TY  - JOUR
PY  - 2020//
TI  - Identifying optimal level-of-care placement decisions for adolescent substance use treatment
JO  - Drug and alcohol dependence
A1  - Agniel, Denis
A1  - Almirall, Daniel
A1  - Burkhart, Q.
A1  - Grant, Sean
A1  - Hunter, Sarah B.
A1  - Pedersen, Eric R.
A1  - Ramchand, Rajeev
A1  - Griffin, Beth Ann
SP  - e107991
EP  - e107991
VL  - 212
IS  - 
N2  - BACKGROUND: Adolescents respond differentially to substance use treatment based on their individual needs and goals. Providers may benefit from guidance (via decision rules) for personalizing aspects of treatment, such as level-of-care (LOC) placements, like choosing between outpatient or inpatient care. The field lacks an empirically-supported foundation to inform the development of an adaptive LOC-placement protocol. This work begins to build the evidence base for adaptive protocols by estimating them from a large observational dataset. <br><br>METHODS: We estimated two-stage LOC-placement protocols adapted to individual adolescent characteristics collected from the Global Appraisal of Individual Needs assessment tool (n = 10,131 adolescents). We used a modified version of Q-learning, a regression-based method for estimating personalized treatment rules over time, to estimate four protocols, each targeting a potentially distinct treatment goal: one primary outcome (a composite of ten positive treatment outcomes) and three secondary (substance frequency, substance problems, and emotional problems). We compared the adaptive protocols to non-adaptive protocols using an independent dataset. <br><br>RESULTS: Intensive outpatient was recommended for all adolescents at intake for the primary outcome, while low-risk adolescents were recommended for no further treatment at followup while higher-risk patients were recommended to inpatient. Our adaptive protocols outperformed static protocols by an average of 0.4 standard deviations (95 % confidence interval 0.2-0.6) of the primary outcome. <br><br>CONCLUSIONS: Adaptive protocols provide a simple one-to-one guide between adolescents' needs and recommended treatment which can be used as decision support for clinicians making LOC-placement decisions.<br><br>Copyright © 2020 Elsevier B.V. All rights reserved.<p />  <p>Language: en</p>
LA  - en
SN  - 0376-8716
UR  - http://dx.doi.org/10.1016/j.drugalcdep.2020.107991
ID  - ref1
ER  -