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

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.