an Alzheimer's unit, suggesting face validity. CONCLUSIONS Guided by the FIF, we developed and used an approach to quantitatively measure overall site-level fidelity in a multi-site pragmatic trial. Future pragmatic trials, particularly in the long-term care environment, may benefit from this approach. TRIAL REGISTRATION Clinicaltrials.gov NCT03821844. Registered on 30 January 2019, https://clinicaltrials.gov/ct2/show/NCT03821844 .
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Affiliation(s)
- Miranda B Olson
- Center for Long-Term Care Quality & Innovation, Brown University School of Public Health, 121 South Main St., Providence, RI, 02912, USA.
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, 121 South Main St., Providence, RI, 02912, USA.
| | - Ellen M McCreedy
- Center for Long-Term Care Quality & Innovation, Brown University School of Public Health, 121 South Main St., Providence, RI, 02912, USA
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, 121 South Main St., Providence, RI, 02912, USA
- Department of Health Services, Policy & Practice, Brown University School of Public Health, 121 South Main St., Providence, RI, 02912, USA
| | - Rosa R Baier
- Center for Long-Term Care Quality & Innovation, Brown University School of Public Health, 121 South Main St., Providence, RI, 02912, USA
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, 121 South Main St., Providence, RI, 02912, USA
- Department of Health Services, Policy & Practice, Brown University School of Public Health, 121 South Main St., Providence, RI, 02912, USA
| | - Renée R Shield
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, 121 South Main St., Providence, RI, 02912, USA
- Department of Health Services, Policy & Practice, Brown University School of Public Health, 121 South Main St., Providence, RI, 02912, USA
| | - Esme E Zediker
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, 121 South Main St., Providence, RI, 02912, USA
| | - Rebecca Uth
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, 121 South Main St., Providence, RI, 02912, USA
| | - Kali S Thomas
- Center for Long-Term Care Quality & Innovation, Brown University School of Public Health, 121 South Main St., Providence, RI, 02912, USA
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, 121 South Main St., Providence, RI, 02912, USA
- Department of Health Services, Policy & Practice, Brown University School of Public Health, 121 South Main St., Providence, RI, 02912, USA
- US Department of Veterans Affairs Medical Center, 830 Chalkstone Ave., Providence, RI, 02908, USA
| | - Vincent Mor
- Center for Long-Term Care Quality & Innovation, Brown University School of Public Health, 121 South Main St., Providence, RI, 02912, USA
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, 121 South Main St., Providence, RI, 02912, USA
- Department of Health Services, Policy & Practice, Brown University School of Public Health, 121 South Main St., Providence, RI, 02912, USA
- US Department of Veterans Affairs Medical Center, 830 Chalkstone Ave., Providence, RI, 02908, USA
| | - Roee Gutman
- Department of Health Services, Policy & Practice, Brown University School of Public Health, 121 South Main St., Providence, RI, 02912, USA
- Department of Biostatistics, Brown University School of Public Health, 121 South Main St., Providence, RI, 02912, USA
| | - James L Rudolph
- Center for Long-Term Care Quality & Innovation, Brown University School of Public Health, 121 South Main St., Providence, RI, 02912, USA
- Department of Health Services, Policy & Practice, Brown University School of Public Health, 121 South Main St., Providence, RI, 02912, USA
- US Department of Veterans Affairs Medical Center, 830 Chalkstone Ave., Providence, RI, 02908, USA
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McCreedy EM, Sisti A, Gutman R, Dionne L, Rudolph JL, Baier R, Thomas KS, Olson MB, Zediker EE, Uth R, Shield RR, Mor V. Pragmatic Trial of Personalized Music for Agitation and Antipsychotic Use in Nursing Home Residents With Dementia. J Am Med Dir Assoc 2022; 23:1171-1177. [PMID: 35038407 DOI: 10.1016/j.jamda.2021.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 11/22/2021] [Accepted: 12/10/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To test the effect of a personalized music intervention on agitated behaviors and medication use among long-stay nursing home residents with dementia. DESIGN Pragmatic, cluster-randomized controlled trial of a personalized music intervention. Staff in intervention facilities identified residents' early music preferences and offered music at early signs of agitation or when disruptive behaviors typically occur. Usual care in control facilities may include ambient or group music. SETTING AND PARTICIPANTS The study was conducted between June 2019 and February 2020 at 54 nursing homes (27 intervention and 27 control) in 10 states owned by 4 corporations. METHODS Four-month outcomes were measured for each resident. The primary outcome was frequency of agitated behaviors using the Cohen-Mansfield Agitation Inventory. Secondary outcomes included frequency of agitated behaviors reported in the Minimum Data Set and the proportion of residents using antipsychotic, antidepressant, or antianxiety medications. RESULTS The study included 976 residents with dementia [483 treatment and 493 control; mean age = 80.3 years (SD 12.3), 69% female, 25% African American]. CMAI scores were not significantly different (treatment: 50.67, SE 1.94; control: 49.34, SE 1.68) [average marginal effect (AME) 1.33, SE 1.38, 95% CI -1.37 to 4.03]. Minimum Data Set-based behavior scores were also not significantly different (treatment: 0.35, SE 0.13; control: 0.46, SE 0.11) (AME -0.11, SE 0.10, 95% CI -0.30 to 0.08). Fewer residents in intervention facilities used antipsychotics in the past week compared with controls (treatment: 26.2, SE 1.4; control: 29.6, SE 1.3) (AME -3.61, SE 1.85, 95% CI -7.22 to 0.00), but neither this nor other measures of psychotropic drug use were statistically significant. CONCLUSIONS AND IMPLICATIONS Personalized music was not significantly effective in reducing agitated behaviors or psychotropic drug use among long-stay residents with dementia. Barriers to full implementation included engaging frontline nursing staff and identifying resident's preferred music.
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Affiliation(s)
- Ellen M McCreedy
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI, USA; Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA; Center for Long-Term Care Quality & Innovation, Brown University School of Public Health, Providence, RI, USA.
| | - Anthony Sisti
- Department of Biostatistics, Brown University School of Public Health, Providence, RI, USA
| | - Roee Gutman
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA; Department of Biostatistics, Brown University School of Public Health, Providence, RI, USA
| | - Laura Dionne
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI, USA
| | - James L Rudolph
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI, USA; Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA; US Department of Veterans Affairs Medical Center, Providence, RI, USA
| | - Rosa Baier
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI, USA; Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA; Center for Long-Term Care Quality & Innovation, Brown University School of Public Health, Providence, RI, USA
| | - Kali S Thomas
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI, USA; Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA; US Department of Veterans Affairs Medical Center, Providence, RI, USA
| | - Miranda B Olson
- Center for Long-Term Care Quality & Innovation, Brown University School of Public Health, Providence, RI, USA
| | - Esme E Zediker
- Center for Long-Term Care Quality & Innovation, Brown University School of Public Health, Providence, RI, USA
| | - Rebecca Uth
- Department of Biostatistics, Brown University School of Public Health, Providence, RI, USA
| | - Renée R Shield
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA; Department of Biostatistics, Brown University School of Public Health, Providence, RI, USA
| | - Vincent Mor
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI, USA; Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA; Center for Long-Term Care Quality & Innovation, Brown University School of Public Health, Providence, RI, USA; US Department of Veterans Affairs Medical Center, Providence, RI, USA
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McCreedy EM, Gutman R, Baier R, Rudolph JL, Thomas KS, Dvorchak F, Uth R, Ogarek J, Mor V. Measuring the effects of a personalized music intervention on agitated behaviors among nursing home residents with dementia: design features for cluster-randomized adaptive trial. Trials 2021; 22:681. [PMID: 34620193 PMCID: PMC8496617 DOI: 10.1186/s13063-021-05620-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 09/13/2021] [Indexed: 11/10/2022] Open
Abstract
Background Agitated and aggressive behaviors (behaviors) are common in nursing home (NH) residents with dementia. Medications commonly used to manage behaviors have dangerous side effects. NHs are adopting non-pharmacological interventions to manage behaviors, despite a lack of effectiveness evidence and an understanding of optimal implementation strategies. We are conducting an adaptive trial to evaluate the effects of personalized music on behaviors. Adaptive trials may increase efficiency and reduce costs associated with traditional RCTs by learning and making modifications to the trial while it is ongoing. Methods We are conducting two consecutive parallel cluster-randomized trials with 54 NHs in each trial (27 treatment, 27 control). Participating NHs were recruited from 4 corporations which differ in size, ownership structure, geography, and residents’ racial composition. After randomization, there were no significant differences between the NHs randomized to each trial with respect to baseline behaviors, number of eligible residents, degree of cognitive impairment, or antipsychotic use. Agitated behavior frequency is assessed via staff interviews (primary outcome), required nursing staff conducted resident assessments (secondary outcome), and direct observations of residents (secondary outcome). Between the two parallel trials, the adaptive design will be used to test alternative implementation strategies, increasingly enroll residents who are likely to benefit from the intervention, and seamlessly conduct a stage III/IV trial. Discussion This adaptive trial allows investigators to estimate the impact of a popular non-pharmaceutical intervention (personalized music) on residents’ behaviors, under pragmatic, real-world conditions testing two implementation strategies. This design has the potential to reduce the research timeline by improving the likelihood of powered results, increasingly enrolling residents most likely to benefit from intervention, sequentially assessing the effectiveness of implementation strategies in the same trial, and creating a statistical model to reduce the future need for onsite data collection. The design may also increase research equity by enrolling and tailoring the intervention to populations otherwise excluded from research. Our design will inform pragmatic testing of other interventions with limited efficacy evidence but widespread stakeholder adoption because of the real-world need for non-pharmaceutical approaches. {2a} Trial registration ClinicalTrials.govNCT03821844. Registered on January 30, 2019. This trial registration meets the World Health Organization (WHO) minimum standard. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05620-y.
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Affiliation(s)
- Ellen M McCreedy
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, 121 South Main St., Box G-S121-6, Providence, RI, 02912, USA. .,Department of Health Services, Policy & Practice, Brown University School of Public Health, 121 South Main St., Providence, RI, 02912, USA. .,Center for Long-Term Care Quality & Innovation, Brown University School of Public Health, 121 South Main St., Providence, RI, 02912, USA.
| | - Roee Gutman
- Department of Biostatistics, Brown University School of Public Health, 121 South Main St., Providence, RI, 02912, USA
| | - Rosa Baier
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, 121 South Main St., Box G-S121-6, Providence, RI, 02912, USA.,Department of Health Services, Policy & Practice, Brown University School of Public Health, 121 South Main St., Providence, RI, 02912, USA.,Center for Long-Term Care Quality & Innovation, Brown University School of Public Health, 121 South Main St., Providence, RI, 02912, USA
| | - James L Rudolph
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, 121 South Main St., Box G-S121-6, Providence, RI, 02912, USA.,Department of Health Services, Policy & Practice, Brown University School of Public Health, 121 South Main St., Providence, RI, 02912, USA.,U.S. Department of Veterans Affairs Medical Center, 830 Chalkstone Ave., Providence, RI, 02908, USA
| | - Kali S Thomas
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, 121 South Main St., Box G-S121-6, Providence, RI, 02912, USA.,Department of Health Services, Policy & Practice, Brown University School of Public Health, 121 South Main St., Providence, RI, 02912, USA.,U.S. Department of Veterans Affairs Medical Center, 830 Chalkstone Ave., Providence, RI, 02908, USA
| | - Faye Dvorchak
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, 121 South Main St., Box G-S121-6, Providence, RI, 02912, USA
| | - Rebecca Uth
- Center for Long-Term Care Quality & Innovation, Brown University School of Public Health, 121 South Main St., Providence, RI, 02912, USA
| | - Jessica Ogarek
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, 121 South Main St., Box G-S121-6, Providence, RI, 02912, USA
| | - Vincent Mor
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, 121 South Main St., Box G-S121-6, Providence, RI, 02912, USA.,Department of Health Services, Policy & Practice, Brown University School of Public Health, 121 South Main St., Providence, RI, 02912, USA.,Center for Long-Term Care Quality & Innovation, Brown University School of Public Health, 121 South Main St., Providence, RI, 02912, USA.,U.S. Department of Veterans Affairs Medical Center, 830 Chalkstone Ave., Providence, RI, 02908, USA
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Esposito-Smythers C, Spirito A, Uth R, LaChance H. Cognitive Behavioral Treatment for Suicidal Alcohol Abusing Adolescents: Development and Pilot Testing. Am J Addict 2006; 15 Suppl 1:126-30. [PMID: 17182428 PMCID: PMC1821071 DOI: 10.1080/10550490601006188] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
The purpose of this study was to pilot a cognitive behavioral treatment protocol for adolescents with co-occurring alcohol use disorder and suicidality, examine its association with symptomatic improvement, and determine its feasibility and acceptability. Treatment consisted of a 6 month acute treatment phase, 3 month maintenance phase, and a 3 month booster phase, as well as case management services. Participants were also permitted to receive concurrent pharmacotherapy. Five of six families completed the protocol. Measures of alcohol use and suicidality were collected at intake, end of acute treatment, and post-treatment. Decreases in alcohol use and suicidal ideation were reported for all participants. Two of the five participants, both with a prior history of suicide attempts, re-attempted during the course of the protocol. Both were maintained in the study and improved over the subsequent portion of the treatment. A high retention rate, strong therapeutic alliance ratings, and low perceived treatment obstacles provide support for the feasibility and acceptability of this intervention. Preliminary results suggest that integrated outpatient cognitive behavioral treatment for alcohol abusing suicidal adolescents is feasible, acceptable, and associated with symptomatic improvement.
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