Effectiveness of the Treatment Readiness and Induction Program for increasing adolescent motivation for change

Effect of applying mindfulness-based relapse prevention nursing program on readiness for change and self-efficacy among clients with substance use disorders: A randomized control trial

OBJECTIVE

Investigate the effect of applying mindfulness-based relapse prevention on readiness for change and self-efficacy among patients with substance use disorders.

DESIGN

A randomized controlled trial with two parallel arms was conducted among 100 male inpatients with substance use disorders, equally divided into a study group and a control group (50 clients in each). Tools included the Five Factors Mindfulness Questionnaire, the Stages of Change Readiness and Treatment Eagerness Scale, and the Drug Abstinence Self-Efficacy Scale.

RESULTS

The study group exhibited significant and immediate improvement in mindfulness post-intervention, with a large effect size sustained to one month. The intervention markedly enhanced mindfulness significantly more than the control group. The study group demonstrated a significant increase in readiness for change and an immediate significant reduction in temptation-related self-efficacy. In addition, there was a significant increase in confidence-related self-efficacy among the study group, more than in the control group.

CONCLUSION

The improvement of the five factors of mindfulness following participation in mindfulness-based relapse Prevention was associated with enhanced readiness for change and self-efficacy among patients with substance use disorders in the study group, in contrast to minimum improvement in the control group.

IMPLICATIONS FOR NURSING PRACTICE

Our findings suggest that psychiatric nurses can effectively integrate mindfulness-based Relapse Prevention into treatment protocols for substance use disorders, thereby enhancing patient outcomes. Their responsibilities include facilitating mindfulness-based relapse prevention sessions, a practice that can empower patients with valuable skills to navigate the challenges of recovery and maintain abstinence.

Mechanisms of Behavior Change in Adolescent Substance Use Treatment: A Systematic Review of Treatment Mediators and Recommendations for Advancing Future Research

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.

Implementation of Substance Use Services to Justice-Involved Youth: Examining Barriers, Facilitators, and Best Practices

Justice-involved youth are known to be at elevated risk of substance use disorder (SUD). This review examines literature published over a 10-year period and summarizes evidence-based practices for screening, treatment, and linkage to care for justice-involved youth as well as barriers and facilitators that may arise during implementation. Strategies to incorporate a health equity lens and trauma-informed approaches are discussed. Despite high prevalence of substance use and research showing that treatment reduces recidivism, few juvenile justice systems universally screen and treat youth with SUD. There is limited developmentally appropriate guidance available for those seeking to better address substance use in juvenile justice settings. This review highlights gaps in the literature, which must be addressed to increase access to treatment and improve outcomes for this vulnerable youth population.

Decision-Making Styles as a Moderator on the Efficacy of the StaySafe Tablet Intervention

Background: People with substance use disorders often differ in their decision-making styles. The present study addressed the impact of two decision-making styles (rational and dependent) on outcomes from a StaySafe tablet computer app intervention designed to improve decision-making around health risk behaviors and previously found to be effective for justice-involved people receiving treatment for a substance use disorder and under community supervision. Objectives: Participants were justice-involved residents in residential treatment. After completing a baseline survey, participants were randomly assigned to either complete the StaySafe app or to a standard procedure condition; and then asked to complete a post-intervention survey three months after baseline (this protocol has been registered with clinicaltrials.gov NCT02777086): 348 participants completed a baseline survey and 238 completed the post-test survey. Outcomes included measures of confidence and motivation around HIV knowledge and risks and getting tested. Multilevel analyses addressed the hypothesis that outcomes were related to decision-making style. Multiple imputation (MI) was used to address the effects of missing data. Results: StaySafe was more effective for those in the lower half of the decision-making dependent scale for HIV risks (HIV-Knowledge, Hepatitis testing, HIV Services testing, and Sex Risk, as well as motivation for treatment. The decision-making rational scale was less consistently related to HIV risk. Conclusions: The present study showed individuals with substance use disorders who differed in their decision-making styles reacted differently to the StaySafe intervention. Two scales, rational decision making, and dependent decision making are relevant to consider with respect to interventions targeting improving decision making among drug users.

The effectiveness of blended versus regular Forensic Outpatient Systemic Therapy in the treatment of juvenile antisocial behavior: a study protocol of a randomized controlled trial

BACKGROUND

Antisocial behavior during adolescence can have long-lasting negative effects and leads to high societal costs. Forensic Outpatient Systemic Therapy (Forensische Ambulante Systeem Therapie; FAST) is a promising treatment for juveniles aged 12-21 showing severe antisocial behavior. The intensity, content and duration of FAST can be adjusted to the needs of the juvenile and their caregiver(s), which is considered crucial for effective treatment. Next to the regular version of FAST (FASTr), a blended version (FASTb) in which face-to-face contacts are replaced by minimally 50% online contacts over the duration of intervention was developed during the Covid-19 pandemic. The current study will investigate whether FASTb is equally effective as FASTr, and through which mechanisms of change, for whom, and under which conditions FASTr and FASTb work.

METHODS

A randomized controlled trial (RCT) will be carried out. Participants (N = 200) will be randomly assigned to FASTb (n = 100) or FASTr (n = 100). Data collection will consist of self-report questionnaires and case file analysis, and include a pre-test at the start of the intervention, a post-test immediately after the intervention, and a six month follow-up. Mechanisms of change will be investigated using monthly questionnaires of key variables during treatment. Official recidivism data will be collected at two-year follow-up.

DISCUSSION

This study aims to improve the effectiveness and quality of forensic mental health care for juveniles with antisocial behavior by studying the effectiveness of blended care, which has not been studied before in treatment of externalizing behavior. If found to be at least as effective as face-to-face treatment, blended treatment can help meet the urgent need for more flexible and efficient interventions in this field. In addition, the proposed study aims to unravel what works for whom, knowledge urgently needed in mental health care for juveniles with severe antisocial behavior.

TRIAL REGISTRATION

This trial was registered at ClinicalTrials.gov on 07/11/2022, registration number NCT05606978.

Avoidance Self-Efficacy: Personal Indicators of Risky Sex and Substance Use among At-Risk Youth

Adolescent substance use (SU) is associated with risky sex behavior and sexually transmitted infections and is a risk factor for subsequent risky sex decisions. Based on a sample of 1,580 youth in residential SU treatment, this study investigated how a static factor (race) and two dynamic personal factors (risk-taking, assertiveness) contributed to adolescents' perceived ability to avoid high-risk SU and sex behavior (avoidance self-efficacy). Results showed that race correlated with risk-taking and assertiveness, with White youth reporting higher ratings of assertiveness and risk-taking. Self-reported assertiveness and risk-taking also predicted SU and risky sex avoidance. This study underscores the importance of race and personal factors in relation to adolescents' confidence in avoiding high-risk situations.

An evaluation of StaySafe, a tablet app to improve health risk decision-making among people under community supervision

BACKGROUND

A self-administered tablet app, StaySafe, helps people under community supervision to make better decisions regarding health risk behaviors, especially those linked to HIV, viral hepatitis, and other sexually transmitted infections. The multi-session StaySafe design uses an interactive, analytical schema called WORKIT that guides users through a series of steps, questions, and exercises aimed at promoting critical thinking about health risks associated with substance use and unprotected sex. Repetition of the WORKIT schema is designed to enhance procedural memory that can be rapidly accessed when individuals are faced with making decisions about risky behaviors.

METHODS

A total of 511 participants under community supervision in community and residential treatment settings from three large Texas counties completed consent forms and baseline surveys, followed by randomization to one of two conditions: 12 weekly StaySafe sessions or standard practice (SP). The study also asked participants to complete a follow-up survey three months after baseline. Outcome measures included knowledge, confidence, and motivation (KCM) scales around HIV knowledge, avoiding risky sex, HIV services, and reducing health risks; decision-making; and reports of talking about issues such as making better decisions, avoiding HIV risks, and HIV prevention or treatment with others (probation officers, counselors, trusted friend or advisor, or family members).

RESULTS

Participants in both community and residential settings voluntarily completed multiple StaySafe sessions, with those in the residential settings completing more sessions. When compared with SP participants, StaySafe participants showed greater improvement in the KCM measures-HIV knowledge, avoiding sex risks, HIV services, and risk reduction skills. In addition, greater improvements in the KCM measures as well as an increased likelihood to discuss issues with others were associated with completing more StaySafe sessions.

CONCLUSION

These results suggest that the StaySafe app is a feasible and potentially effective tool for improving health risk reduction decision-making for individuals under community supervision.

Evidence Base on Outpatient Behavioral Treatments for Adolescent Substance Use, 2014-2017: Outcomes, Treatment Delivery, and Promising Horizons

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.

Correlates of Treatment Readiness among Formerly Incarcerated Homeless Women

Treatment readiness is a key predictor of drug treatment completion, rearrest, and recidivism during community reentry; however, limited data exists among homeless, female ex-offenders (HFOs). The purpose of this study was to present baseline data from a randomized controlled trial of 130 HFOs who had been released from jail or prison. Over half (60.8%) of HFOs had a treatment readiness score of ≥ 40 (n = 79, μ = 40.2, SD = 8.72). Bivariate analyses revealed that methamphetamine use, psychological well-being, and high emotional support were positively associated with treatment readiness. On the other hand, depressive symptomology and depression/anxiety scores were negatively associated with the treatment readiness score. Multiple linear regression revealed that depressive symptomology was negatively associated with treatment readiness (β = -0.377; p = .001). Further analyses revealed that the effect of emotional support on treatment readiness was mediated by depressive symptomatology.

StaySafe: A self-administered android tablet application for helping individuals on probation make better decisions pertaining to health risk behaviors

This paper describes the development and protocol for feasibility and efficacy testing of a risk reduction intervention designed to improve behavioral health outcomes among drug offenders on probation under community supervision or in residential substance abuse treatment centers. StaySafe is a self-administered tablet-based intervention for teaching better decision-making skills regarding health risk behaviors, especially those involving HIV risks. We are using pre/post, experimental/control group randomized clinical trial (RCT) in both community and residential probation settings with goals to 1) assess the feasibility and acceptance of StaySafe by examining participation rates and satisfaction measures, and 2) examine the impact of StaySafe on decision-making skills, confidence and motivation to avoid sex and drug risks, willingness to discuss health risks and concerns with helpful others, and engagement in health risk behaviors. StaySafe consists of 12 brief sessions and utilizes an evidence-based decision-making schema, called WORKIT, which guides participants through steps for identifying the problem and options, evaluating the options and making a decision about which option to carry out. Multiple sessions of StaySafe provide a practice effect so that the WORKIT steps become easily accessible to participants when making decisions. Three of the sessions provide participants a choice of activities designed to provide additional information about HIV and reinforce lessons learned during the WORKIT sessions. Preliminary data demonstrate feasibility and high levels of satisfaction with StaySafe.

A structural model of treatment program and individual counselor leadership in innovation transfer

BACKGROUND

A number of program-level and counselor-level factors are known to impact the adoption of treatment innovations. While program leadership is considered a primary factor, the importance of leadership among clinical staff to innovation transfer is less known. Objectives included explore (1) the influence of two leadership roles, program director and individual counselor, on recent training activity and (2) the relationship of counselor attributes on training endorsement.

METHODS

The sample included 301 clinical staff in 49 treatment programs. A structural equation model was evaluated for key hypothesized relationships between exogenous and endogenous variables related to the two leadership roles.

RESULTS

The importance of organizational leadership, climate, and counselor attributes (particularly counseling innovation interest and influence) to recent training activity was supported. In a subset of 68 counselors who attended a developer-led training on a new intervention, it was found that training endorsement was higher among those with high innovation interest and influence.

CONCLUSIONS

The findings suggest that each leadership level impacts the organization in different ways, yet both can promote or impede technology transfer.

Is Treatment Readiness Associated With Substance Use Treatment Engagement? An Exploratory Study

With nearly 8.2% of Americans experiencing substance use disorders (SUDs), a need exists for effective SUD treatment and for strategies to assist treatment participants to complete treatment programs (Chandler, Fletcher, & Volkow, 2009). The purpose of the current research is to contribute to an emerging knowledge base about treatment readiness and its utility for predicting substance use treatment process performance measures. The study examines the relative salience of treatment readiness as a predictor of treatment engagement. Data are derived from adult cases included in the 2012 Global Appraisal of Individual Needs-Intake data set ( n = 5,443). Binary logistic regression was used to identify if treatment readiness predicts substance use treatment engagement. The findings of this study do not provide support for treatment readiness significantly predicting substance use treatment engagement. Further research is needed to better understand treatment engagement.

The Effectiveness of the Treatment Readiness and Induction Program (TRIP) for Improving During-Treatment Outcomes

Treatment engagement is a primary pathway to change. Because motivation consistently predicts engagement and sustained recovery following treatment, targeted efforts at improving problem recognition (i.e., a significant ingredient in motivation) during early weeks of treatment are critical. The purpose of this study is to compare the effectiveness of Standard Operating Practice (SOP) versus SOP plus an 8-session Treatment Readiness and Induction Program (TRIP; delivered in the first weeks of treatment) on cognitive indicators and treatment engagement among youth in 5 residential substance use treatment settings. Structural Equation Modeling (SEM) documented higher problem recognition, decision making, and treatment engagement (participation, satisfaction, counselor rapport) among youth receiving TRIP (compared to SOP only), even when controlling for background characteristics such as age, race-ethnicity, gender, baseline drug use severity, etc. Findings suggest that TRIP is an effective induction tool that directly impacts targeted constructs (i.e., problem recognition, decision making), and also directly affects indicators of engagement.