• Covariates Associated with Completing Short-Term Residential Treatment for a Substance Use Disorder Among Adults in the U.S.

      Ware, Orrin; Sacco, Paul; 0000-0002-3269-5324 (2021)
      Substance use disorders (SUDs) are associated with harmful outcomes across the biopsychosocial spectrum. Although completion of treatment for SUDs is associated with beneficial outcomes such as improved well-being and reduced mortality, premature treatment termination remains high in the United States. Short-term residential treatment is brief and for more severe SUD. This 3-paper dissertation focuses on exploring covariates of treatment completion in a short-term residential setting for adults with an SUD. Secondary data include the Treatment Episode Data Set Discharges 2017 and the Short-Term Residential Treatment Dataset, which contains data gathered from a Mid-Atlantic treatment facility’s electronic medical records. Paper 1 examines the associations of sociodemographic and substance use characteristics with completion of short-term residential treatment. This paper also has a primary focus on observing sex differences in treatment completion. Results from logistic regression models indicated that men were more likely to complete treatment than were women, nonpolysubstance users were more likely to complete treatment than were polysubstance users, and individuals with alcohol identified as their primary substance were more likely to complete treatment than were individuals with other primary substances. Paper 2 examines the associations between perceived stress, distress tolerance, and treatment completion in the short-term residential SUD treatment setting. Perceived stress and distress tolerance were negatively associated. Men had lower perceived stress and higher distress tolerance than did women. Those who completed treatment had lower perceived stress and higher distress tolerance than did those who were discharged from treatment prematurely. Lower perceived stress was found to predict treatment completion conditional to including a Perceived Stress × Distress Tolerance interaction variable. Distress tolerance did not moderate the relationship between perceived stress and treatment completion. Paper 3 examines a scale based on the theory of planned behavior to predict treatment completion in the short-term residential SUD treatment setting. In a path model, the theory of planned behavior’s constructs attitude and perceived behavioral control positively predicted greater intention to complete treatment. Intention to complete treatment and perceived behavioral control did not have a direct effect on treatment completion.
    • Exploring Child Welfare Placement Pathways to Residential Treatment Settings: A Three Paper Dissertation

      McCarthy, Lauren; Lee, Bethany R. (2022)
      Residential treatment settings (RTS) provide access to services in a safe environment for child welfare involved youth with behavioral health challenges. Despite the potential benefits of RTS, there are concerns that have led to legislation aiming to reduce their use. Policy that aims to reduce the use of RTS should be informed by an understanding of how youth enter RTS. This three-paper dissertation aimed to increase our understanding of how youth placement histories are related RTS entry in the context of youth behavior and development using secondary analysis of state administrative child welfare data. This dissertation also aimed to understand how caregivers experience accessing mental health care for youth through interviews. The first paper explored aggregate patterns of placement transitions and individual factors associated with risk of RTS entry. Findings include that transitions are most likely to occur between similar types of placement settings and that developmental period at first entry to out-of-home care is associated with RTS entry. The second paper explored the presence of unobserved subgroups of child welfare involved youth based on placement histories and whether youth move through these groups over time. The second paper found two subgroups of placement histories, multiple placements in group settings and stability in family care settings. The second paper further found that child behavior and developmental period at first entry to care were associated with group membership and transitions. The third paper identified that caregivers gain empowerment in decision making when accessing mental health services, but that this empowerment declines when accessing acute inpatient services. The third paper further found that accessing RTS was a challenging journey that impacted caregiver well-being, and that the decision to place a child in RTS came following a safety inflection point. Implications include that youth who enter out-of-home care in pre- and early adolescence and their caregivers may require additional support to remain stable in family placement settings. Further implications include the need to improve caregiver access to knowledge about the mental health care system to improve empowerment when making decisions and more resources for acute mental health service settings.