Parent SMART (Substance Misuse in Adolescents in Residential Treatment)

Building upon a successful National Institute on Drug Abuse (NIDA)-funded R34, this study evaluates a technology-assisted parenting intervention with evidence of high feasibility and acceptability, as well as preliminary evidence of effectiveness as an adjunct to residential treatment as usual (TAU). Specifically, this study involves a fully powered evaluation of Parent SMART (Substance Misuse among Adolescents in Residential Treatment), which was developed based on extensive formative research with parents, adolescents, and residential treatment staff, and subsequently tested in a NIDA-funded pilot trial.

Parent SMART was intentionally designed with scalability in mind. It consists of an off-the-shelf computer program called Parenting Wisely (PW) that has robust evidence of efficacy in improving parenting skills and reducing youth behavior problems across five clinical trials. Guided by formative research, Parent SMART augments PW with four telehealth coaching sessions and access to a state-of-the-art, mobile networking forum (available via both mobile phone app and web browser), where parents can submit questions to an expert and connect with other parents of adolescents in residential substance use treatment. Parent SMART was piloted at both short (i.e., 6-10 day length of stay) - and long-term (i.e., 30-45 day length of stay) residential facilities: the model was feasible and acceptable in both settings, and effective at improving parental monitoring and communication in both settings. In the short-term setting, Parent SMART was also effective at reducing days of substance use (i.e., days of binge drinking, days of all other drug use) and reducing school problems: the pilot project was underpowered to detect differences at the long-term setting. The current trial is a fully powered evaluation of Parent SMART as an adjunct to residential treatment as usual.

Adolescent-parent dyads (n = 220; 440 participants) will be randomized to receive either residential treatment as usual (TAU) only or Parent SMART + TAU. Those randomized to TAU will be offered the technology-delivered elements of Parent SMART at the 6-month follow-up. Parent SMART telehealth sessions will be delivered by bachelor's and master's level counselors to enhance scalability. Multi-method follow-up assessments (i.e., self-report measures, videotaped interaction task, urine screens) will be conducted 6-, 12-, and 24-weeks post-discharge.

The primary aims of this study is to examine the effectiveness of Parent SMART as an adjunctive treatment, relative to adolescent residential treatment-as-usual on: parenting processes (Primary Aim 1) and adolescent substance use outcomes (Primary Aim 2). A secondary aim is to test the effectiveness of Parent SMART compared to residential treatment-as-usual on adolescent high-risk behaviors. An additional Exploratory Aim will test whether change in parenting processes mediates change in adolescent substance use outcomes.

Pursuit of these aims is significant given the potential to improve the outcomes of adolescents following discharge from residential substance use treatment by offering their parents a novel technology-assisted intervention. Technology-assisted interventions have the potential for marked public health impact by extending the reach, duration, and scalability of evidence-based care.

Inclusion criteria

for Adolescents:

• admitted to residential treatment due to concerns about frequency and/or severity of substance use
• report alcohol and/or drug use in the past 90 days
• be discharged to live with primary guardian
• fluent in English or Spanish
• willing and able to participate in a 2 hour interview prior to discharge from residential

Exclusion criteria

for Adolescents:

• does not report alcohol or drug use in the past 90 days
• discharge plan does not include living with primary guardian
• not fluent in English or Spanish
• not willing or able to complete baseline interview

Inclusion criteria

for Parents:

• parent or legal guardian of adolescent aged 12-18 years inclusive, at project start
• adolescent admitted to residential treatment due to concerns about frequency and/or severity of substance use
• will be primary guardian living with adolescent after discharge from residential
• fluent in English or Spanish
• willing and able to complete the baseline assessment prior to the adolescent's discharge
• access to a smartphone that can receive text messages and reliably access the internet

Exclusion criteria

for Parents:

• not legal guardian of adolescent or adolescent not aged between 12-18 years
• adolescent not admitted to residential treatment due to substance use concerns
• will not be living with adolescent after adolescent's discharge from residential
• not fluent in English or Spanish
• not willing or able to complete the baseline assessment prior to the adolescent's discharge
• does not have access to a smartphone that can receive text messages and reliably access the internet