Kimberlee J. Trudeau, Ph.D. - US grants

[unreadable] DESCRIPTION (provided by applicant): This proposed project develops and tests an interactive, multimedia (CD-ROM) adolescent alcohol and other drug assessment instrument called the Multimedia Addiction Severity Index for Adolescents (ASI-A-MV). This tool is intended for use with adolescents (aged 13-18 years) at the outset of substance abuse treatment or upon entry into the juvenile justice system to guide treatment planning. The numbers of adolescents with diagnosed substance abuse problems is distressing both in treatment facilities and in the criminal justice system. Reported statistics do not include youth with substance abuse issues who are institutionalized or otherwise in trouble but have not been identified as misusing substances. Adolescent alcohol and other drug use frequently occurs in a constellation with other risky behaviors. The financial and societal costs of alcohol and/or drug abuse by adolescents are high. Early substance abuse can significantly delay attainment of normative developmental tasks, and estimated health and criminal costs for a lifetime of heavy drug abuse are staggering. Such considerations highlight the importance of early assessment and treatment for adolescents who are struggling with substance use issues. In Phase I, a paper-version scripted flowchart of the ASI-A-MV was created. Phase II will entail production of the ASI-A-MV CD-ROM, usability testing of the program to ensure functionality, and a clinical field trial to finalize a scoring system and determine reliability and validity of the ASI-A-MV. [unreadable] [unreadable]

[unreadable] DESCRIPTION (provided by applicant): The potent physical, psychological, and social consequences of drug use by college students are as serious as those associated with alcohol use (if not more so), and underscore the need for prevention programming that reaches a majority of students. Beyond drug use, college students face health risks from alcohol use, tobacco use, unhealthy diet and inadequate physical activity, stress, and unsafe sexual behavior. To address drug use and other health risks Inflexxion has developed a comprehensive college health risk intervention called MyStudentBody.com (MSB). MSB is an innovative group of Web-based programs specifically targeting college students that aims to reduce health risks by providing tailored health information in the critical areas of drugs, alcohol, STDs, tobacco, stress, and nutrition, and physical activity. Many schools measure student health risk behavior, but very few use systematic means of measuring the efficacy of health risk programming. Empirical findings are often not used to support intervention strategies or measure outcomes, due in part to the lack of reliable and timely methods of gathering data to support campus administrators and health professionals in this endeavor. There is a critical need for effective tools to gather data on the effectiveness of campus health initiatives and measure outcomes. The proposed product, Campus Benchmark, will be a key component in Inflexxion's effort to build a comprehensive prevention infrastructure for college campuses. The product will provide school administrators and health professionals with a reliable, and user-controlled method for measuring the efficacy and outcomes of prevention programming over time, through a flexible, highly customizable platform. Schools will be able to assess their students risk behaviors, on a user-determined schedule, and store, aggregate, and present data graphically so administrators can utilize survey results without need of a statistician or research analyst, and in a way that protects the privacy of the students. An important innovation of Campus Benchmark will be the building of a large, national database through which participating institutions can upload and compare their data with a de-identified data set. With nearly 750,000 students currently using MSB, this database will become a significant resource for the field of college health research. This product will help Inflexxion provide the most comprehensive and innovative college health programming available in the marketplace. By providing the critical links between the scientifically-based intervention methods developed and validated though our MSB research, and the program implementation component that is currently being developed through the Campus Task Force project, Campus Benchmark will allow Inflexxion to offer the college health market a complete, integrated solution, linking intervention (MSB), evaluation (Campus Benchmark), and program development and dissemination (Campus Task Force).NARRATIVE [unreadable] [unreadable] Public Health Relevance: Campus Benchmark program will help Inflexxion provide the most comprehensive and innovative health risk prevention programming for the college health market. By providing the critical link between the scientifically- based intervention methods developed and validated though our MSB RCTs, and the program implementation component that is currently being developed through the Campus Task Force project, Campus Benchmark will allow Inflexxion to offer the college health market a comprehensive, integrated solution, linking intervention (MSB), evaluation (Campus Benchmark), and program development and dissemination (Campus Task Force). [unreadable] [unreadable] [unreadable]

[unreadable] DESCRIPTION (provided by applicant): One of every five adults in the United States (46.4 million people) is affected by arthritis. Increasing the number of days individuals are free of arthritis pain is one of the Healthy People 2010 objectives. Although there are a variety of medical treatments and medications available, self-management is a critical component in helping arthritis sufferers learn how to identify, avoid, and help manage their pain. Unfortunately, clinicians face significant time pressure, leaving little time for desired patient-provider education and collaboration. This is an important omission as tailored advice (e.g., exercise to reduce pain) from health providers could enable behavior change and improve outcomes. Therefore, widely accessible and tailored interventions that address motivational issues are needed to facilitate self-management education among arthritis patients. Because of its reach across demographic groups, the Internet is an excellent vehicle for offering a self-management program to arthritis sufferers. We propose to develop an interactive, pain self-management program for adults who suffer from pain associated with the two most common types of arthritis, osteoarthritis and rheumatoid arthritis. This on-line health intervention, Pain Action: Arthritis, will provide clinically reliable information about diagnosis, treatment, and management of arthritis, written for consumers in a clear and engaging manner. Moreover, this website will be designed to complement and connect to our other SBIR-supported pain websites (chronic back pain, migraine pain, neuropathic pain) to be a more comprehensive resource for those seeking pain management assistance. Pain Action: Arthritis will be course-based and include motivational, tailored feedback, and self-management recommendations, as well as unique personal tracking and social networking features. Our review of available arthritis websites suggests that no site currently offers this combination of empirically derived self-management features and thus will represent a significant advance in arthritis care. The content and intervention model of this on-line health intervention will be developed through consultation with arthritis experts and people with arthritis pain, concept mapping to determine key domains of information, and a pilot test of a demonstration program of one lesson about arthritis pain with people who experience arthritis pain. We will also seek feedback from arthritis experts on the feasibility of the Phase I concept through a review of the demonstration program. One of every five adults in the United States (46.4 million people) is currently affected by arthritis and this number is expected to continue to grow to 67 million over the next twenty years. The global initiative, The Decade of Bone and Joint Disease, was begun in recognition of the growing personal, social, and economic costs of arthritis to global society. The proposed project will employ consultation with people with arthritis pain as well as experts from diverse disciplines in this area to develop content for inclusion in a course-based on-line health intervention. This on-line interactive resource for health consumers will include motivational, tailored feedback, self-management recommendations, unique personal tracking tools, and social networking features. [unreadable] [unreadable] [unreadable]

DESCRIPTION (provided by applicant): The majority of adolescents struggling to avoid substance use during early recovery are also coping with many other issues (e.g., relationships, legal, mental health) for which they require consistent support. We are proposing the development of an online relapse prevention program for adolescents called Staying Off Substances (SOS). Specific content in the program will be recommended to counselors based on their client's reported needs and strengths on the Comprehensive Health Assessment for Teens (CHAT), a web-enabled interactive adolescent self-report assessment for use in treatment settings. Counselors will be able to assign the client's user name to access privileges for that content and/or other content per their clinical judgment. We expect that CHAT: SOS will ultimately have eight modules (i.e., Physical Health, Emotional Health, Family Relationships, Peer Relationships, Romantic Relationships, School, and Legal) corresponding with the CHAT subscales. CHAT: SOS will include opportunities to reinforce the skills and philosophies that adolescents learn in treatment through online interactive exercises and journaling activities. This resource will be available to them during treatment and post-treatment. Adolescents will receive tailored recommendations and an individualized user experience because CHAT: SOS will utilize an innovative software logic application called LogicBase. In addition, CHAT: SOS will utilize motivational feedback to motivate clients to recognize and address issues in early recovery. CHAT: SOS will also provide counselors will guidelines on how to use this program with their clients (e.g., in sessions, during aftercare) and custom user reports, including adolescents'ratings of program content. This intervention will address all areas of the CHAT assessment in Phase II, but we will focus on the Peer Relationships module in the Phase I feasibility test. PUBLIC HEALTH RELEVANCE: Adolescent substance abuse is a significant public health issue. Unfortunately, the 2005 federal Treatment Episode Data Set indicated that less than 150,000 adolescents received treatment. Typically, 75% of those who receive treatment relapse within the following year. To address the need for cost-effective assessment, Inflexxion, Inc. developed the Comprehensive Health Assessment for Teens (CHAT), a web-enabled interactive self report assessment for use in treatment settings. We propose augmenting CHAT`s scope by adding a supplemental online relapse prevention program called CHAT: Staying Off Substances (SOS). CHAT: SOS will use an adolescent's responses to the CHAT assessment to tailor web-based relapse prevention content to the adolescent's individual needs. When completed in Phase II, CHAT: SOS will use state of the art technology, including multimedia features and text messaging, to make the program interactive and accessible when other support might not be available. To assure CHAT: SOS's appeal and effectiveness, content and program features will be developed with input from focus groups and interviews with adolescents with a substance abuse diagnosis and experts in adolescent substance abuse treatment.

DESCRIPTION (provided by applicant): Prescription opioid misuse/abuse is a growing national issue (ONDCP, 2008a;SAMHSA, 2007a) that requires immediate, targeted intervention. Typical approaches include various types of global prevention and education strategies (e.g., advertising, reports, websites) to assist professionals and at-risk populations. These approaches are not targeted to the local climate (e.g., needs, readiness for intervention). It is necessary to address educational and prevention messages in a way that local communities can come to a consensus to set goals and respond effectively to prescription opioid misuse/abuse. Community anti-drug coalitions offer a potential avenue for such intervention due to their understanding of local needs, links to the community, and knowledge of local drug prevention resources. The proposed online program, CAP: The Coalition Action Planner, would help anti-drug coalitions by providing: (1) an automated online survey to assess coalition members'perception of the local climate for public health change;(2) a tailored report that review strategies based on community readiness;(3) Strategy Briefs and an interactive Strategy Finder that help communities identify methods for dealing with prescription drug abuse at a local level;and (4) resources such as a Prescription Drug Index, Ask the Expert, and a community message board. Maintenance of this product will be supported by pharmaceutical company sponsorships and will be available for free to coalitions. Although this application focuses on the prescription opioid problem, the long-term vision for this program is a coalition planning tool to help coalitions efficiently and effectively respond to any emerging drug problem. PUBLIC HEALTH RELEVANCE: Prescription pain reliever misuse and abuse is a growing national issue that requires immediate, targeted intervention. Community anti-drug coalitions know about both local needs and resources;therefore, we propose to test the feasibility of a new online program: CAP: The Coalition Action Planner. CAP would help coalitions by providing a) an online survey to assess community willingness to participate in prescription pain reliever prevention and intervention and b) survey feedback and related tools to help coalitions mobilize communities towards action in a timely and effective manner

DESCRIPTION (provided by applicant): The majority of adolescents struggling to avoid substance use during early recovery are also coping with many other issues (e.g., peer relationships) for which they require consistent support. We propose to develop an online relapse prevention program for adolescents called Staying Off Substances (SOS). Specific content in the program will be recommended to counselors based on their client's a) age, b) current motivation level, and, when available, c) reported needs and strengths on the Comprehensive Health Assessment for Teens (CHAT(R)), a Web-enabled interactive adolescent self-report assessment for use in treatment settings. Whereas current online programs for adolescents are geared for primary prevention, CHAT(R): SOS will be an intervention for use in clinical populations. Counselors will assign the client's user name to access privileges for that content and/or other content per their clinical judgment. We expect that CHAT(R): SOS will ultimately have six modules corresponding with the CHAT(R) subscales (i.e., Psychological Health, Family Relationships, Peer Relationships, Tobacco Use, Alcohol Use, Drug Use). CHAT(R): SOS will include opportunities to reinforce the skills and philosophies that adolescents learn in treatment through online interactive exercises, writing activities, and access to a supportive, online community. This resource will be available to them during treatment and post-treatment to help them navigate challenges in early recovery. Adolescents will receive tailored recommendations and an individualized user experience because CHAT(R): SOS will utilize an innovative content management and logic solution called Ektron. CHAT(R): SOS will also provide counselors with guidelines on how to use this program with their clients (e.g., in sessions, during aftercare) and custom user reports. To demonstrate the feasibility of the program concept, the Phase I study focused on the Peer Relationships domain. All feasibility criteria were met and findings indicated: (1) Proposed content was based on highly positive findings from concept mapping, as well as usability and acceptance testing with clients and experts. Ratings of potential effectiveness and appeal were high. (2) Usability testing indicated that the program was usable by the target audience, the skills and outcomes were relevant to the target audience, and the program was regarded as potentially very helpful to the treatment process. We surpassed feasibility benchmarks for both clients and experts. (3) Our technical/design team a) produced a demonstration program that was perceived by key stakeholders as highly usable and engaging multimedia program and b) determined the necessary technologies to produce the complete program in Phase II. In Phase II we will develop the program then test its efficacy in a field trial. The field trial will examine the primary hypotheses that, relative to the control condition (CHAT(R) only), CHAT(R): SOS will be associated with significantly higher motivation, higher self-efficacy, more relapse coping, and lower substance use. PUBLIC HEALTH RELEVANCE: Adolescent substance abuse is a significant public health issue. Unfortunately, the 2005 federal Treatment Episode Data Set indicated that less than 150,000 adolescents received treatment. Typically, 75% of those who receive treatment relapse within the following year. To address the need for cost-effective assessment, Inflexxion, Inc. developed the Comprehensive Health Assessment for Teens (CHAT(R)), a Web-enabled interactive self report assessment for use in treatment settings. We propose developing a supplemental online relapse prevention program called CHAT(R): Staying Off Substances (SOS). CHAT: SOS will use an adolescent's 1) age, 2) motivational level, and, when available, 3) responses to the CHAT(R) assessment to recommend Web-based relapse prevention content to address the adolescent's individual needs. This resource will be available to adolescents during treatment and post-treatment to help them navigate challenges in early recovery.

DESCRIPTION (provided by applicant): The addiction treatment field continues to lag in implementing treatments based on scientific evidence. Treatment systems are now being held accountable for providing evidence-based treatments (EBTs). As a result, there is increasing pressure on counselors to adopt and implement empirically-supported treatments such as motivational enhancement, cognitive behavioral treatment, and twelve-step facilitation. Current efforts rely primarily on downloads, online courses, and training announcements - all of which are static methods. These methods are not tailored to counselors' educational needs or client caseloads. We are therefore proposing the development of Behavioral Health Solutions, which will provide tailored, real-time, evidence- based treatment recommendations to substance abuse counselors. These recommendations will be based on core elements of EBTs and provide step-by-step EBT delivery directions, instructional videos, and handouts for clients. The goal of this product is to increase the understanding and effective use of evidence-based practices so that counselors can more flexibly use these practices with their substance-abusing clients. Behavioral Health Solutions will be available on mobile devices, allowing counselors to easily access important interventions that are relevant to current client needs. This innovative product represents a major advancement over current training methods, which are asynchronous with treatment delivery, cumbersome, and often too costly to use in day-to-day clinical work. Other advantages of this product include: (1) training that occurs in proximity to treatment, thereby increasing the potential for implementation; (2) content that is linked to pertinent client resources; (3) standard content review and updates (via Hazelden's large editorial operation); (4) content that is easily tagged and pushed, and (5) the ability to track counselor implementation of EBTs. This Phase II embodies a collaboration between two organizations with extensive experience in the addictions and behavioral health fields. Hazelden Publishing (Center City, MN) is a leader in providing evidence-based programs for the full continuum of care, ranging from prevention and intervention to treatment and recovery management. Inflexxion (Newton, MA) has conducted interactive health research in the addictions for the past 17 years. The goal of Phase II is to demonstrate that Behavioral Health Solutions will significantly improve counselor EBT implementation. The field test will examine the primary hypotheses that, relative to a control condition (treatment as usual with access to online EBT materials), counselors assigned to the Experimental group will evidence significantly greater: (1) EBT self-efficacy, (2) positive attitudes about the use of EBTs, and (3) self- reported use of EBTs.

DESCRIPTION (provided by applicant): Pain management including the use of opioid analgesics is recommended for adolescents who are suffering from recurrent or chronic pain associated with a specific etiology such as cancer, cystic fibrosis, sickle cell anemia, hemophilia or organ transplants (see citations by etiology in letter of support from CO-I, Dr. Solodiuk). Preventive screening tools provide information that can be used by the provider to inform prescription choices (use of opioid versus another medication) and subsequent monitoring (e.g., urine screens, pill counts), resulting in safe and effective pain management. Pediatric hospitals are currently using screeners developed and tested with other populations because there is no validated tool for this specific patient population. The primary aim of this application is to begi development of a screening tool called the Adolescent Screener and Opioid Assessment for Patients with Pain (A-SOAPP) for use with adolescent-aged patients with secondary, recurrent or chronic pain accompanying complex medical conditions like cancer. The A-SOAPP will fill a void that exists for a screening tool to help healthcare providers identify individuals who may be at increased risk for opioid misuse among those patients being considered for episodic or long-term opioid therapy, including cancer patients and patients with sickle cell disease. Similar to development of the adult version, a rigorous methodical approach will be employed to develop a screener with stable, high predictive validity. An adolescent version of such a screener presents significant psychometric challenges including item content that is age-appropriate, accounting for the role of caregivers in the administration and monitoring of medication use, and operationally defining indicators of aberrant medication-related behaviors and signs indicating possible addiction in this population. Thus, in addition to meeting an important clinical need, an age-appropriate, population-appropriate screener for opioid risk represents a significant innovation in the field. In our view, the achievement of this goal will require the concept of a screener to deviate from the self-report behavioral screeners typically used to detect or predict substance use problems. Rather, this screener will endeavor to capitalize on predictive relations of data from a variety of sources (e.g., provider observations, demographic information, medical history, as well as patient self-report), to best model and predict the outcome of interest, namely aberrant medication-related behaviors.

DESCRIPTION (provided by applicant): A mobile-based intervention to improve adolescents' headache self-management Abstract Headache pain is a common and significant problem for adolescents (King et al., 2011). As headaches become more frequent and severe, the negative impact on happiness increases and adolescents report less satisfaction with their health and with their life (Sillampaa, 1983). There are a number of challenges associated with treatment, including adolescents' lack of consistent symptom tracking, medication overuse, and low self-efficacy for making lifestyle changes and for communicating about headaches. Self-management skills training addresses these types of challenges by increasing patients' self-efficacy for healthful behaviors (Burckhardt, 2005) and while it has been found to be successful with adolescents (e.g., Trautmann and Kroner- Herwig, 2009), it is not widely available. We propose to develop ThinkMe, a highly engaging mobile-based program that will help adolescents to make connections between behaviors and symptoms. The following specific aims were successfully completed as part of the Phase I investigation: (1) gather input from adolescents, caregivers, and experts; (2) produce content, design, and development plans; (3) produce the demonstration program; (4) assess whether the demonstration program is easy to navigate and relevant to adolescents and caregivers; (5) assess experts' beliefs about adoption, implementation, and maintenance of the program. Based on the results of the Phase I project, the mobile-based program will provide a state of the art pain tracker, a toolbox of tailored coping strategies, and evidence-based self-management skill-building information. The program will be tailored based on (1) the adolescent's demographic information, (2) how the adolescent feels each day, and (3) coping strategies that have worked in the past. In this way, ThinkMe will offer a maximally engaging way to help adolescents track their pain, make connections between lifestyle and pain, and learn key self-management skills. The specific aims of the Phase II are to: (1) create the program and (2) test its efficacy in a randomized controlled trial. We hypothesize that, compared to adolescents in the attention control group, adolescents who use ThinkMe will demonstrate: (1) increased coping; (2) decreased intensity of headaches; (3) decreased frequency of headaches, and (4) increased functioning and quality of life. Secondary outcomes are that adolescents will experience (1) decreased school absenteeism, (2) improved school functioning, (3) improved physical and psychosocial functioning, and (4) decreased health care utilization. The innovation of the current proposal is delivering an individually tailored, theory-driven, pain self-management intervention that can be widely disseminated with the novel use of technology to address self-management challenges associated with adolescent headaches. Successful completion of the aims of this Phase II proposal has the potential to have a significant public health impact by improving health, functioning, and quality of life for millions of adolescents with headache.