Parent SMART (Substance Misuse in Adolescents in Residential Treatment): Pilot randomized trial of a technology-assisted parenting intervention

Abstract

Adolescents in residential level of care for substance-related problems have high risk of relapse following discharge. Parent engagement lowers relapse risk, but there are myriad barriers to engaging parents in residential treatment and continuing care. Parent SMART (Substance Misuse in Adolescents in Residential Treatment) is a technology-assisted parenting intervention that was designed to circumvent barriers associated with traditional, office-based continuing care interventions to better engage parents. This pilot randomized trial assessed the acceptability, feasibility, and preliminary effectiveness of Parent SMART as an adjunctive intervention to adolescent residential treatment-as-usual (TAU). Sixty-one parent-adolescent dyads were randomized to Parent SMART+TAU or TAU-only. Thirty-seven dyads were recruited from a short-term facility and 24 dyads were recruited from a long-term facility. Those randomized to Parent SMART received a multi-component technology-assisted intervention combining an off-the-shelf online parenting program, coaching sessions, and a parent networking forum. Parent and adolescent assessments were conducted at baseline, 6, 12, and 24-weeks post-discharge. Feasibility (e.g., parental effectiveness) and acceptability (e.g., parental satisfaction, willingness to recommend the intervention) benchmarks were specified a priori as the primary hypotheses. Secondary effectiveness indicators were the proportion of days adolescent used alcohol, cannabis, and any substance. All acceptability and feasibility benchmarks were met or exceeded among dyads in both short- and long-term residential. Generalized linear mixed models showed no significant effects pooled across sites. Analyses by facility revealed two significant time by condition interactions. Adolescents in short-term residential whose parents received Parent SMART showed fewer drinking days and fewer school problems over time, relative to adolescents whose parents received TAU. Results indicate that Parent SMART was both acceptable and feasible, with preliminary indication of effectiveness among those in short-term residential. A fully-powered trial is warranted to reliably test the effectiveness of Parent SMART and understand possible mechanisms of improvement.

Trial registration: ClinicalTrials.gov NCT03592186.

Keywords: Adolescent; Parent; Residential; Substance use; Technology-assisted.

Fig. 1.

CONSORT Diagrams a. CONSORT for Short-term Facility b. CONSORT for Long-term Facility.

Fig. 1.

CONSORT Diagrams a. CONSORT for Short-term Facility b. CONSORT for Long-term Facility.

Fig. 2.

Exemplar Content from the Parent SMART Networking Forum a. Forum Home Page b. Parent Post Example b. Example Text Messages. Note: Links are meant to be illustrative and are not active.

Fig. 3.

Significant Time by Condition Interactions at the Short-term Residential Facility. TAU = Treatment as Usual. Unadjusted data are based on Baseline n = 61, Week 6 n = 51, Week 12 n = 47, Week 24 n = 46. The figures present adjusted (estimated) means using all available data. Fig. 3a depicts the count distribution of the proportion of days used excluding the logit distribution.