Angela D. Moreland

What's the harm? Alcohol and marijuana use and perceived risks of unprotected sex among adolescents and young adults

The link between substance use and risky sexual behavior, particularly unprotected sex, among adolescents and young adults has been well established in the literature; however, less is known regarding how different patterns and types of substance use differentially relate to unprotected sex and perceived risks of unprotected sex. The current study examined perceived risks and unprotected sex among adolescents and young adults, and examined whether marijuana use, alcohol use, and dual marijuana and alcohol use were differentially linked to unprotected sex and perceived risks of unprotected sex. METHOD A sample of N=144 adolescents and young adults (Mage=18.77, SDage=3.4, range: 12-25) completed self-report questionnaires regarding past month substance use, unprotected sex, and perceived risks of having unprotected sex. RESULTS In a hierarchical logistic regression, only alcohol use was related to having unprotected sex at last intercourse (b=0.25, p<0.001). The second multinomial logistic regression showed that the interaction of alcohol and marijuana use was significantly related to lower levels of perceived risk of unprotected sex (moderate risk: b=0.06, p=0.04, OR=1.07; no/slight risk: b=0.07, p=0.03). CONCLUSION While dual marijuana and alcohol use was related to lower perceived risk of unprotected sex, only alcohol use only was associated with a higher likelihood of unprotected sex.

Community-based implementation of trauma-focused interventions for youth: Economic impact of the learning collaborative model.

This study investigated the economics of the learning collaborative (LC) model in the implementation of Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT), an evidence-based intervention for traumatic stress in youth. We evaluated the cost-effectiveness of the LC model based on data from 13 LCs completed in the southeastern United States. Specifically, we calculated cost-effectiveness ratios (CERs) for 2 key service outcomes: (a) clinician TF-CBT competence, based on pre- and post-LC self-ratings (n = 574); and (b) trauma-related mental health symptoms (i.e., traumatic stress and depression), self- and caregiver-reported, for youth who received TF-CBT (n = 1,410). CERs represented the cost of achieving 1 standard unit of change on a measure (i.e., d = 1.0). The results indicated that (a) costs of

Parenting outcomes of parenting interventions in integrated substance-use treatment programs: A systematic review

18,679 per clinician were associated with each unit increase in TF-CBT competency and (b) costs from

Implementing trauma-focused CBT for children of veterans in the VA: Providing comprehensive services to veterans and their families.

5,318 to

Does caregiver abuse history relate to caregiver focus, support, and attendance at follow-up sessions in a child advocacy setting?

6,548 per youth were associated with each unit decrease in mental health symptoms. Thus, although the impact of LC participation on clinician competence did not produce a favorable CER, subsequent reductions in youth psychopathology demonstrated high cost-effectiveness. Clinicians and administrators in community provider agencies should consider these findings in their decisions about implementation of evidence-based interventions for youth with traumatic stress disorders.

Barriers to Participation in Parenting Programs: The Relationship between Parenting Stress, Perceived Barriers, and Program Completion

The high prevalence of women in substance use treatment programs with children, and the co-occurring negative physical and mental health outcomes associated with substance use, led to the development of integrated substance use treatment programs that target a range of women-specific issues. Integrated programs typically offer some type of parenting component, although the level of parenting services varies widely. Existing reviews have found positive child and parent outcomes following integrated treatment programs in general, although studies were not selected on the basis of whether they included parenting interventions. Due to the large percentage of substance using parents and research that parenting interventions contribute to decreased maternal substance use, this critical review examines parental outcomes of published studies on integrated programs that specifically include a parenting intervention component, as well as moderators of parenting and parental substance use/relapse. Across the 15 studies identified, this systematic review primarily focused on 8 parenting outcomes, including program retention, substance use, parenting stress, psychosocial adjustment, depression, child abuse potential, parenting behaviors, and parent-child interaction; as well as 5 additional secondary outcomes. The review discusses results on each of these outcomes, as well as retention rates across the parenting interventions.

Investigating Longitudinal Associations Between Sexual Assault, Substance Use, and Delinquency Among Female Adolescents: Results From a Nationally Representative Sample

Military families experience unique stressful circumstances such as frequent moves, service-related physical and mental health difficulties, and separation from support. Although many families exhibit high resilience in response to these stressors, military children are at an increased risk for emotional and behavioral difficulties, exposure to intimate partner violence, and child maltreatment. These potential problems not only affect child functioning, but often also negatively impact family and veteran outcomes. Although the Department of Defense has enhanced efforts to address child and family trauma among military families, many veterans’ families are still not receiving timely, evidence-based treatment. With many veterans receiving care through Veterans Affairs (VA) medical centers, incorporating family treatment into VA services is important for promoting optimal veteran outcomes. Trauma-focused cognitive–behavioral therapy (TF-CBT) has been used successfully for civilian and military children exposed to trauma including child maltreatment, intimate partner violence, and traumatic grief. This article reviews research regarding veterans’ mental health, child and family functioning, and parenting, and highlights the value of implementing TF-CBT in the VA given its family and-resilience-focused structure, strong empirical support, and flexible delivery model. Strengths of delivering TF-CBT in the VA (e.g., provision of trauma services for families where veterans are already receiving care, family education about trauma), as well as implementation barriers (e.g., VA policy regarding veteran-focused treatment, reduced facility resources) are discussed. Finally, future research directions are proposed, including mixed-methods research with veterans’ families to investigate the effectiveness and feasibility of TF-CBT dissemination within VA facilities.

Gender moderates the association between distress tolerance and alcohol use among individuals with opioid use disorder

ABSTRACT Utilizing quantitative and qualitative clinical service data collected at a Child Advocacy Center, the present study investigated whether caregiver history (history of childhood abuse or adult victimization, mental health treatment history) was associated with caregiver focus and attendance at a scheduled follow-up appointment. Results of mixed method analyses indicated that caregiver history of abuse was positively associated with caregivers being supportive/protective. Other than a history of prior service-related problems, our study did not identify any predictors of attendance at follow-up sessions. This and other findings are discussed in the context of engaging caregivers in child welfare services.

Service needs of adolescent parents in child welfare: is an evidence-based, structured, in-home behavioral parent training protocol effective?

Families experiencing child maltreatment or risk factors for child maltreatment often receive referrals to interventions focused on changing parenting practices. Compliance with specific parenting programs can be challenging as many of the stressors that place families at-risk may also interfere with program participation. Because families may receive limited benefit from programs they do not fully receive, it is critical to understand the relationship between parenting stress and barriers to program completion. We used structural equation modeling to examine the relationship among parenting stress, perceived barriers to program participation, and program completion in two datasets involving low-income parents. Data were collected at two time points from a sample of parents involved with child welfare services and a sample of parents considered at-risk of future involvement (total study n = 803). Direct paths from parenting stress at time 1 to barriers to participation and parenting stress at time 2, and from parenting stress at time 2 to program completion were significant. Interestingly, increased barriers to participation were related to increased parenting stress at time 2, and greater parenting stress was related to increased program completion. Results suggest that with increasing levels of parenting stress, parents have an increased likelihood of completing the program. Assessing and addressing the influence of perceived barriers and parenting stress on program participation may decrease the likelihood of treatment attrition.

Reaching Latino Families Through Pediatric Primary Care: Outcomes of the CANNE Parent Training Program

PURPOSE Few studies have explored relations among sexual assault and prospective development of high-risk behaviors among adolescent girls. METHODS The present study examined longitudinal associations among child sexual assault (CSA) and high-risk behaviors (nonexperimental alcohol and drug use; delinquent behavior) in a nationally representative sample of adolescent girls aged 12-17. RESULTS Using path modeling, findings provided support for the link between CSA and nonexperimental alcohol use, drug use, and delinquent behavior after controlling for demographic characteristics and Time 1 functioning. Additionally, past 6-month post-traumatic stress disorder assessed at Time 1 was significantly associated with CSA and delinquency measured at Time 2, although the indirect effects did not reach traditional levels of significance. CONCLUSIONS These findings suggest that CSA may potentiate risk for a number of public health problems.