Posters

The Brief Addiction Monitor (BAM) was developed by the VA as a comprehensive substance use disorder (SUD) outcome metric intended to fill a gap in quality measurement. Research to date has only validated this measure in veteran populations with SUD, and not among different subgroups. The purpose of this study was to examine the factor structure and psychometric performance of the BAM in a diverse, non-veteran SUD population. Through a series of exploratory factor analyses, our findings suggest that the BAM might not be a reliable and valid instrument for all populations. For example, we were unable to confirm the validity of the BAM’s original three subscales, suggesting that the BAM might not be a multidimensional measure in non-veteran populations. In addition, the BAM had inconsistent factor structures and loading patterns across subgroups, which have implications for clinical practice. Clinicians require standardized, reliable tools that can be administered to all patients. However, the factor loading variation suggests that the tool might only be reliable in the group that it originally intended to monitor. Clinicians might be discouraged from using an assessment if they have to be selective about which groups are appropriate for receiving it, potentially leading to variation in practice and lower overall quality. Developing validated SUD instruments is particularly challenging because recovery pathways are individualized. These results reflect the ongoing barrier in measuring recovery and changes in recovery over time, namely that a recovery definition is still elusive as are the domains that comprise it.

Background: The Brief Addiction Monitor (BAM) was developed by the Veterans Administration as a comprehensive substance use disorder (SUD) outcome metric intended to fill a gap in quality measurement. Research to date has only validated this measure in veteran populations with SUD. The purpose of this research was to examine the factor structure and validity of the BAM in a non-veteran SUD population. Methods: Non-veteran patients admitted to a SUD treatment program (n = 2,227) completed the BAM at intake. An exploratory factor analysis (EFA) was used to assess the factor structure and psychometric properties of the BAM within the full sample and within subgroups, specifically racial, referral source (mandated vs. not), and primary SUD diagnosis. Results: An exploratory factor analysis in the full sample supported a 4-factor model. This model (Representing Stressors, Alcohol Use, Risk Factors, and Protective Factors) was derived from 13 items. Subsequent EFAs were conducted separately in each subgroup and revealed variability in the number of resulting factors and pattern matrices. The internal consistency also varied among factors and between these subgroups. In general these results suggest that reliability was greatest for the Alcohol Use scale and either poor or questionable for pattern matrices resulting in scales reflecting Risk Factors or Protective Factors. Conclusion: The findings from our study suggest that the BAM might not be a reliable and valid instrument for all populations. More research is needed to develop and validate tools that are clinically meaningful and allow clinicians to track recovery progress over time.

Purpose of the study: The COVID pandemic catalyzed use of telehealth services across substance use disorder (SUD) treatment services, despite open questions about how telehealth care would impact patient engagement and treatment retention. We aimed to identify differences among patients who received hybrid care (telehealth, telephone, and in person) and to evaluate time to discharge or dropout between these groups. Methods: This analysis examined the impact of using telehealth (within a “hybrid” model) on patient engagement and retention rates. We conducted a retrospective analysis of patient engagement among adult SUD patients (n=891) from October-April 2021. We used a retrospective cohort design, where groups were defined as telehealth, telephone, and in-person. Survival curves were assessed, with a log-rank test of group differences. To analyze the influence of hybrid care and potential predictors on treatment retention, Cox proportional hazard regression analysis was conducted. A subgroup analysis based on primary SUD (opioid, alcohol, cannabis and other) was performed to assess the potentially differential effects of hybrid care on treatment outcomes. Results Summary: After adjusting for confounding variables, patients who received care via telehealth were 64% (CI, 51%-73%) less likely to drop out of care, as compared to the in-person group. Hybrid care patients had a statistically significant, lower hazard of dropout compared to in-person care during the follow up period [hazard ratio, 95% CI: 0.36 (0.27, 0.49)]. Telehealth was also associated with a lower likelihood of dropout among opioid [0.33 (0.20, 0.54)], alcohol [0.39 (0.20, 0.76)], and other drug [0.21 (0.08, 0.54)] patients, compared to treatment as usual. Conclusion: Results suggest that a tech-enabled, hybrid care approach is related to greater engagement and retention in care, and that patients with SUDs who used telehealth were less likely to drop from care than those patients who did not use telehealth. These findings support use of telehealth within SUD treatment models and advocacy for relaxation of regulations that govern telehealth for SUD treatment. These findings enhance a growing body of research advocating that use of telehealth in SUD treatment yields positive treatment outcomes by improving access, decreasing barriers, reducing costs, circumventing stigma, and providing greater flexibility to both patients and clinical staff.

Purpose of the study: The “TeleFirst” hybrid care model was developed to address access to care, engagement, and outcomes for patients seeking substance use disorder (SUD) treatment. We provide a full continuum of care, and our crisis stabilization unit (CSU) opened in a converted emergency department shortly before shelter-in-place orders due to the Covid-19 pandemic. Thus, telehealth became a primary method of delivering care. Our “hybrid” model enabled patients to receive treatment on site and/or remotely via the Technology Platform. Methods: Our initial model of care was in-person, but we quickly transitioned to delivering services with an approach we called “TeleFirst”: providing remote services when possible, but services that needed to be provided onsite (e.g., urine drug testing, injection services) continued in-person. We transformed the CSU to a Crisis Stabilization “Service” and deployed a 24/7 Nurse Telehealth line to offer services. Clinical assessments were done remotely, and providers and patients worked together to maintain services uninterrupted. Results Summary: Patients served via telehealth increased treatment initiation, and telehealth addressed barriers such as lack of transportation and work schedule conflicts. Additionally, for patients living in rural areas outside of our primary service area, telehealth allowed them to receive needed care that might otherwise have been prohibitively far from them. We explored patient engagement, comparing in-person, remote, and hybrid care delivery, and found that patients who utilize telehealth (remotely) are significantly more likely to engage and remain in care. Telehealth services also reduced density in the CSU, and provided reduced patient loads in emergency departments in the community. Conclusion: Preliminary analyses are promising, suggesting that patients receiving the majority of care remotely remain engaged, and that hybrid care is a viable alternative/augmentation to traditional services. Our hybrid care model, a tech-enabled care approach that offers flexibility to patients, is related to greater engagement & retention in care. One of the primary outcomes of establishing the Crisis Stabilization Unit’s TeleFirst model of care was that it addressed barriers to care. This allowed patients to continue to receive much needed recovery support in accessible ways and we were able to maintain services throughout the pandemic.

Specialized instruments in American Sign Language (ASL) are scarce, and validated versions of translated instruments are even more so. This scarcity contributes to increased likelihood of errors in screening, geographically specific instruments that are not widely usable, and can contribute to Deaf consumers disenfranchisement with pursuing treatment. In part this is due to small numbers of professionals doing this work and the lack of appropriate tools to improve the quality of the resulting instruments. This analysis is one part of improving that process by leveraging latent semantic analysis to reduce researcher bias in the back translation process. Twenty-eight items were used from the Suicide Behaviors Questionnaire Revised (SBQ-R), and translations (n = 30) were compared to original text and ASL gloss using a semantic textual similarity (STS) analysis combining distributional similarity and latent similarity analysis. Results suggest that these scores accurately predict similarity (p < .05) between ASL gloss and final back translations, as well as agreement among back translators. In addition to the STS scores, translators were asked to rate similarity for each item and give each item a “go/no go” rating for the translation. The scores provided offer an objective way of comparing large samples of back translation content and reduce subjectivity among researchers during the process of choosing the most linguistically appropriate items. STS is not a substitution for a skilled panel of native-signers, but instead augments the decision-making process by including their input in a way that reduces the bias of the researcher in filtering items.

Telehealth services have emerged as a promising option to address barriers for consumers with disabilities, especially those with transportation barriers. To investigate the acceptability of telehealth services to persons who are Deaf or who have disabilities, we conducted a survey of individuals with disabilities in southwest Ohio to assess the acceptability of online services to these populations. This survey focused on interest in telehealth services and access to computers and Internet connectivity and was completed by 84 Ohio vocational rehabilitation consumers with the assistance of their counselors. Of the participants, 35% had developmental or intellectual disabilities, 17% had mental illness, 13% had a visual disability, 13% had mobility-related disabilities, 11% were deaf/hard-of-hearing, 7% had learning disabilities, 3% had traumatic brain injury, and 1% had medically related disabilities. Only 26% of the consumers surveyed were interested in receiving online services, and 74% were not; 43% had access to computers and Internet, and 57% did not. When comparing disability groups, 100% of deaf individuals, 62% of individuals with mobility-related disabilities, and 40% of individuals with learning disabilities wanted online services; the other groups were not interested in receiving online services (p < .001). Chief reasons for refusing to use telehealth services included cognitive inability (21%), dislike for computers (20%), preference for face-to-face meetings (19%), and no access to computers/internet (14%). This study demonstrates that online services are not universally acceptable to all populations, especially those with certain disabilities.

There are few mental health, substance abuse and/or career assessment instruments available in American Sign Language(ASL). Additionally, validated versions of translated instruments are rare, contributing to an increased likelihood of inaccurate results. The Substance Abuse Resources and Disability Issues (SARDI) Program in the Boonshoft School of Medicine at Wright State University (WSU) received a five year Disability and Rehabilitation Research Project (DRRP), funded through NIDILRR. The goals include: 1) translation and validation from English to ASL of substance abuse and mental health instruments, as well as a career interest profiler; 2.) the development of an online portal for accessing and scoring the instruments and; 3.) the provision of training on how to utilize the instruments on line. The project includes, the Satisfaction with Life Scale(SWLS), Rosenberg Self-Esteem Scale(RSES), Beck Depression Inventory(BDI), Alcohol Use Disorders Identification Test(AUDIT), Drug Abuse Screening Test(DAST), Global Appraisal of Individual Needs-Short Screener(GAIN-SS), the Patient Health Questionnaire(PHQ-9- depression screening tool), the Generalized Anxiety Disorder- 7 item(GAD-7- anxiety screening tool) and the Operational Network Evaluation Tool (O*NET) Interest Profiler. Using forward translation, instruments were translated into ASL by a team of culturally deaf experts followed by back translation completed by bi-lingual deaf and adult children of deaf adults (n=30). Lastly, cognitive interviews were conducted with culturally deaf (n = 20) people across the United States, and field-testing was conducted (n = 450+). The results of field testing will be presented and training materials for assessing and using the online instruments will be reviewed.

This poster presentation will showcase 6 CRCC CEU approved online webcasts. The webcasts are Best Practices and Strategies for Telecounseling; Assistive Technology and Video Conferencing; Online Assessment; JSST, Job Search, Job Development and Job Placement; Career Exploration and Vocational Training and Educational Opportunities; Supportive Employment and Job Coaching. All webcasts provide relevant information related to providing Vocational Rehabilitation Counseling and Guidance Services. These webcasts can be beneficial for VR counselors new to the field as well as for experienced counselors to learn about bringing contemporary technology to the VR process.

This study explores differences between adult suicide rates in counties in Ohio from 2007-2012, specifically differences between major metropolitan and rural areas. Less densely populated states in the nation have been shown to have the highest rates of completed suicide, and that trend was hypothesized to exist in the least densely populated counties in Ohio. Suicide rates in the three most densely populated counties in Ohio (Cuyahoga, Franklin, and Hamilton) were found to have rates below the national average for adults (12.2 per 100,000). In contrast, seven of the ten least densely populated counties had rates above the average, and the least densely populated county (Ashland) had a rate more than twice as high (26.6 per 100,000) as the average. Several of the least populous counties in Ohio had less than 20 suicides in the sample, so aggregate suicide rates were calculated to obtain stable rates. Although the hypothesized relationship did exist, many factors found to be associated with increased rates of completed suicide were not included in this study. Future studies might include method and distance from emergency and mental health treatment services, as well as more years to compensate for small samples size in less densely populated counties.

Online counseling, telepsychiatry, and other telemedical services are ubiquitous in today’s health services market. Research has demonstrated that online services are enthusiastically utilized by consumers who are deaf. We conducted a survey of individuals with disabilities to assess the acceptability of telehealth services to these populations. Methods: A survey that asked about interest in telehealth services and access to computers and internet was completed by 84 vocational rehabilitation (VR) consumers with the assistance of their counselors in southwest Ohio. Of the participants, 35% had developmental or intellectual disabilities, 17% had mental illness, 13% had a visual disability, 13% had mobility-related disabilities, 11% were deaf/hard-of-hearing, 7% had learning disabilities, 3% had traumatic brain injury (TBI), and 1% had medically related disabilities. Results: Only 26% of the VR consumers surveyed were interested in receiving online VR services, and 74% were not; 43% had access to computers and internet, and 57% did not. When comparing disability groups, 100% of deaf individuals, 62% of individuals with mobility-related disabilities, and 40% of individuals with learning disabilities wanted online services; the other groups were not interested in receiving telehealth services (Χ2 = 40.6, p < .001). Chief reasons for refusing to use telehealth services included cognitive inability (21%), dislike for computers (20%), preference for face-to-face meetings (19%), and no access to computers/internet (14%). Conclusions: This study demonstrates that telehealth services are not universally acceptable to all populations, especially those with certain disabilities. Individuals who are deaf are accustomed to using videophones, and the leap to online counseling and other telehealth services is a simple move for them. Individuals with mobility and/or transportation issues also welcome the opportunity to receive health services at home. However, most individuals with disabilities are not comfortable with receiving telehealth services.

Numerous barriers exist when attempting to provide culturally appropriate assessment instruments for persons who are Deaf. In addition to a scarcity of specialized instruments, validated versions of translated instruments are also rare, contributing to an increased likelihood of errors in screening, costs time and money for providers, and can contribute to Deaf consumers disenfranchisement with pursuing treatment. Instruments were translated; a process called forward translation, into ASL gloss by a team of Culturally Deaf experts. Thirty Bi-lingual Deaf and adult Children of Deaf Adults (CODA) participated in back translation. Lastly, cognitive interviews were conducted with culturally Deaf (n = 20) people across the United States, and field-testing was conducted (n = 450+). Instruments included the Satisfaction With Life Scale (SWLS), Rosenberg Self Esteem Scale (RSES), Beck Depression Inventory (BDI), Alcohol Use Disorders Identification Test (AUDIT), Drug Abuse Screening Test (DAST), Wide Range Interest and Occupation Test (WRIOT), Operational Network Evaluation Tool (O-NET), and Global Appraisal of Individual Needs (GAIN). Translations were compared to original text and ASL gloss using a semantic textual similarity (STS) analysis combining distributional similarity and latent similarity analysis. Results suggest that these scores accurately predict similarity (p < .05) between ASL gloss and final back translations, as well as agreement among back-translators. Although STS is not a substitution for a skilled panel of native-signers, the scores provided offer an objective way of comparing large samples of back translation content and reduce subjectivity among researchers during the process of choosing the most linguistically appropriate items.

Purpose: The eCAM program was designed to address multiple barriers to substance abuse treatment. This technology-enhanced program is based on a communication portal system with secure personal web pages in English and ASL that permit access to a personal online videoconferencing with staff and online support groups and access to online educational resources and personal EHR records. This study was conducted to assess the effectiveness of eCAM, compared to traditional treatment programs that are provided by the same staff. Methods: A total of 179 individuals with substance use disorders (SUD) were enrolled in eCAM. At 6-month follow-up, data were collected from 75% of these consumers. Their outcomes were compared to those of 175 randomly selected consumers in treatment for SUD in traditional treatment programs. Drug and alcohol use were assessed with the AUDIT, DAST, and ASI at baseline and at 6-month follow-up. Findings: For eCAM consumers, drug use was significantly reduced. ASI results indicated a significant reduction (p = .009) in ASI drug scores from intake to follow-up; DAST scores were also significantly lower at follow-up, compared to baseline (p = .02). The number of individuals scoring in the most severe level of the AUDIT was significantly reduced for eCAM consumers. When comparing no-show rates and clinical contact, eCAM consumers kept more appointments than did non-eCAM consumers and had significantly more contact with clinical providers than did consumers in traditional treatment. Conclusions: Our online eCAM treatment program produced treatment results better than traditional face-to-face SUD treatment. Individuals with disabilities significantly benefitted from eCAM. Deaf individuals, especially, appreciated the improved access to treatment by culturally and linguistically appropriate providers via eCAM. Our clinical treatment site was also able to provide SUD treatment to consumers across the state, due to eCAM technology. Other benefits included reduced no-shows and increased contact with counselors.

The Deaf Off Drugs & Alcohol (DODA) Program provides culturally appropriate cessation and recovery support services via e-therapy to Deaf individuals with substance use disorders (SUD). Analysis of intake data revealed that the prevalence of lifetime suicide attempts among prelingually Deaf members (n=108) of this population was 41.5%, which is significantly higher than rates (15-30%) reported for other disabled groups with SUD. Analyses revealed that gender, age, and past mental health diagnosis were predictors of suicidality, with females (p=.002), younger individuals (p=.009), and those with a mental health diagnosis (p<.001) reporting higher rates of past suicide attempts. There was a marginally significant relationship between communication with immediate family members and suicidality (p=.076), with Deaf individuals who stated that they did not communicate with family during childhood more likely to report past suicide attempts. When compared to a hearing population also in SUD treatment at the same facility, DODA consumers were less likely to have social support (p<.05). Since social connectedness is considered a protective factor for suicide, we propose that communication barriers during development, and a lack of access to the tools necessary to build social support, may contribute to an increased risk of suicidal behaviors in adulthood. These findings may suggest more than a risk factor, and point to alternative explanations of suicidal behavior in this population.

Utilizing Semantic Textual Similarity to improve Back Translation and Validation of Instruments in American Sign Language Statement of the problem Numerous barriers exist when attempting to provide culturally appropriate assessment instruments for persons who are Deaf. In addition to a scarcity of specialized instruments created in American Sign Language (ASL), validated versions of translated instruments are rare. This contributes to an increased likelihood of errors in screening, costs time and money for providers, and contributes to Deaf consumers increased disenfranchisement with pursuing treatment. The lack of culturally and linguistically accessible instruments is in large part due to the complexity and high cost of producing such instruments. Procedure English versions of the Instruments were translated; a process called “Forward Translation,” into ASL gloss by a team of Culturally Deaf experts. Upon completion of the Forward Translation, another team of ASL experts, both Deaf and Hearing, record a video of each question in ASL. It is during this part of the process that the ASL grammar and structure are fine-tuned. Each video is sent to 30 individuals, both Deaf and Children of Deaf Adults (CODA), for “Back Translation.” Deaf and CODAs are used exclusively; those whose first language is ASL. The Back Translation consists of two parts – to translate the ASL version of what is seen into English and to provide any comments with regards to ASL structure, grammar, and syntax. These translations are compared to the original text and the ASL gloss using a semantic textual similarity (STS) analysis combining distributional similarity and latent similarity analysis (LSA). This analysis dictates whether any of the questions need to be re-recorded, and the process repeated. After all portions of an instrument are equivalent in meaning to the original instrument, the videos continue on to a process of cognitive interviewing and field-testing. Results This process was completed for the Satisfaction With Life Scale (SWLS), Rosenberg Self Esteem Scale (RSES), Beck Depression Inventory (BDI), Alcohol Use Disorders Identification Test (AUDIT), Drug Abuse Screening Test (DAST), Wide Range Interest and Occupation Test (WRIOT), Operational Network Evaluation Tool (O’NET), and Global Appraisal of Individual Needs (GAIN). Preliminary results suggest that these scores accurately predict similarity between ASL gloss and final back translations, as well as agreement among back-translators. STS scores comparing original English and ASL gloss are less promising, and suggest more complex conceptual differences between English and ASL. Conclusions Although STS is not a substitution for a skilled panel of native-signers, the scores provided offer an objective way of comparing large samples of back translation content and reduce subjectivity among researchers during the process of choosing the most linguistically appropriate items. The possibility or crowd-sourcing back translation efforts and using natural language processing (NLP) holds particular promise, to reduce costs and to minimize differences in regional signs that can contribute to reduced understanding.

Statement of the problem Limited research has been conducted looking at the relationship between the drugs involved in substitute addictions. It is important to understand the relationship between drug substitutions. For example, the use of anti-anxiety medications such as benzodiazepines is not the first option among many clinicians treating addictions due to their addictive quality and possibility of becoming just another substitute addiction. In this project, preferred drug use and use of other addictive substances, including benzodiazepines, were measured at treatment onset and then again six months following the initial treatment. Population Data from individuals (n = 558) receiving treatment for substance abuse (61% male, 53% Caucasian, 43% African American) in Ohio were used in this analysis. These individuals received intensive outpatient therapy without medication assisted treatment (MAT). Procedure Participants were asked the number of days in the past 30 days that they used alcohol, opioids, cocaine/crack, methamphetamine, and benzodiazepines. Multiple regression analyses were conducted using alcohol, opioids, cocaine/crack and methamphetamine as dependent variables while drug use for the other drug categories served as predictor variables. Results Benzodiazepine use was significantly increased following six months of treatment for cocaine use (Beta = -.118, t = -2.085, p = .038). However, benzodiazepine use did not increase following treatment for alcohol, opioid, or methamphetamine use. No differences were found between genders and racial groups. Conclusions Clinicians should be aware of the potential for drug substitution or cross substitution of drugs of abuse during treatment for drug addiction. This is especially true for benzodiazepines in the case of cocaine addicts. This project highlights the need for more investigation in this area.

Purpose: To determine if an automated text-message system (CareText) with messages based on individualized Motivational Interviewing (MI) goals enhances adherence to follow-up or treatment goals in patients who screened positive for alcohol or other drug use. Methods: Patients (n = 27) who screened above the cut-off on the Alcohol Use Disorders Identification Test (AUDIT-C) or Drug Abuse Screening Test (DAST-10) were randomized into an intervention group (n = 12), which received SBIRT/MI and CareText, or a control group (n = 15), which received only SBIRT/MI. CareText messages arrived weekly until patients responded “STOP” to the message or they stopped responding. Patients completed AUDIT-C and DAST-10 three and six months after enrollment. A chart review was done for the same periods. Results: While AUDIT scores for both groups decreased over time, the CareText group had greater reductions in AUDIT scores at 3-month follow-up (F = 6.28, p = .019). CareText participants who responded most consistently to messages had the greatest change in AUDIT scores from intake to 3-month follow-up (r = .608, p = .036). No group differences were found for primary care and ED visits. However, CareText patients cancelled significantly more appointments (t = 2.26, p = .033). Conclusions: Despite the small sample size, CareText responders had significant changes in their AUDIT scores, reflecting improved alcohol habits. However, the participants who were most responsive to CareText may be those who were more actively involved in their care and, therefore, may have had improved AUDIT scores with or without CareText messages.

The Consumer Advocacy Model (CAM) is an outpatient program providing specialized services for individuals with substance use disorders and/or mental illness, especially those with co-occurring disabilities. Using technological enhancements through the eCAM program, CAM utilizes electronic resources to meet the needs of consumers and overcome barriers to accessibility. Consumers (n= 179) access services via web portals created dynamically and tailored to their needs. These portals were designed to minimize barriers and improve accessibility. For example, American Sign Language video and English audio formats are provided for Deaf consumers and for those low literacy, respectively. Other resources include automated text message and e-mail appointment reminders, access to electronic health records, and online video counseling sessions. For the past three years, consumers utilizing SUD services had a slight reduction in their alcohol consumption and a significant decrease in their illegal drug use. For alcohol dependent consumers, there was a decrease in their Alcohol Use Disorder Identification (AUDIT) test scores from intake to follow-up, and the number of consumers scoring high enough to warrant further evaluation for dependence dropped from 16.7% (n= 11) at intake to 10.6% (n= 7). There was also a significant decrease (p= .026) in the number of consumers scoring high enough to indicate substance abuse on the Drug Abuse Screening Test (DAST), dropping from 53% (n= 35) to 37.9% (n= 25). By meeting consumers where they are and making materials accessible from the beginning, the eCAM program represents an open-source alternative to commercial applications that is secure and accessible.

Since 2013, volunteer educators have been hosting a conference in collaboration with The Walter Henry School in Santa Cruz, Bolivia, and faculty from the School of Professional Psychology at Wright State University. The purpose of the conference is to work with Bolivian Methodist and public schools, Methodist churches, social services agencies, and families, to help Bolivian schools better accommodate students with disabilities. Children with disabilities in Bolivia are sometimes referred to as the "second patio children", in other words defective, and not to be seen, and therefore, largely hidden from society. The pervasive impact of these beliefs are seen in the gross inequities and injustices experienced by these children. Specific, to education, one study reported that only 1-3 % of children with disabilities in Bolivia ever receive an education despite laws in Bolivia stating children with disabilities are to have equal access to education. As part of the conference and associated trainings, researchers have administered assessments of participants’ attitudes toward people with disabilities. The ATPD was given at the beginning and end of each conference for approximately 50 attendees per year. Measured attitudinal change in teachers, administrators and parents following disability training. No significant change occurred among teachers and parents with a trend towards improved attitudes. However, a significant decline was demonstrated among administrators. There were also differences according to gender and education. Results from three years of ATPD data will be discussed.

Cellular text messaging is an emerging technology that influences patients’ decisions on health behaviors. It offers a cost-effective method to reduce healthcare costs by improving management for diseases or conditions associated with high morbidity/mortality. The objectives for this review are: 1) review current evidence on using text messages to influence patients’ health behaviors; 2) evaluate which conditions or diseases are most influenced by text messaging; 3) determine if basing the text messaging in a theoretical framework improves outcomes. Common literature databases were searched for any published review articles since 2005 on this subject. Thirty-six reviews met inclusion criteria. Overall, there is high quality evidence of improvement in tobacco cessation rates with text message interventions with low quality evidence of positive results with text messaging improving weight loss, diabetic selfcontrol, and asthma control. The heterogeneity of studies (small sample size, mixed media interventions combined with texting, varying frequency of intervention and study length) creates difficulty in interpreting overall effectiveness of text messaging. There was also a lack of evidence to support using a behavior change theory to frame the interventions. However, motivational interviewing (MI) has been shown to motivate patients in changing health-related behaviors, but has not been explored within text messaging trials. MI could offer a new technique to improve the effectiveness of text messaging interventions. High-quality research should continue to examine the use of text messaging with MI messaging.

Two NIDRR-funded projects that innovated services for deaf individuals will be presented. The FI-R grant assessed a telemedicine-delivered program that provides treatment/ recovery services to deaf individuals. A currently funded DRRP project that develops VR assessment tools in ASL will be described. DemonstraFons of the technology and assessments will be provided.

Since 2013, volunteer educators have been hosting a conference in collaboration with The Walter Henry School in Santa Cruz, Bolivia, and faculty from the School of Professional Psychology at Wright State University. The purpose of the conference is to work with Bolivian Methodist and public schools, Methodist churches, social services agencies, and families, to help Bolivian schools better accommodate students with disabilities. Children with disabilities in Bolivia are sometimes referred to as the "second patio children", in other words defective, and not to be seen, and therefore, largely hidden from society. The pervasive impact of these beliefs are seen in the gross inequities and injustices experienced by these children. Specific, to education, one study reported that only 1-3 % of children with disabilities in Bolivia ever receive an education despite laws in Bolivia stating children with disabilities are to have equal access to education. As part of the conference and associated trainings, researchers have administered assessments of participants’ attitudes toward people with disabilities. The ATPD was given at the beginning and end of each conference for approximately 50 attendees per year. Measured attitudinal change in teachers, administrators and parents following disability training. No significant change occurred among teachers and parents with a trend towards improved attitudes. However, a significant decline was demonstrated among administrators. There were also differences according to gender and education. Results from two years of ATPD data will be discussed.

Since 2008, the Deaf Off Drugs & Alcohol (DODA) Program has been providing culturally appropriate ATOD cessation and recovery support services via telemedicine to Deaf/HH individuals with a clinically diagnosed substance use disorder (SUD). In 2013, a NIDRR Research grant began evaluating the effectiveness of DODA compared with two residential treatment programs using four outcome measures in ASL. The residential programs are the Minnesota Chemical Dependency Program for Deaf and Hard of Hearing Individuals and the Awakenings Program in southern California. Consumers (n=78) are from across the United States and represent a wide range of age, racial, and socioeconomic backgrounds. Outcome measures include the Satisfaction With Life Scale (SWLS), the Rosenberg Self-Esteem Scale (RSES), the Beck Depression Inventory (BDI), and the Substance Abuse Screener in American Sign Language (SAS-ASL). Surveys were administered electronically in ASL, and while most consumers completed the self-directed survey online, approximately 20% did the survey by videophone. The latter often occurred as an accommodation when consumers did not have access to a computer during the window for follow-up. Analysis of baseline responses revealed that 43.6% abused alcohol, 23.1% abused marijuana, 20.5% abused cocaine, 11.5% abused prescription drugs, 10.3% abused methamphetamines, and 3.8% abused opiates. A preliminary examination shows consumers improving at all three sites with no significant difference in outcomes between consumers receiving in-person care and those receiving electronic services, and suggests that online SUD treatment can provide a cost-effective alternative to inpatient treatment and increase access to care.

Purpose: The Technology Assisted Care (TAC) program was designed to address the barriers to SUD treatment faced by consumers with co-existing disabilities. During the three year study, consumers (n=168) from across the state of Ohio received counseling and case management through a tele-health model.

Population: Those served include persons with disabilities with barriers to successful treatment (for example Deaf consumers, persons with developmental disabilities, traumatic brain or spinal cord injuries.) Outreach and services were also provided to former military and their families, especially veterans where a service-related or other disability inhibited that person from fully benefiting from traditional SUD treatment. Consumers receiving TAC services reside in communities across Ohio. The current average distance of a TAC consumer is 66.59 miles, with the furthest consumer living 209 miles away, and the closet consumers living within one mile.

Methods: The program made every effort to meet consumers where they are, in terms of technology, accessibility, linguistics, and consumer preferences. More than 73% of consumer contacts were conducted remotely, and more than 84% of counseling contacts happened through technology.

Results: TAC consumers were more likely to show up for scheduled appointments, with a “no-show” rate 10% lower than traditional consumers in the same facility, and higher rates of contact per month. Consumers who started the program with active alcohol use reduced the number of days of use significantly (p=0.001) after six months. Similarly, consumers who started the program with active illegal drug use also reduced the number of days of use significantly (p=0.030).

The TAC program has developed a sustainability plan that will allow TAC services to continue at the end of the funded project, and offers exciting possibilities for persons with disabilities who experience a number of risks which increase their chances for substance abuse and introduce barriers to receiving treatment.

The eCAM program was designed to address the barriers to substance use disorder (SUD) treatment faced by consumers with co-existing disabilities, by utilizing culturally appropriate cessation and recovery support services via e-therapy. The program implemented improvements for universal access to online materials (audio versions, screen reader compatibility, etc.), and development of personal web portals tailored to each consumers individual needs. Emphasis was placed on making interactions and resources as accessible as possible, both culturally and technologically. In addition, open source solutions were used whenever possible to reduce cost and ease replication of the study. Because access to technology is as diverse as the types of accommodations required to facilitate recovery, every effort was made to minimize barriers across the program. This included enhancements from language choice, and the ability to tailor resources to match individual consumer's needs, to optimizing portals to work across major platforms, browsers, and mobile devices. CAM populations include Deaf/HH, making access to resources in American Sign Language a priority. Additionally, eCAM participants had an average reading level of 8th grade, with 39.08% scoring at that grade level or lower; necessitating materials in simple English and audio formats. Electronic reminders of upcoming appointments were sent by email and text in response to chronic absenteeism and high no-show rates among traditional SUD consumers, resulting in a decrease in no-show rates. By meeting consumers where they are and making materials accessible from the beginning, the eCAM program represents an open-source alternative to commercial applications that is secure and accessible.

Anxiety and depression are mental illnesses that affect millions annually. Mental health remains a critical area where African Americans hesitate to seek treatment (Brown & Palenchar 2004, Safran et. al., 2009). This study sought to identify the subgroups in the underserved Dayton (Ohio) African American community that report more days of experienced anxiety and depression. Income, years of education, gender, and age were the demographic factors investigated for associations with reported days of anxiety and depression in the past (0-30); days of psychiatric medication was a co-variate. T-tests and analysis of variance models were used to test the associations of each variable and adjust for others in the model. There was a significant association between gender and both anxiety and depression; women reported significantly more days of anxiety and depression than men. There was a positive association between age and days of reported depression and anxiety. There was a significant association between education and reported depression, but not anxiety. There was no significant association between income and anxiety or depression.

Since 2008, the Deaf Off Drugs and Alcohol (DODA) Program has provided culturally appropriate cessation and recovery support services via e-therapy to Deaf/HH individuals with a clinically diagnosed substance use disorder (SUD). Over 150 Deaf consumers have received treatment through DODA, to date. Analysis of intake interviews revealed that 49.3% abused alcohol, 30.4% abused marijuana, 18.8% abused cocaine, 7% abused opiates, and 4.0% abused prescription drugs. Surprisingly, the prevalence of lifetime suicide attempts in the Deaf population was 46.5%, which is significantly higher than the rate (15 – 30%) reported for other disabled groups with SUD. In addition to attempts, suicidal ideation was reported by 53.5% of Deaf consumers, with the highest rates among women. An initial examination of the variables associated with suicide attempts was conducted. Past mental health Diagnosis were significantly associated with attempts (chi square = 20.31, p < 0.001). In addition, communication ability was also associated with increased likelihood of suicide attempts. Deaf individuals who had delayed language acquisition in youth had higher rates of suicide attempts: among the prelingually deaf, language acquisition was on average one year later among those with reported suicide attempts than those without. We propose that if language is delayed though major developmental milestones of childhood, Deaf individuals may have less access to the tools necessary to build social support and positive social identity. Alternatively, the attempts may represent a maladaptive form of communication stemming from delayed ability to express unmet emotional needs.