Efficacy of scalable approaches to reducing alcohol and other drug use among traumatised young people

COPE-A is an integrated psychological therapy targeting substance use and traumatic stress among adolescents. The therapy will be delivered one-on-one by registered psychologists employed on the project over a maximum of 16 weekly, 60-90 minute, sessions. The number of sessions will be based on the psychologist's professional judgement of progress and participants' preferences. The COPE-A program has been adapted from the efficacious adult COPE therapy (Mills et al., 2012; JAMA 308:690-699) to meet the developmental needs of adolescents. COPE-A comprises gold standard cognitive-behavioural techniques (CBT) for traumatic stress and substance use. The components of the COPE-A program include: 1) psychoeducation; 2) motivational interviewing, 3) enhancing stress management and problem-solving skills; 4) recognising and challenging unhelpful cognitions; and 5) CBT for substance use and trauma-focused CBT therapy for PTSD (including imaginal and in vivo prolonged exposure). A client workbook is used to assist with the delivery of treatment. The workbook contains information corresponding to the therapy sessions, instructions for homework exercises and worksheets to be completed in treatment. The workbook is introduced in the first therapy session and is used flexibly according to the needs the clients (i.e., the psychologist may give the workbook to the participant to work through alongside the psychologist as part of treatment or may keep the workbook and give handouts to the participant during each session). The workbook can be emailed to participants as a pdf with fillable forms or given to the participants in hardcopy. The new treatment, COPE-A (telehealth), will involve delivery of the COPE-A therapy sessions via telehealth (i.e., video conferencing). Modifications have been made to the COPE-A manual to accommodate delivery via video conferencing, including the adaption of worksheets and handouts for digital use and the implementation of additional safety measures. Therapy sessions will be conducted at times convenient to the participant and employ flexible scheduling to minimise logistical barriers to attendance. Participants will also be reminded of scheduled appointments the day prior (e.g., via phone, text message, email). Therapists will keep a log of participant session attendance. All trial therapists will undergo study specific training in how to deliver COPE-A at least one week before commencement of the intervention, including the use of the protocol based treatment manual (3 days, face-to-face, delivered by psychologists experienced in the delivery of CBT for traumatic stress and substance use). Therapists will also be trained in the delivery of telehealth including the technical aspects of the video conferencing software and additional considerations for risk assessment and management and development of the therapeutic relationship. Provisions will be made to ensure close therapeutic compliance with the COPE-A treatment manual: i) therapists will receive regular clinical supervision; ii) the treatment manuals will be taken into each session and a session checklist completed; and iii) with the participants’ consent, all sessions will be audio recorded and reviewed weekly by the project coordinator using a checklist to document compliance (a greater than 90% compliance rate will be required); and iv) 10% of each therapist’s sessions will be randomly selected and rated for compliance by a blind independent assessor. Assessments will be conducted at baseline, end-of-treatment (i.e. 4-months post-baseline) and 12-months post-baseline with the project’s research assistants using a combination of study-specific and standardised semi-structured interviews and questionnaires. All interviews will take approximately 2 hours. These interviews will not be audio recorded.