Adaptive Intervention Strategies in Conduct Problems Prevention
PI: Gerald J. August, Ph.D.
FUNDING: National Institute of Mental Health (P20MH085987; R34MH097832)
COMMUNITY PARTNER: St. Paul Youth Services
APPROACH: Adaptive-Sequential Intervention Design – applying SMART technology
This R34 study employs a SMART design to inform the construction of adaptive-sequential intervention strategies to prevent the escalation of serious conduct problems including alcohol and drug abuse among high risk youth. High risk is defined as referral for pre-court juvenile diversion services as a consequence of being ticketed by law enforcement for an offense. The experimental design features randomization to one of two first stage brief-type interventions (either youth- or parent-based). Non-responders to first stage interventions are randomized a second time to either (a) extended sessions of their first-stage intervention, or (b) switched to the alternative intervention option. The study seeks to answer tactical questions in preventive intervention such as, “What is the best first-stage intervention option”, “Which second-stage intervention option is best for youth who do not show adequate response to first stage intervention options,” and “Which sequence of intervention yields the greatest long-term benefits.” In addition, the study will explore candidate moderators (youth characteristics, i.e., executive functioning, including response inhibition, cognitive flexibility and delay of gratification) that influence a youth’s response to various interventions.
Differential Sensitivity Markers in Youth Drug Abuse Prevention
PI: Gerald J. August, Ph.D.
FUNDING: National Institute on Drug Abuse (R34DA037888)
COMMUNITY PARTNER: Natalis Counseling & Psychology Solutions
APPROACH: Comparative Effectiveness Design – using a multiple levels of analysis framework
This study employs a two-group randomized controlled trial to inform the construction of a personalized intervention model to prevent the persistence and escalation of serious conduct problems including alcohol and drug abuse among high risk youth. High risk is defined as referral to a community-based clinic for early drug use involvement. The study seeks to examine moderating effects of personal risk factors representing two theoretically distinct frameworks and determine whether these variables operate independently or in combination to influence the differential efficacy of two models of an adolescent preventive intervention. One model of moderation is based on risk severity (RS) as reflected in individual differences in delay discounting (DD), a form of the impulsivity trait that is positively associated with escalation to more serious levels of abuse and addiction. A second more exploratory model is based on differential sensitivity (DS) theory. The DS framework stipulates that individuals, due to specific sensitivity factors, vary in their responsiveness to environmental influence such as those delivered via an intervention. The study will explore DS markers associated with the reward motivational system, including dopaminergic genes, the post auricular reflex and a high sensory-processing sensitivity trait.
Parent Preferences and Family Engagement in a Conduct Problems Prevention Program
PI: Abigail Gewirtz, Ph.D.
FUNDING: National Institute of Mental Health (P20MH085987)
COMMUNITY PARTNER: State of Michigan Department of Health and Human Services (Detroit area community mental health clinics)
APPROACH: Hybrid Double Randomized Client Preference Trial
This pilot preference study involves culturally diverse children (ages 6-12) and their parents who were referred to community mental health clinics (in the greater Detroit, Michigan and surrounding communities) as the result of risk behaviors (primarily conduct problems). The study employs a parallel hybrid preference design in which participants are first randomized to either preference or no-preference arms. Those randomly assigned to the preference condition are allowed to choose among three intervention options involving different modality of delivery for the Parent Management Training-Oregon program. 1. Individual-home-based, 2. Group-clinic-based, or 3. Individual-clinic-based. A fourth group received clinic-based services as usual. Participants in the no-preference arm are randomized a second time to the one of four treatment modalities. The study assesses the relationships between pre-intervention variables: motivational cognitions (i.e., parent health beliefs, locus of control, parenting/conduct problems intervention expectancies, and parent and child desire for involvement in decision-making), family context variables (i.e., parent education, ethnicity, parent psychopathology, substance use, and child externalizing), and program preference and engagement. The goals of the study are: (a) to assess the empirical relationships between pre-intervention variables, rates of program engagement, and intervention condition (preference/no-preference). It is hypothesized that: (i) offering choice of intervention (preference condition) will result in higher levels of engagement, and (ii) that pre-intervention cognitions will moderate the relationship between preference condition and engagement. (b) To identify (in the preference group only) pre-intervention variables that are associated with preference for/selection of particular intervention options (i.e. services-as-usual, in-person group, web-based group, in-home individual parent training, or clinic-based individual parent training).
Culture-Specific Engagement Booster for Parent Training Programs – An Adaptation of the Incredible Years Program
PIs: Richard Lee, Ph.D. (UMN), Judy Ohm (Wilder Foundation)
FUNDING: Corporation for National and Community Service’s Social Innovation Fund (administered through the Twin Cities United Way)
COMMUNITY PARTNER: Amherst H. Wilder Foundation
APPROACH: Brief – Motivational Enhancement Design
This is a pilot study to identify barriers to participation in a parent training program and the cultural needs and preferences of parents. In addition, the study evaluates the feasibility of a culturally adapted version of the evidence-based Incredible Years Program (Webster-Stratton, et al. 2008). The Wilder Foundation has augmented its delivery of Incredible Years by adding a new session at the start of the program to increase parent motivation and retention. This session was developed in response to parent focus groups and pilot sessions conducted. Additionally, Wilder received funding from the Corporation for National and Community Service’s Social Innovation Fund (administered through the Twin Cities United Way) to scale-up and implement this augmented, adapted version of Incredible Years within the St. Paul Promise Neighborhood (modeled after the Harlem Children’s Zone) to Hmong and African American families. Thus far, over 60 families have completed one of three adapted versions of this parent training program. With the support of an internal grant from the University of Minnesota, the research team has completed the development and manualization of a two-session engagement module titled INTERFACE. INTERFACE expands upon the work with Wilder to augment Incredible Years with sessions to increase parent motivation and retention. The research team is conducting theater-test style focus groups with parents with children ages 2-10 and will pilot this engagement module adjoined to Incredible Years.
CPPR PROJECTS IN DEVELOPMENT
Effects of Mindfulness Training on Emotion Regulation in High Risk Adolescents
PIs: Timothy Piehler, Ph.D., Carolyn Porta, Ph.D.
COMMUNITY PARTNER: Headway Emotional Health Services
APPROACH: Microtrial Design
This proposed study will test a brief-targeted mechanism-based intervention (Learning to Breathe: LTB; Broderick, 2009) with high risk adolescents (ages 12-17) identified by law enforcement for commission of a misdemeanor offense, referred for juvenile diversion programming, and who screened positive for substance use. LTB attempts to restore balance of autonomic nervous system hyper-reactivity through stimulation of the vagal nerve via breathing exercises and activates PFC-mediated executive functioning by increasing awareness and acceptance of emotions including letting go of maladaptive cognitions and emotions. An exploratory hypothesis is that LTB may work better for some adolescents than others, and that adolescents with high motivation to change and those scoring in the impaired range on emotion regulation at baseline may benefit most. Our rationale is that emotion regulation is a modifiable process that can be influenced by training adolescents to shift attention toward the present moment without interference from emotional reactivity thereby increasing tolerance of unpleasant situations, uncomfortable feelings and stress.
A Randomized Sequential Responder Trial for Targeted Drug Abuse Prevention with Adolescents
PI: Michael Bloomquist, Ph.D.
COMMUNITY PARTNER: PrairieCare Mental Health Clinics
APPROACH: Adaptive-Sequential Intervention Design – nonresponder trial
This proposed study will test and further develop a personalized model of targeted prevention services for depressed adolescents who have begun using drugs. The study will evaluate the comparative effects of parent-focused versus adolescent-focused adaptive intervention strategies (AIS) where interventions are delivered sequentially as needed based on response as interventions unfold. A randomized sequential responder design will be used to compare two targeted prevention AIS stated as decision rules focused on either the parent/family or adolescent. Adolescents will be randomized to one of two AISs. One is a Parent/Family AIS with decision rules stated as: begin with a 6-session stage 1 Family Motivation with Positive Behavior Parent Support module, and if adolescent responds then monitor for maintenance , but if the adolescent fails to respond, then add a 6-session stage 2 module of Parent Limit Setting with Positive Family Interaction Skills Training. The other is an Adolescent AIS with decision rules stated as: begin with a 6-session stage 1 Adolescent Motivation with Behavioral Activation module, and if adolescent responds then follow, but if the adolescent fails to respond, then add a 6-session stage 2 module of Helpful Thinking with Stress Management Skills Training. We will evaluate the AISs on primary response outcomes of drug use and depression; in addition, we will examine indicators of parenting/family relationships and adolescent personal coping as mediators and predictors/moderators to inform the creation of candidate tailoring variables that can later be used in practice to assign AISs.
A Precision-Based Intervention Model to Prevent Drug Abuse in High Risk Youth
CPPR ECIN PI: Rachel Foster
CPPR MENTORS: Gerald August, Ph.D., Eric Thibodeau, Ph.D., and Dante Cicchetti
COMMUNITY PARTNER: Natalis Counseling and Psychology Solutions
APPROACH: Baseline Moderated Mediator Design
The proposed pilot project seeks to employ a novel research design to parse response heterogeneity and improve intervention precision in optimizing outcomes for adolescents who are at the early stage of drug use involvement. In a baseline target moderated mediation (BTMM) design (Howe et al., 2016), those with elevated baseline levels of a target risk mechanism are predicted to respond best because of good target-risk fit and most room for improvement. Here, the baseline level of the target risk mechanism serves a role both as a mediator (i.e., change in target mechanisms explains the effect of preventive intervention) as well as moderator (i.e., baseline levels predict response heterogeneity of intervention outcome). Such a design is intuitive, but to our knowledge it has never been tested with an adolescent drug use intervention. Against this backdrop, this pilot will test a preventive-type intervention, the Teen Intervene (TI) program (Winters & Leitten, 2007). TI targets a core mechanism of adolescent drug involvement, namely, impulsive decision-making. Adolescents selected because they have begun using alcohol or other drugs will be randomized to either TI or a usual standard of preventive care. In accord with the BTMM framework, we hypothesize that those with elevated baseline levels of impulsive decision-making will exhibit significant improvement in response to TI. Those least likely to show improvement with TI are hypothesized to show low levels of impulsive decision-making. A longitudinal moderated-mediation model will be used to test the BTMM design and determine whether drug use reductions produced by TI are indeed explained by improvements in impulsive decision-making. It is noteworthy that although informative for intervention responders, the BTMM design in and of itself is not informative for youth non-responders who conceivably have low baseline levels of the target risk mechanism. Identifying individual characteristics of TI non-responders may unveil alternative risk profiles and help fine tune interventions that target alternative mechanisms, thereby resolving response heterogeneity.
Cultural Adaptation of the Nurse-Family Partnership Intervention for Prepartum Native American Women Addicted to Drugs
CPPR ECIN PI: Rebecca Distefano
CPPR MENTORS: Arthur Rolnick, Ph.D., and Gerald August, Ph.D.
APPROACH: Feasibility Design
The proposed pilot study aims to (1) culturally adapt a well-known prenatal substance abuse prevention program to accommodate the needs of the White Earth Native American reservation of Northern Minnesota; (2) assess the feasibility of implementing the adapted program on the reservation with paraprofessional delivery agents; and (3) evaluate the intervention with a group of pregnant women living in White Earth. This year’s annual White Earth State of the Nation address declared substance abuse as an epidemic on the reservation (Quam, 2016, May 4). During the previous year (2015), 144 babies on the reservation were born addicted to heroin. A number of programs exist at the White Earth reservation, including an early childhood education program (Anderson et al., in prep), a post-natal nurse home visiting program, called LIFE, modeled after the Nurse-Family Partnership Program (NFP; White Earth website), and a maternal outreach program focusing specifically on opioid addiction during pregnancy (Maternal Outreach and Mitigation Services; White Earth website). However, none of these programs combine comprehensive prenatal substance prevention with the promotion of maternal health through home visiting. This study will utilize the infrastructure set in place by the LIFE program and the early childhood education program to provide substance abuse treatment and prevention to pregnant mothers on the White Earth Reservation. Due to the pilot nature of this study, women at all stages of pregnancy will be recruited. However, increased efforts will be made to target women during the 1st and 2nd trimester. Women report increased alcohol use during the 1st and 2nd trimester compared to the 3rd (Khan, Robinson, Smith, & Dillard, 2013). In rodent models, exposure to substances is particularly problematic in the 2nd trimester (Thompson, Levitt, &, 2009). Furthermore, brain development is rapid during 3-16 weeks post-conception, suggesting that targeting the 1st trimester may be critically important (Moore, Negrusz, & Lewis, 1998). Finally, a critical piece to this intervention will be personalizing the program to meet the cultural needs of the reservation. The proposed study will extend the current LIFE program to include a prenatal substance use prevention component in order to: decrease substance abuse among pregnant women, decrease the number of infants born addicted, and increase fetal and infant health.