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iTRAC Emotion Regulation + Substance Use Prevention

iTRAC Emotion Regulation + Substance Use Prevention

Klein Buendel Investigators, Ms. Julia Berteletti and Dr. W. Gill Woodall, are collaborating with Dr. Chris Houck from Rhode Island Hospital and Dr. Stephanie Parade from Brown University on a new 5-year project to integrate substance use content with iTRAC emotion regulation material to reduce substance use among child welfare involved youth. The web-based intervention is being developed and evaluated in partnership with the Rhode Island Department of Children, Youth, and Families.

Nearly 700,000 children experience maltreatment each year, and youth with a maltreatment history are at heightened risk for substance use across the lifespan. Emotion regulation is a modifiable mechanism underlying the impact of maltreatment on risk behaviors but is often impaired in youth with a maltreatment history due to the neurotoxic effects of early trauma/neglect and inconsistent modeling of adaptive emotion regulation strategies. Emotion regulation is related to substance use in adolescence, and interventions to support the development of adaptive emotion regulation in youth with a maltreatment history have outstanding potential to interrupt trajectories of risk and prevent substance use. However, youth with a maltreatment history often face structural and psychosocial barriers to engagement. Furthermore, the child welfare system, which is designed to protect and support youth with maltreatment histories, is under resourced and often unable to meet the critical needs for prevention in this population. Interventions targeting substance use with this population must be acceptable, easily accessible, and low resource for the child welfare system.

During the Planning and Intervention Enhancement Phase (R61), the investigators will interview adolescents, caregivers, and child welfare professionals to obtain diverse perspectives regarding the integration of emotion regulation and substance use. They will create and program this content within the iTRAC framework, followed by acceptability testing to ensure usability and understanding. Upon completion of Phase 1, the team will begin Phase 2 (R33), during which a Stage III real-world efficacy (hybrid efficacy-effectiveness) trial of 200 youth with maltreatment histories will evaluate the iTRAC for Substance Use (iTRAC-SU) intervention.

Phase 1 – Planning and Intervention Enhancement (R61) Specific Aims

Aim 1: To create and integrate digital content linking substance use with ER into existing iTRAC modules. Information gathered via qualitative interviews with adolescents, caregivers, and staff in the child welfare system will be used to develop the substance use content.

Aim 2: To assess acceptability and usability with 10 adolescents (representing diverse backgrounds) over two iterative rounds of feedback.

Aim 3: To ensure successful completion of the Phase 2 Aims, planning activities with Rhode Island Department of Children, Youth, and Families. will take place to establish procedures for developing the workforce for the project, recruiting families, and avoiding interference by research in the critical mission of Department of Children, Youth, and Families programs.

Phase 2 – Randomized Trial (R33) Specific Aims

Aim 4: To conduct a randomized controlled trial examining the impact of the iTRAC-SU intervention on substance use relative to a waitlist control among 200 adolescents ages 12 to 15.

Aim 5: To examine iTRAC-SU relative to a waitlist control in enhancing theoretically important emotional competencies (such as emotion regulation, emotion recognition, distress tolerance) that mediate risk as measured by self-report, performance measures, caregiver report, and respiratory sinus arrhythmia.

Aim 6: To examine the feasibility, acceptability, uptake, and costs of iTRAC-SU when implemented with child welfare involved youth.

This research project was awarded to the Rhode Island Hospital by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (DA059785; Dr. Chris Houck and Dr. Stephanie Parade, Multiple Principal Investigators). Collaborators include Ms. Julia Berteletti and Dr. W. Gill Woodall from Klein Buendel, and the Rhode Island Department of Children, Youth, and Families. The enhanced iTRAC modules will be designed and programmed by the Creative Team at Klein Buendel.

Collaborator Spotlight:
Dr. Wendy Hadley

Collaborator Spotlight:
Dr. Wendy Hadley

Wendy Hadley, PhD, is an Associate Professor in the Department of Counseling Psychology and Human Services in the College of Education at the University of Oregon. She is also the Julie and Keith Thomson Faculty Chair and HEDCO Clinic Director at the University of Oregon.  

Dr. Wendy Hadley

Dr. Hadley received her doctoral degree in clinical child psychology and behavioral medicine from the University of Memphis in 2003. She went on to complete a postdoctoral fellowship with the Brown University Clinical Consortium. Dr. Hadley has worked with many pediatric patients and their families, including those affected by cancer, HIV, feeding disorders, cardiac issues, and obesity.  

In addition to her clinical work, Dr Hadley conducts research on adolescent health issues such as obesity, substance use, and risky sexual behaviors. Her recent work has focused on the development and evaluation of interventions focusing on parent-child communication, parental monitoring, and adolescent emotion regulation skills. Some of her work uses web-based technology to deliver and enhance the interventions. 

Dr. Hadley is currently working as a Co-Investigator on a collaborative web-based project with Dr. Christopher Houck (Principal Investigator) from Rhode Island Hospital and its parent organization Lifespan Health Systems.  The program is called iTRAC, which stands for “Talking about Risk and Adolescent Choices.” The research is funded by an STTR Fast-Track grant to Klein Buendel from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (Dr. Christopher Houck, Principal Investigator; HD110333). The goal of the project is to convert the previously existing TRAC program to a web app format while integrating emotional regulation and sexual health education. The program targets young adolescents (ages 12-14 years) at a crucial time of development in order to provide them with evidence-based approaches to manage emotional situations and risky behavior. Additional Co-Investigators include Dr. David Barker from Rhode Island Hospital and Ms. Julia Berteletti from Klein Buendel.  

iTRAC Pilot Study

iTRAC Pilot Study

A research team led by Dr. Christopher Houck from Lifespan and the Rhode Island Hospital has published a paper in the Journal of Developmental & Behavioral Pediatrics on the feasibility and acceptability of an initial digital iTRAC (Talking About Risk and Adolescent Choices) intervention. Collaborators included colleagues from the Rhode Island Hospital, the University of Oregon, Brown University, Penn State University, and Klein Buendel. iTRAC is a tablet-based intervention to promote emotion regulation skills among middle schoolers as a strategy for reducing risky behavior.

For the pilot study, adolescents aged 12–14 years were recruited from three urban schools for advisory groups (n=15), acceptability testing (n=11), and pilot testing (n=85). Youth advisory boards and expert panels tailored content, resulting in an animated intervention of instructional videos, games, and activities designed to teach emotion regulation strategies to young adolescents. Eighty-five adolescents were randomized to the 4-module digital iTRAC intervention or a wait-list control group. Adolescents and one parent completed baseline and 3-month follow-up questionnaires examining emotion regulation attitudes and behaviors. The adolescent participants also completed behavioral tasks related to distress tolerance.

Eighty-eight percent of those randomized to iTRAC completed all modules. Moderate effect sizes were found from baseline to follow-up on adolescents’ beliefs in the controllability of emotions, awareness of emotions, self-efficacy for managing emotions, perceived access to emotion regulation strategies, and use of emotion regulation strategies. Parent measures of adolescent regulation showed mixed results.

A tablet-based intervention to enhance emotion skills for youth in early adolescence was deemed feasible and demonstrated promising indicators of impact on emotional competence. Increasing adolescents’ awareness of and access to emotion regulation strategies may reduce decisions driven by transient emotions, which in turn may reduce engagement in risky behavior and resultant negative health outcomes. The authors conclude that the brief iTRAC intervention may be used to increase emotional competency among middle schoolers.

Dr. Valerie Myers and Ms. Tiffany Jerrod, both formerly from Klein Buendel, were co-authors on this publication. Research on the full production and evaluation of iTRAC is continuing with an STTR Fast Track grant to Klein Buendel from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (Dr. Christopher Houck, Principal Investigator from Lifespan; HD110333). Collaborators on the current study include Dr. Wendy Hadley from the University of Oregon; Dr. David Barker from Rhode Island Hospital; and Ms. Julia Berteletti from Klein Buendel. The iTRAC modules will be programmed by Klein Buendel’s Creative Team.  

iTRAC Fast Track Project

iTRAC Fast Track Project

A collaborative research team from the University of Oregon, Rhode Island Hospital and its parent organization Lifespan Health Systems, and Klein Buendel has launched a new research project to develop and evaluate the impact of an emotion regulation program for adolescents. iTRAC will be a web-based program for “Talking about Risk and Adolescent Choices” to prevent risky sexual behavior and negative sexual health outcomes through emotion regulation strategies. The original TRAC program was developed and evaluated in multiple previous studies (MH078750, NR011906, and HD089979) by Dr. Christopher Houck from Lifespan and his team. 

In the new study, the original TRAC will be enhanced for emotion regulation, programmed as a web-based app (iTRAC) and assessed for acceptability by adolescents ages 12 to 14. The investigators will then conduct a randomized controlled trial examining the efficacy of the completed iTRAC intervention relative to a waitlist control among 120 adolescents. The study will examine the efficacy of iTRAC relative to a waitlist control in enhancing theoretically important emotional competencies, such as emotion regulation, emotion recognition, and distress tolerance that mediate risk as measured by self-report, performance measures, and parent report. 

The investigators hypothesize that: (1) iTRAC will receive positive adolescent ratings during acceptability testing for ease of use, enjoyment, and usefulness of content; (2) participants in iTRAC will report greater self-efficacy for sexual risk prevention skills over 6-month follow-up than comparison participants; and (3) youth in iTRAC will exhibit improved emotional competencies relative to the comparison group. 

The iTRAC project is funded by an STTR Fast Track grant to Klein Buendel from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (Dr. Christopher Houck, Principal Investigator from Lifespan; HD110333). Collaborators include Dr. Wendy Hadley from the University of Oregon; Dr. David Barker from Rhode Island Hospital; and Ms. Julia Berteletti from Klein Buendel. The iTRAC modules will be programmed by Klein Buendel’s Creative Team.