Improving Outcomes of Adolescents in Residential Substance use Treatment via a Technology-Assisted Parenting Intervention

Project Description
Adolescents in residential substance use (SU) treatment have the most serious SU disorders and the highest
rates of psychological, behavioral, legal, environmental, and vocational problems. Adolescents in residential
SU treatment are also at high risk of relapse, with follow-up studies demonstrating that 60% of discharged
adolescents relapse within 90 days. Parenting practices, including parental monitoring and parent-adolescent
communication, have been established as key predictors of adolescent SU outcomes and likelihood of relapse,
but parents are notoriously difficult to engage in adolescent SU treatment. Accordingly, there is a clear need for
effective, accessible, and scalable interventions for parents of adolescents receiving residential SU treatment.
Building upon our successful NIDA-funded R34, this study evaluates a technology-assisted parenting
intervention called Parent SMART (Substance Misuse among Adolescents in Residential Treatment), which
has evidence of high feasibility and acceptability, as well as preliminary evidence of effectiveness, as an
adjunct to short-term residential treatment as usual (TAU). Parent SMART centers around an off-the-shelf
computerized intervention, Parenting Wisely (PW), which has demonstrated robust evidence of improving
parenting skills and reducing youth behavior problems in multiple clinical trials. We conducted extensive
formative research with parents, adolescents, and residential staff to guide the development and delivery of
two highly scalable enhancements: 1) access to a state-of-the-art mobile networking app; and 2) up to four
telehealth coaching sessions to tailor PW content. Our networking app allows parents to submit questions to
an SU expert and connect with other parents of adolescents in residential SU treatment in real-time, while
reinforcing parenting skills via “Tip of the Day!” push notifications. In our pilot trial, Parent SMART was highly
feasible and acceptable, and demonstrated evidence of effectiveness in improving parental monitoring and
communication, reducing days of adolescent binge drinking and all other drug use, and reducing school-related
problems, among parents in short-term residential treatment. This R01 proposes a fully powered evaluation of
Parent SMART. Adolescent-parent dyads (n = 220 dyads; 440 in total) will be randomized to receive either
TAU only or Parent SMART + TAU. Multi-method follow-up assessments (i.e., self-report parent and
adolescent measures, parent-adolescent in vivo interaction task, 8-panel urine screens) will be conducted 6-,
12-, and 24-weeks post-discharge, to examine parenting skills, adolescent SU, and adolescent problem
behaviors. Exploratory analyses will test whether improvements in parenting skills partially mediate reductions
in adolescent SU. The proposed research has the potential to advance the field by: serving a high-need,
underserved population during a vital treatment juncture; targeting parenting practices (putative mediators) that
have been shown to predict adolescent SU outcomes; addressing barriers to accessing continuing care; and
testing a highly scalable intervention model informed by extensive formative research.

Grant Number: 5R37DA052918-05
NIH Institute/Center: NIH
Principal Investigator: Sara Becker