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In-Home Therapist Use of Family Intervention Approaches and Treatment Outcomes for Geographically Isolated Adolescents with Substance Use Challenges.

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Title:In-Home Therapist Use of Family Intervention Approaches and Treatment Outcomes for Geographically Isolated Adolescents with Substance Use Challenges.
Authors:Hee, Puanani J.
Contributors:Psychology (department)
Keywords:adolescent substance use
geographic isolation
family involvement
family interventions
Date Issued:Aug 2018
Publisher:University of Hawaiʻi at Mānoa
Abstract:Family-based intervention approaches are efficacious for treating adolescent substance
use. Rural, geographically isolated families, who experience unique stressors and tend to value
self-sufficiency and independence might be limited in their ability and/or willingness to
participate in family-based therapeutic approaches. Furthermore, some evidence suggests rural
youth do not experience the same treatment response and have reduced access to services in
comparison to urban youth, and that rural providers use fewer evidence-based practices than
urban providers. Using a three-level multilevel modeling approach, this study examined whether
(1) geographic isolation predicted poorer outcomes for youth with adolescent substance use, (2)
family interventions (practices) and family involvement (number of months parent or family was
involved in treatment/total number of treatment months) in services predicted better youth
response to treatment, and given results from both (1) and (2), if (3) the extent of family
interventions and involvement in treatment mediated any relationship between geographic
isolation and outcomes directly and after controlling for covariates including child age, ethnicity,
impairment at treatment entry, and level of comorbidity. The first six months of clinical and
service data for geographically isolated (n = 269) and non-isolated (n = 365) youth receiving inhome
treatment that included targeting substance use in the state of Hawaiʻi Child and
Adolescent Mental Health Division were included in analyses. Contrary to the hypothesis, there
was no evidence that average substance use progress ratings were lower in geographically
isolated areas. On average, families of geographically isolated youth were involved in treatment
more (rather than less) frequently than non-isolated families. Level of family interventions or
involvement in treatment did not predict youth improvement. Other post-hoc analyses revealed that under some conditions, geographically isolated youth showed greater improvement than
non-isolated youth. In addition, when family involvement and interventions were examined
separately from individual involvement or interventions, more family interventions (practices)
was a significant predictor of improvement. While further research is needed, findings suggest
geographically isolated youth and their ecologies in Hawaiʻi may have protective factors that
support their progress during treatment which could distinguish them from youth in rural-based
treatment studies elsewhere in the USA.
Description:Ph.D. Thesis. University of Hawaiʻi at Mānoa 2018.
URI:http://hdl.handle.net/10125/62754
Rights:All UHM dissertations and theses are protected by copyright. They may be viewed from this source for any purpose, but reproduction or distribution in any format is prohibited without written permission from the copyright owner.
Appears in Collections: Ph.D. - Psychology


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