FAMILY THERAPY VIA VIDEO TELECONFERENCE FOR SUBSTANCE-ABUSING RURAL ADOLESCENTS
Barrett Holly
Oregon Research Institutecity: Eugene country: United States (us)
Grant 1R01DA032260-01A1 from National Institute On Drug Abuse
Abstract: It has been well documented that only about 10% of adolescents with clinically diagnosable substance use problems receive treatment in any given year. One of the major contributing factors to chronic levels of unmet need for treatment among this population is the unavailability and inaccessibility of treatment services. Service accessibilty is particularly limited in rural areas. To address problems of service availability and accessibiliy in rural areas, the use of video teleconferencing technology to provide direct services has emerged within the fields of medicine and psychiatry in particular. The use of such technology to enhance the delivery of behavioral psychotherapy is beginning to emerge as well. A handful of primarily small-scale pilot and feasibility studies indicate that psychotherapy interventions administered using video teleconferencing technology may be as effective as traditional face-to-face interventions. Few randomized clinical trials of telepsychotherapy have been conducted to date, however, and virtually have examined video teleconferencing interventions for any type of child or adolescent behavioral problem including substance abuse. The proposed study is intended to address the need for research evaluating the application of video teleconferencing technology as a means of service delivery for substance abusing adolescents and their families living in rural areas. Specifically, the current proposal is a randomized clinical trial testing th efficacy of Functional Family Therapy (FFT) administered by video teleconference (FFT-V) in the homes of substance abusing adolescents. In the proposed investigation, FFT-V will be compared with FFT administered face-to- face in the family home as well as to a services-as-usual (SAU) condition. The overarching objective of the study is to examine the degree to which an empirically based model of substance abuse treatment such as FFT can be effectively administered via video teleconferencing to adolescents and families living in rural and remote areas who would be otherwise unlikely to access treatment. The specific aims of the proposed study are to (1) evaluate the efficacy of FFT-V compared to FFT and SAU in reducing adolescent drug use, HIV risk behavior, delinquency, and recidivism, (2) evaluate the efficacy of FFT-V compared to FFT in establishing functional levels of therapeutic alliance formation, treatment attendance, retention, and satisfaction with treatment, (3) evaluate the efficacy of FFT-V compared to FFT and SAU in impacting core mechanisms of change in adolescent behavior including improved levels of family functioning and adolescent association with substance using peers, and (4) conduct a preliminary cost-effectiveness analysis to derive initial estimates of the relative costs of each treatment modality per outcome unit. . It is well known that adolescents and families in rural communities face substantial limitations in the availability and accessibility of substance abuse treatment and other health care services. This study addresses this disparity in access to services by investigating the feasibility and efficacy of providing treatment for substance abuse and associated behavioral problems such as delinquency and HIV risk behavior to adolescents in rural areas using web-based video teleconferencing technology
Keywords: Address; Adolescent; Adolescent Behavior; adolescent drug use; adolescent substance abuse; adolescent substance use; Affect; Aftercare; Alcohol or Other Drugs use; Area; base; Behavior Therapy; Behavioral; Child; Chronic; Clinical; Clinical effectiveness; community setting; Complex; cost; cost effective; Cost Effectiveness Analysis; County; Diagnostic; Diffusion of Innovation; Drug abuse; Drug Formulations; Evaluation; Evidence based treatment; Face; Family; Family psychotherapy; Feasibility Studies; follow-up; health care delivery; Health Services; Health Services Accessibility; HIV; Home environment; implementation science; improved; Intervention; Investigation; Life; Lifestyle-related condition; Medicine; meetings; Modality; Modeling; Motivation; New Mexico; Online Systems; Outcome; Parents; Participant; peer; Persons; Pilot Projects; Population; probation; Problem behavior; Process; Psychiatry; Psychotherapy; Public Policy; Randomized; Randomized Clinical Trials; recidivism; Relative (related person); Research; Risk; Risk Behaviors; Rural; rural area; Rural Community; satisfaction; Services; Substance abuse problem; substance abuse treatment; Substance Addiction; Substance Use Disorder; Technology; Technology Transfer; Teleconferences; Testing; theories; Therapeutic; Treatment Efficacy; Youth
Relevance: It is well known that adolescents and families in rural communities face substantial limitations in the availability and accessibility of substance abuse treatment and other health care services. This study addresses this disparity in access to services by investigating the feasibility and efficacy of providing treatment for substance abuse and associated behavioral problems such as delinquency and HIV risk behavior to adolescents in rural areas using web-based video teleconferencing technology
Project start date: 2012-02-01
Project end date: 2015-11-30
Budget start date: 1-FEB-2012
Budget end date: 30-NOV-2012
1R01DA032260-01A1 (2012): $666860
Sponsored Links Excellgen http://Excellgen.com
Grants awarded to Barrett Holly
ADOLESCENT SUBSTANCE ABUSE: PROGRESSIVE TREATMENT
Barrett Holly, Research Scientist
Oregon Research Institutecity: Eugene country: United States (us)
Grant 5R01DA023568-05 from National Institute On Drug Abuse
Abstract: Project Summary Research on efficacious adolescent substance abuse interventions over the past two decades has consistently demonstrated heterogeneity of response to treatment. Key challenges for the .field include understanding these various response trajectories and establishing strategies to adapt treatments to enhance their effectiveness for those who are not responsive to standard interventions. Such research is critically needed to inform treatment services providers on optimal care strategies. An important advance in treatment services research efforts is the increasing movement away from a "one-size-fits-all" perspective inherent in standardized interventions and a call for the development of adaptive interventions that incorporate treatment algorithms to aid clinical decision-making. The Sequential Multiple Assignment Randomized Trial (SMART) outlines a process whereby a series of randomizations within an individual study is used to create an optimal adaptive intervention. We propose two studies to examine the efficacy of eight potential adaptive treatment strategies using the SMART design. Study 1 goals are twofold (1) to examine which of two distinct sets of criteria for defining early treatment response (abstinence vs. minimal use) is the best guide for subsequent treatment decisions, i.e., how best to determine when response to a minimal treatment intervention is "good enough" for an adolescent to step out of treatment without risking a significant relapse. (2) to determine which of two stepped adaptive interventions result in better outcomes for treatment non-responders and relapsers an enhanced version of the same treatment or a new treatment? Participants (n=80) will receive an initial dose of treatment consisting of MET/CBT8. At completion, participants will be randomly assigned, in sequential steps, to one of two treatment response criteria and, if needed, one of two stepped interventions. Pre- to post-treatment outcomes will be examined using the SMART protocol framework to identify the specific clinical components comprising the optimal adaptive treatment strategy in response to a particular treatment outcome. Study 2 is a pilot (n=60) test of the efficacy of the optimal adaptive strategy identified in Study 1 vs. a standard MET/CBT 12 group intervention, with follow up assessments at 3 and 6 months post-treatment. Relevance This research will provide a systematic set of optimal decision rules for treatment agencies on how best to proceed when adolescents receiving an initial course of MET/CBT8 show initial treatment response, persist in their substance use, or demonstrate an initial treatment response followed by later relapse. This type of "practical" clinical trial begins the long overdue process of addressing critical gaps between traditional treatment efficacy research and key questions that emerge in clinical practice such as determining when adolescents have received sufficient treatment, how to proceed when initial treatment efforts are not effective, and how best to address relapse. Mechanisms of change will also be examined in Study 2
Keywords: Abstinence; Accounting; Address; Adolescent; adolescent substance abuse; adolescent substance use; Adopted; Aftercare; Alcohol or Other Drugs use; Algorithms; Ally; Attention; Back; base; Biological Assay; Caring; Clinical; clinical decision-making; clinical practice; Clinical Trials; Clinical Trials Design; clinically significant; Cognitive Therapy; Coping Behavior; Cost Allocation; Decision Making; design; Development; dosage; Dose; Drug usage; Early treatment; Effectiveness; efficacy research; efficacy testing; Empirical Research; Ensure; Evaluation; Experimental Designs; Family; Family psychotherapy; Family Relationship; follow up assessment; Foundations; Frequencies (time pattern); Goals; group intervention; Guidelines; Health Services Research; Heterogeneity; Individual; Individual Differences; Intervention; Investigation; Judgment; Link; Literature; Maintenance; Measurement; Mediating; meetings; Mental Depression; Methods; Modeling; Motivation; motivational enhancement therapy; Movement; Outcome; Participant; Patient Self-Report; peer; pilot trial; Play; Problem behavior; Process; programs; Protocols documentation; Provider; Randomized; Randomized Clinical Trials; randomized trial; rehearsal; Relapse; Relative (related person); Research; research and development; Research Priority; Research Project Summaries; Resources; response; Risk; Role; Sampling; Series; Services; skills; Staging; standard care; Substance abuse problem; substance abuse treatment; Substance Addiction; Substance Use Disorder; success; Testing; Time; Toxicology; treatment effect; Treatment Effectiveness; Treatment Efficacy; Treatment outcome; Treatment Protocols; treatment response; treatment strategy; Urine; Youth
Project start date: 2007-08-15
Project end date: 2012-05-31
Budget start date: 1-JUN-2011
Budget end date: 31-MAY-2012
PFA/PA: PA-05-139
5R01DA023568-05 (2011): $527037
FUNCTIONAL FAMILY THERAPY FOR ADOLESCENT SUBSTANCE ABUSE IN CHILE
Barrett Holly, Research Scientist
Oregon Research Institutecity: Eugene country: United States (us)
Grant 5R03TW008705-02 from Fogarty International Center
Abstract: Advances in treating adolescent problem behaviors have resulted in an increased emphasis on redirecting resources to transport evidence-based treatments (EBTs) into clinical practice settings. Efforts to transport efficacious interventions and evaluate the effectiveness of EBTs in global regions where adolescent drug abuse and delinquency represent challenges have been rare. Additionally, training of scientists in developing countries to strengthen the research infrastructure can provide the framework for introducing and maintaining EBTs in these countries. Studies have revealed that adolescent drug use is growing exponentially in many countries in South America, including Chile. However, no EBTs for drug abuse have yet been transported to or developed there. There is consensus, however, among Chilean researchers, mental health leaders, and governmental agencies that adopting EBTs for drug abuse and related problems is a critical next step to improving treatment outcomes nation-wide. The confluence of a ready clinical infrastructure, laws favoring drug treatment availability, and scientists poised and motivated to develop a research expertise to implement and evaluate treatments places Chile in a unique position to pursue research evaluating EBTs for drug abusing youth. One intervention approach that holds great promise for dissemination and evaluation in Chile is Functional Family Therapy (FFT), a widely-disseminated intervention program for youth with behavior problems that is supported by more than three decades of research. The effectiveness of FFT for adolescents with conduct/delinquent behaviors has been replicated across sites, settings, and service providers with diverse backgrounds and training. Further, FFT is a well established treatment for adolescent substance abuse and has been shown to be particularly efficacious for Hispanic American families in the United States. Thus, the overarching goals of the proposed research are to 1) evaluate the feasibility and promise of FFT, as implemented by community-based practitioners in Santiago, Chile, on adolescent drug use and conduct/delinquent behaviors, and 2) to mentor Chilean scientists within a collaborative effort to extend their expertise to clinical areas with the long term goal of conducting randomized clinical trials (RCTs) in the treatment of adolescent substance abuse themselves. Families (n=32) of drug abusing adolescents referred to outpatient treatment facilities in Santiago, will receive SAU (services as usual) or FFT+SAU (FFT in the context of usual services). The three specific clinical aims of this project are 1) To examine differences between FFT+SAU vs SAU in improving treatment outcomes for both delinquency and drug abuse. 2) To examine differences between FFT+SAU and SAU in improving families´ engagement and retention in treatment. 3) To examine differences between FFT+SAU and SAU in improving family functioning. The successful completion of this project will provide a foundation for future RCT research led by Chilean scientists. Adolescent drug use in Chile has grown dramatically in recent years and effective treatments are urgently needed. The proposed study is designed to evaluate the implementation of an evidence-based family treatment adapted to Chilean cultural customs and practices. The collaborative aspects of this study will foster the development of research capacity in a developing country
Keywords: Adolescent; adolescent drug abuse; adolescent drug use; adolescent substance abuse; adolescent substance use; Adopted; Area; base; Behavior; Chile; Clinical; clinical infrastructure; clinical practice; Clinical Research; Collaborations; Communities; Competence; Consensus; Country; Custom; design; Developing Countries; Development; Drug abuse; Drug abuser; Drug usage; effective therapy; Effectiveness; Epidemiologic Studies; Evaluation; evidence base; Evidence based treatment; Family; Family psychotherapy; follow-up; Fostering; Foundations; functional outcomes; Future; Goals; Government; Hispanic Americans; improved; interest; International; Intervention; intervention program; Justice; Laws; Mental Health; Mentors; Modeling; Netherlands; Outpatients; Pharmaceutical Preparations; Pilot Projects; Play; Population; Positioning Attribute; Problem behavior; Process; Provider; public health relevance; Randomized Clinical Trials; Relative (related person); Research; research and development; Research Infrastructure; Research Methodology; Research Personnel; Resources; Role; Scientist; Services; Site; South America; Supervision; System; theories; Training; Treatment outcome; treatment site; United States; Work; Youth
Relevance: Adolescent drug use in Chile has grown dramatically in recent years and effective treatments are urgently needed. The proposed study is designed to evaluate the implementation of an evidence-based family treatment adapted to Chilean cultural customs and practices. The collaborative aspects of this study will foster the development of research capacity in a developing country
Project start date: 2010-07-01
Project end date: 2013-06-30
Budget start date: 1-JUL-2011
Budget end date: 30-JUN-2012
PFA/PA: PAR-08-223
5R03TW008705-02 (2011): $74834