Cindy M. Schaeffer - US grants

DESCRIPTION (provided by applicant): Parental substance abuse is a leading determinant of child maltreatment and, consequently, is often linked with detrimental clinical outcomes for children, exorbitant fiscal costs for the child welfare system, and serious social costs for our nation. Yet, in spite of the gravity of child maltreatment in the context of parental substance abuse, substance abusing parents rarely receive evidence-based treatments for their problems. Rather, such parents are usually referred from the child welfare system to the adult substance abuse system. Unfortunately, the adult substance abuse treatment system rarely provides the type of outreach needed to engage the parents in treatment or the intensity and breadth of services needed to place these parents and families on more productive life trajectories. Four years ago, at the behest of the Connecticut Department of Children and Families and with the support of the Annie E. Casey Foundation, the investigators developed a comprehensive community-based treatment program to address the problem of co-occurring parental substance abuse and child maltreatment. Importantly, and in collaboration with investigators at the Johns Hopkins University, this program, named "Building Stronger Families" (BSF), integrated an innovative evidence-based treatment for adult substance abuse (i.e., Reinforcement-Based Therapy [RBT];Jones, Wong, Tuten, &Stitzer, 2005) with an evidence-based treatment of child abuse and neglect (i.e., Multisystemic Therapy for Child Abuse and Neglect [MST-CAN];Swenson, Schaeffer, Henggeler, et al., 2009). The purpose of the present proposal is to request funding for a randomized trial of the BSF model, now 4 years in operation. A feasibility review and quasi-experimental evaluation of BSF have been completed. Regarding feasibility, the Department of Children and Families, which funds the clinical services, and the Annie E. Casey Foundation, which funds the quality assurance (e.g., treatment manuals, training) and ongoing involvement of the investigators, remain enthusiastic supporters of BSF. Moreover, BSF acceptability and feasibility are supported by 87 percent participant recruitment and 93 percent treatment completion rates. Regarding preliminary outcomes, a matched-comparison study (N = 52) indicated that BSF was significantly more effective than Comprehensive Community Treatment (CCT) at preventing reabuse, with BSF achieving an average reduction of 75 percent in substantiated reports of maltreatment at 24 months. Further, BSF participants were 50 percent less likely to have experienced an out-of- home placement at 18 months and 65 percent less likely at 24 months, with results approaching significance at 24 months. In light of these promising results, the proposed study aims to provide a rigorous and comprehensive evaluation of BSF by comparing this model to CCT on key clinical and system indices from baseline through 18 months. The intervention addresses the most prevalent, challenging, costly, and understudied area within the child welfare and parental substance abuse fields. If successful, this research could provide a substantial contribution, positively impacting the lives of millions of the most vulnerable families. PUBLIC HEALTH RELEVANCE: Parental substance abuse is a leading determinant of child maltreatment and, consequently, is often linked with detrimental clinical outcomes for children, exorbitant fiscal costs for the child welfare system, and serious social costs for our nation. Yet, in spite of the gravity of child maltreatment in the context of parental substance abuse and that there are well-established effective treatments for adult substance abuse, substance-abusing parents in the child welfare system are less likely to be offered services and receive services and well-integrated treatments for the dual problem are virtually nonexistent in the research literature. This application is a randomized controlled trial comparing Comprehensive Community Treatment to Building Stronger Families (BSF), an integrated model of two evidence-based treatments for parental substance abuse and child maltreatment that has shown promise in a 4-year pilot.

PROJECT SUMMARY/ABSTRACT Suicidal behaviors (ideation, planning, attempts) and non-suicidal self-injurious behaviors (NSSI) are highly prevalent among juvenile justice-involved transition-age (TA) youth. More than half of youth in the juvenile justice (JJ) system report suicidal ideation; one-third report a history of suicidal behavior. Black youth are disproportionately represented in juvenile justice and are also at increased risk of suicide, as rates of suicidal behavioral and death by suicide among Black youth have risen at an alarming rate, faster than other racial/ethnic groups. This increase has resulted in a number of government initiatives to increase suicide prevention efforts for Black youth. Reducing suicide risk among JJ-involved youth must occur in conjunction with interventions addressing their broader needs for reduced externalizing behavior and in ways that are culturally appropriate for Black youth. iKinnect is a paired mobile app platform that supports parents (in delivering) and youth (in receiving) evidence-based practices to reduce youth problem behaviors. Based on Multisystemic Therapy principles, iKinnect1.0 was originally designed to help youth with serious conduct problems. Results from a randomized controlled trial (RCT; N=72) demonstrated its efficacy in reducing externalizing behaviors and improving parent effectiveness. This fast-track proposal seeks to significantly expand iKinnect to prevent NSSI, suicidal behaviors (ideation, planning, attempts), and death by suicide in JJ-involved TA youth while continuing to decrease externalizing behaviors and prevent recidivism. Leaders in the area of suicide risk among Black youth and cultural appropriateness of interventions will guide these efforts. This 33-month fast track will include three primary phases of evaluation: (1) a proof-of-concept formative evaluation phase during which we will iteratively design, test, and build a central portion of iKinnect2.0 to achieve its usability, acceptability, and relevance (Months 1-10); (2) a product design-and-build formative evaluation phase, where we will design, build, and test all remaining features for iOS and Android phones, while also preparing the platform for clinical use (Months 11-23); and (3) a summative evaluation phase involving a pilot test (N=15) of iKinnect2.0 and an RCT (N=120) comparing iKinnect2.0 to an active control condition; and results will then be analyzed, reported, and disseminated (Months 24-33). We predict that iKinnect2.0 TA youth and parents will report a significantly greater decrease in suicidal and NSSI behaviors and in conduct problem behaviors in TA youth. Furthermore, iKinnect2.0 participants (TA youth and parents) will report significantly greater use of behavioral skills, as well as self-efficacy in coping with emotional distress and other challenging situations. iKinnect2.0 parents will report greater awareness of and confidence in applying evidence-based strategies to prevent suicide/NSSI and support their suicidal youth through a suicide crisis.