Family Support Protocol for Adolescent Internalizing Disorders:Protocol for a Pre-Post Quantitative Treatment Development Study

Background: Internalizing disorders (IDs), primarily depression and anxiety, are highly prevalent among adolescents receivingcommunity-based treatment for substance use disorders (SUDs). For such clients, interventions that do not holistically addressboth SUDs and IDs are less effective. Objective: This pilot treatment development study aims to develop and test a modular treatment protocol for addressingcooccurring IDs among adolescents (aged 13 to 18 years) enrolled in routine care for substance use problems: Family SupportProtocol for Adolescent Internalizing Disorders (Fam-AID). As an adjunctive protocol, Fam-AID will not require clinicians tomarkedly alter existing base practices for SUD. It will be anchored by 3 evidence-based foundations for treating cooccurringadolescent IDs: family engagement techniques, transdiagnostic individual cognitive behavioral therapy techniques, and familypsychoeducation and safety planning. Methods: This quasi-experimental study will proceed in 2 stages. The pilot stage will use rapid-cycle prototyping methods incollaboration with end-user stakeholders to draft protocol delivery and fidelity guidelines adapted from existing resources, solicitprovider and client input on protocol content and delivery via cognitive interviewing, and pilot prototype components on 4 to 6cases. The second stage will be an interrupted time series study for 60 comorbid SUD+ID cases across 2 sites serving diverseadolescents: 30 will receive treatment as usual (TAU); following clinician training in the protocol, 30 new cases will receiveTAU enhanced by Fam-AID. For aim 1, the focus is on evaluating the acceptability of the Fam-AID protocol through therapistand client interviews as well as assessing fidelity benchmarks using therapist- and observer-reported protocol fidelity data. Foraim 2, the plan is to compare the effects of TAU only cases versus TAU+Fam-AID cases on family treatment attendance and onadolescent ID and substance use symptoms, with measurements taken at baseline and at 3-month and 6-month follow-ups.Results: Study recruitment will begin in April 2025. Conclusions: We anticipate that Fam-AID will contain 5 treatment modules that can be delivered in any sequence to meet client needs: family engagement of primary supports in treatment planning and services; relational reframing of family constraints, resiliencies, and social capital connected to the adolescent's ID symptoms; functional analysis of the adolescent's ID symptoms and related behaviors; cognitive behavioral therapy to address the adolescent's ID symptoms and functional needs, featuring 3core techniques (emotion acceptance, emotional exposure, and behavioral activation) to address negative affect and emotional dysregulation; and family psychoeducation and safety planning focused on education about comorbid SUD+ID and prevention of adolescent self-harm. If the abovementioned modules are found to be feasible and effective, Fam-AID will offer a set of pragmatic interventions to SUD clinicians for treating cooccurring IDs in adolescent clients.