A Review of COVID-19 Initial Response Systems and A Proposal to Adjust the Operation of Residential treatment centers

Objective: The COVID-19 pandemic has caused a periodic shortage of quarantine beds, medical personnel, and medical equipment in South Korea. Asthe pandemic is expected to continue, a need existsto readjust the capacities of residentialtreatment centersfor asymptomatic ormild cases. Thisstudy aimed to identify howother countriestreat asymptomatic or have mild COVID-19 patients, and suggest a effective operation plan of residential treatment centers.Methods: A literature review was conducted to examine how policies on asymptomatic or mild COVID-19 cases have changed at different phases of the pandemic in different countries. A reviewwas also conducted on the epidemiological characteristics of Korean patients, including clinicalstatus and treatment period, and public opinion on residential treatment centers. A plan to improve how residential treatment centers operate during the pandemic was derived based on expert advice, and discussion within the research team.Results: Home care is being recommended for asymptomatic or mild cases of COVID-19 in many countries. In Korea, despite the increase in the number of newly confirmed cases, fatality rate of COVID-19 shows a decreasing and vaccination rate an increasing trend. Three-fourths of the public recognized that home care may be more appropriate for asymptomatic or mild cases. Assuch,we recommend a reduction in length ofstay in residential treatment centers, from 10 to 3 or 5 days, and ensuring patient’s participation in decision‒making of hospitalization.Conclusions: A need existsto prepare a systematic response system, including patient education, virtual treatment and transfersystem in orderto shorten patients’ admission period in residential treatment centers and expand home care. A functioning emergency response system should also be prepared concurrently.

Parent SMART (Substance Misuse in Adolescents in Residential Treatment): Protocol of a Randomized Effectiveness Trial of a Technology-assisted Parenting Intervention (Preprint)

BACKGROUND Adolescents in residential substance use treatment are at extremely high risk for relapse following discharge to the community. Parenting practices, including parental monitoring and parent-adolescent communication, have been established as key predictors of adolescent substance use outcomes and relapse. However, traditional office-based therapy may not be feasible for parents who face structural and systemic barriers. There is a clear need for effective, accessible, and scalable interventions for parents of adolescents receiving residential substance use treatment. In a prior pilot randomized controlled trial, we tested Parent SMART (Substance Misuse among Adolescents in Residential Treatment) – a technology-assisted parenting intervention informed by extensive formative research - as an adjunct to residential treatment as usual (TAU). Parent SMART demonstrated high feasibility and acceptability, as well as evidence of effectiveness in improving parental monitoring and communication. OBJECTIVE This protocol paper describes a fully-powered randomized controlled pragmatic effectiveness trial of Parent SMART as an adjunct to residential TAU. We hypothesize that families who receive Parent SMART will demonstrate greater improvements in parenting skills, reductions in adolescent substance use, and reductions in adolescent problem behaviors, relative to families that receive residential TAU. We will test the exploratory hypothesis that reductions in adolescent substance use will be partially mediated by improvements in parenting skills. METHODS Adolescent-parent dyads (n = 220 dyads; 440 total) will be randomized to either residential TAU only or Parent SMART + TAU. Parents randomized to Parent SMART will receive access to a networking forum, an off-the-shelf computer program called Parenting Wisely, and up to four telehealth coaching calls. Multi-method follow-up assessments consisting of self-report parent and adolescent measures, a parent-adolescent in vivo interaction task, and 8-panel urine screens will be conducted 6-, 12-, and 24-weeks post-discharge from residential. Measures will assess parenting skills, adolescent substance use, and adolescent problem behaviors. Analyses will be conducted using latent change score structural equation modeling. RESULTS The trial was funded August 2021; ethics approval was obtained in August 2020, prior to funding. Due to concerns with the administrative interface in the pilot trial, the Parent SMART networking forum is currently being rebuilt by a different vendor. The programming is scheduled to be completed by December 2021 with recruitment beginning in February 2022. CONCLUSIONS The proposed research has the potential to advance the field by: serving a high-need, underserved population during a vital treatment juncture; targeting parenting practices (putative mediators) that have been shown to predict adolescent substance use outcomes; addressing barriers to accessing continuing care; and testing a highly scalable intervention model. CLINICALTRIAL clinicaltrials.gov/ awaiting release (internal Brown University identifier: 2006002748) adolescent, residential, technology-assisted, substance use, parent

Adults With Opioid and Methamphetamine Co-use Have Lower Odds of Completing Short-Term Residential Treatment Than Other Opioid Co-use Groups: A Retrospective Health Services Study

Objective: There is an increase in persons entering substance use treatment who co-use opioids and methamphetamines in recent years. Co-using these substances may negatively impact treatment retention in the residential setting. We explored predictors of adults completing short-term residential treatment among persons with primary opioid use disorder (OUD) who co-use either alcohol, benzodiazepines, cocaine, or methamphetamines.Methods: This study used the 2019 de-identified, publicly available Treatment Episode Dataset-Discharges. The sample included adults discharged from short-term residential treatment with primary OUD who co-used either alcohol, benzodiazepines, cocaine, or methamphetamines. The final sample size included 24,120 treatment episodes. Univariate statistics were used to describe the sample. Two logistic regression models were used to predict completing treatment. The first logistic regression model included the co-use groups as predictors and the second model added other demographic and treatment-relevant covariates.Results: A slight majority (51.4%) of the sample prematurely discharged from treatment. Compared to the other three co-use groups, the opioid and methamphetamine co-use group had the highest proportion of individuals who were women (45.0%), unemployed (62.5%), current injection drug use (76.0%), living in the Midwest (35.9%), living in the south (33.5%), and living in the west (15.5%). The opioid and methamphetamine co-use group also had the highest proportion of individuals not receiving medications for OUD (84.9%), not having a prior treatment episode (28.7%), and not completing treatment (57.4%). In the final logistic regression model, which included covariates, the opioid and alcohol (OR = 1.18, 95% CI = 1.080–1.287, p < 0.001), opioid and benzodiazepine (OR = 1.33, 95% CI = 1.213–1.455, p < 0.001), and opioid and cocaine (OR = 1.16, 95% CI = 1.075–1.240, p < 0.001) co-use groups had higher odds of completing treatment than the opioid and methamphetamine co-use group.Conclusions: Opioid and methamphetamine co-use may complicate short-term residential treatment retention. Future work should identify effective strategies to retain persons who co-use opioids and methamphetamines in treatment.

Music Therapy with Children Whose Mothers Are in Residential Treatment for Substance Use Disorders: A Program Evaluation

Children who experience multiple stressors may benefit from music therapy programming that addresses the development of social skills, self-expression, and coping mechanisms. Emerging evidence supports the use of improvisation techniques, group songwriting, and drumming activities to support self-regulation and increase social competence. In this article, we aimed to describe the inception and evaluate the implementation of a music therapy program for children at a residential treatment facility for women with substance use disorders (SUDs) at Dove’s Nest, a residential facility for women with SUDs. In this facility, children can reside with their mothers during the length of treatment. We collected pre/post data from children ages 5–11 (N = 20) who attended 8 nonconsecutive music therapy sessions by asking the mothers to complete the Home and Community Social Behavior Scale (HCSBS; Merrell, K. W., & Caldarella, P. (2008). Home & Community Social Behavior Scales user’s guide. Paul H. Brookes Publishing Company). Statistical analyses showed no significant changes on individual HCSBS subscale pre–post comparisons. The total number of scale items on HCSBS flagged as areas of concern was reduced both in social competence (31 pre to 6 post or a decrease of 80.65%) and antisocial behavior (34 pre to 17 post or a decrease of 50%) scales. Evaluation results indicated that even though the children assessed may score within average ranges for social competence and antisocial behaviors, they still exhibit a high number of areas of concern at baseline, particularly in the defiant/disruptive category, which warrants preventive interventions. Clinicians may need to focus on interventions that promote social integration, self-regulation, and assertiveness while addressing behaviors such as blaming and attention seeking.