Effect of the Communities that HEAL intervention on receipt of behavioral therapies for opioid use disorder: A cluster randomized wait-list controlled trial.

BACKGROUND: The U.S. opioid overdose crisis persists. Outpatient behavioral health services (BHS) are essential components of a comprehensive response to opioid use disorder and overdose fatalities. The Helping to End Addiction Long-Term® (HEALing) Communities Study developed the Communities That HEAL (CTH) intervention to reduce opioid overdose deaths in 67 communities in Kentucky, Ohio, New York, and Massachusetts through the implementation of evidence-based practices (EBPs), including BHS. This paper compares the rate of individuals receiving outpatient BHS in Wave 1 intervention communities (n = 34) to waitlisted Wave 2 communities (n = 33). METHODS: Medicaid data included individuals ≥18 years of age receiving any of five BHS categories: intensive outpatient, outpatient, case management, peer support, and case management or peer support. Negative binomial regression models estimated the rate of receiving each BHS for Wave 1 and Wave 2. Effect modification analyses evaluated changes in the effect of the CTH intervention between Wave 1 and Wave 2 by research site, rurality, age, sex, and race/ethnicity. RESULTS: No significant differences were detected between intervention and waitlisted communities in the rate of individuals receiving any of the five BHS categories. None of the interaction effects used to test the effect modification were significant. CONCLUSIONS: Several factors should be considered when interpreting results-no significant intervention effects were observed through Medicaid claims data, the best available data source but limited in terms of capturing individuals reached by the intervention. Also, the 12-month evaluation window may have been too brief to see improved outcomes considering the time required to stand-up BHS. TRIAL REGISTRATION: Clinical Trials.gov http://www. CLINICALTRIALS: gov: Identifier: NCT04111939.

Exploring the association between post-critical incident intervention preferences and self-reported coping self-efficacy among firefighters.

Critical incident stress debriefing (CISD) is a commonly utilized intervention in the fire service that aims to minimize psychological harm and adverse mental health outcomes after a potentially traumatic incident. This study aimed to explore firefighter preferences regarding CISD and alternative post-critical incident interventions in relation to firefighter coping self-efficacy (FFCSE) and trauma coping self-efficacy (CSE-T). Firefighters (N = 241) completed an online survey and provided complete data. Most participants were White (n = 203, 84.2%), non-Hispanic (n = 221, 91.7%) men (94.2%; n = 227). CISD was the most preferred intervention among firefighters (n = 113, 46.9%) as compared to informal peer support (n = 31, 12.9%), formal one-on-one counseling (n = 29, 12.0%), and no intervention (n = 68, 28.2%). Firefighters who preferred CISD had statistically significant lower levels of FFCSE, R2 = .033-.044, ps = .012-.030, and CSE-T, R2 = .035-.061 ps = .017-.024, compared to those who preferred no intervention. Firefighters who preferred formal one-on-one counseling had statistically significantly lower levels of FFCSE, R2 = .033-.044, ps = .003-.011, and CSE-T, R2 = .035-0.061, p < .001-p = .002, compared to those who preferred no intervention. The findings from this study may guide future research to increase knowledge on firefighter intervention preferences and the association between preference and coping self-efficacy.

Impact of the Communities That HEAL Intervention on Buprenorphine-Waivered Practitioners and Buprenorphine Prescribing: A Prespecified Secondary Analysis of the HCS Randomized Clinical Trial.

Importance: Buprenorphine significantly reduces opioid-related overdose mortality. From 2002 to 2022, the Drug Addiction Treatment Act of 2000 (DATA 2000) required qualified practitioners to receive a waiver from the Drug Enforcement Agency to prescribe buprenorphine for treatment of opioid use disorder. During this period, waiver uptake among practitioners was modest; subsequent changes need to be examined. Objective: To determine whether the Communities That HEAL (CTH) intervention increased the rate of practitioners with DATA 2000 waivers and buprenorphine prescribing. Design, Setting, and Participants: This prespecified secondary analysis of the HEALing Communities Study, a multisite, 2-arm, parallel, community-level, cluster randomized, open, wait-list-controlled comparison clinical trial was designed to assess the effectiveness of the CTH intervention and was conducted between January 1, 2020, to December 31, 2023, in 67 communities in Kentucky, Massachusetts, New York, and Ohio, accounting for approximately 8.2 million adults. The participants in this trial were communities consisting of counties (n = 48) and municipalities (n = 19). Trial arm randomization was conducted using a covariate constrained randomization procedure stratified by state. Each state was balanced by community characteristics including urban/rural classification, fatal opioid overdose rate, and community population. Thirty-four communities were randomized to the intervention and 33 to wait-list control arms. Data analysis was conducted between March 20 and September 29, 2023, with a focus on the comparison period from July 1, 2021, to June 30, 2022. Intervention: Waiver trainings and other educational trainings were offered or supported by the HEALing Communities Study research sites in each state to help build practitioner capacity. Main Outcomes and Measures: The rate of practitioners with a DATA 2000 waiver (overall, and stratified by 30-, 100-, and 275-patient limits) per 100 000 adult residents aged 18 years or older during July 1, 2021, to June 30, 2022, were compared between the intervention and wait-list control communities. The rate of buprenorphine prescribing among those waivered practitioners was also compared between the intervention and wait-list control communities. Intention-to-treat and per-protocol analyses were performed. Results: A total of 8 166 963 individuals aged 18 years or older were residents of the 67 communities studied. There was no evidence of an effect of the CTH intervention on the adjusted rate of practitioners with a DATA 2000 waiver (adjusted relative rate [ARR], 1.04; 95% CI, 0.94-1.14) or the adjusted rate of practitioners with a DATA 2000 waiver who actively prescribed buprenorphine (ARR, 0.97; 95% CI, 0.86-1.10). Conclusions and Relevance: In this randomized clinical trial, the CTH intervention was not associated with increases in the rate of practitioners with a DATA 2000 waiver or buprenorphine prescribing among those waivered practitioners. Supporting practitioners to prescribe buprenorphine remains a critical yet challenging step in the continuum of care to treat opioid use disorder. Trial Registration: ClinicalTrials.gov Identifier: NCT04111939.

Effects of the Sacramento Neighborhood Alcohol Prevention Project on rates of child abuse and neglect 7 years post-implementation (1999-2010).

INTRODUCTION: Evaluations of alcohol environmental prevention efforts examine short-term effects of these interventions on alcohol-related problems. We examine whether the effects of the Sacramento Neighborhood Alcohol Prevention Project (SNAPP), an alcohol environmental intervention aimed to reduce alcohol-related problems in two neighbourhoods, on child abuse and neglect remained 7 years post-implementation. METHODS: SNAPP used a quasi-experimental non-equivalent control group design, where intervention activities occurred in the South area, followed by those in the North area 2 years later. Our sample size is 3912 space-time units (326 census block groups × 12 years [1999-2010]). Outcomes were measured at the household level and included: (i) all foster care entries total; and (ii) the subset of foster care entries that were alcohol related. Data were analysed using Bayesian conditionally autoregressive space-time models. RESULTS: We find that the decreases in total (relative rate [RR] = 0.882, 95% credible interval [CrI] 0.795, 0.980) and alcohol-related (RR = 0.888, 95% CrI 0.791, 0.997) foster care entries remain in the North intervention area although the magnitude of those changes are smaller than immediately post-intervention. Increases found in alcohol-related foster care entries in the South area immediately post-intervention were not significant 7 years later (RR = 1.128, 95% CrI 0.975, 1.307). DISCUSSION AND CONCLUSIONS: Reductions in child abuse and neglect due to an alcohol environmental intervention can be maintained. Environmental interventions that provide community-level primary prevention strategies could be more easily sustained and more cost effective than individual-level interventions, although more research is needed to identify why interventions may be successful in specific contexts and not others.

Using ecological momentary assessments to understand how drinking during special occasions relates to parenting behaviors.

BACKGROUND: Drinking on special occasions (e.g., Super Bowl, Christmas) often results in more alcohol consumed. Further, police often report higher levels of crime, such as assaults and domestic violence, on days of major sporting events (e.g., Super Bowl, World Cup). Yet, drinking behaviors of parents during special occasions or large sporting events have not been assessed for their effects on parenting behaviors. Here, we assess the relationship between drinking during the Super Bowl and on Valentine's Day to determine whether they differ. METHODS: Participants, recruited from social media, completed a 40-min baseline survey and 14 days of three daily Ecological Momentary Assessments (EMAs) about parenting. Two hundred fifty-five participants (with 684 EMAs) were enrolled on the Super Bowl and 184 (492 EMAs) were enrolled on Valentine's day. Measures of parenting include aggressive, punitive, and nonpunitive discipline and positive techniques. Drinking was assessed on days 7 and 14 of the EMA and corresponded to the EMA time frame during the previous week. Participants were largely White, well-educated mothers. Data were analyzed using multilevel logistic regression models. RESULTS: Parents who reported drinking on the day of the Super Bowl were more likely to use aggressive discipline (OR = 2.560; 95% CI: 1.308, 5.150) and punitive parenting (OR = 2.701; 95% CI: 1.394, 5.257) during the time that drinking occurred. In contrast, parents who reported drinking on Valentine's Day were less likely to use aggressive discipline (OR = 0.197; 95% CI: 0.077, 0.502). CONCLUSIONS: The differential relationship between drinking and parenting measures could be the result of differing norms or differences in who is present during the special occasions studied here. Identifying and understanding how alcohol use on special occasions contributes to parenting could help to create environments that are most conducive to positive parenting behaviors and reduce harms related to harsh or aggressive parenting.

Affordable Housing and Neighborhood Child Maltreatment Reports.

Reports of child maltreatment vary by neighborhood characteristics, yet the influence of housing affordability is less understood. The current study examines the relationship between reports of suspected child maltreatment and the spatial distribution of affordable housing across 2,341 census tracts in Los Angeles County, California. Bayesian conditionally autoregressive model results indicate that neighborhoods where residents paid a greater share of their income in rent had fewer reports of suspected child maltreatment, while neighborhoods with a higher number of subsidized rental units had more reports. These findings suggest that higher cost neighborhoods provide supportive resources and amenities to families which may reduce risk of child maltreatment. Subsidized housing units are more likely to be located in high poverty, under resourced neighborhoods, thus undermining the benefits of these programs to families. These findings have implications for equitable housing policy that promotes inclusive communities as a primary prevention strategy for child maltreatment.

Longitudinal Changes in Self-Reported Alcohol Consumption by Mothers' During the COVID-19 Pandemic.

Previous research shows that drinking by mothers was higher during the initial stages of the pandemic. Less is known about whether these drinking levels were maintained years after the first stay-at-home orders. Using three waves of data, each approximately a year apart, drinks per day remain elevated, whereas drinking frequency and continued volume have decreased during subsequent waves.

Assessing the effects of the Sacramento Neighborhood Alcohol Prevention Project (SNAPP) on child abuse and neglect.

BACKGROUND: The role of alcohol use in the etiology of abusive and neglectful parenting is significant. We examined how the Sacramento Neighborhood Alcohol Prevention Project (SNAPP) may have reduced rates of substantiated child maltreatment, entries into foster care, and entries into foster care where alcohol use was a factor. PARTICIPANTS AND SETTING: The study sample is 326 Census block groups: 21 and 16 in the South and North intervention areas, respectively, and 289 in the At-Large comparison area in Sacramento, California. METHODS: SNAPP used a quasi-experimental design to reduce alcohol supply and alcohol-related problems among 15-29 year olds in two economically, racially, and ethnically diverse neighborhoods. The dependent variables are substantiated child abuse and neglect; total foster care entries; and alcohol-related foster care entries. RESULTS: Substantiated child abuse and neglect was inconclusive for both intervention areas. In the North, total (RR = 0.822, 95 % CI [0.721, 0.933]) and alcohol-related (RR = 0.760, 95 % CI [0.634, 0.914]) foster care entries decreased by 17.8 % and 24.0 %, respectively. Intervention effects in the South were not well-supported for foster care entries (RR = 1.118, 95 % CI [0.988, 1.258]), but increased alcohol-related foster care entries (RR = 1.264, 95 % CI [1.075, 1.484]). CONCLUSIONS: Environmental intervention strategies may be effective at reducing child abuse and neglect. However, given the mixed findings from our work, we need to identify under what conditions these interventions work best and whether some components of these strategies (e.g. awareness vs. enforcement of underage sales) differentially affect child abuse and neglect.

Neighborhood market potentials for alcohol use and rates of child abuse and neglect.

BACKGROUND: Alcohol use can lead to child abuse and neglect even if the person using alcohol does not use heavily. Yet relatively few measures that reflect alcohol use are available at smaller geographic units. We assess whether the estimated level of total alcohol use per capita is related to measures of child abuse and neglect that include substantiated reports of maltreatment, total entries into foster care, and alcohol-related entries into foster care. METHODS: Our sample consists of 326 Census block groups in Sacramento, California over three time points (978 space-time units). Administrative data for substantiations of child abuse and neglect and foster care entries are our outcomes. We create market potentials for alcohol use among 18- to 29-year-olds as our primary independent variable. Data are analyzed using Bayesian conditionally autoregressive spatio-temporal models. RESULTS: Higher alcohol use potentials (as measured by total volume per capita of 18- to 29-year olds) are related to more children entering foster care due to drinking-related concerns by a parent or caregiver (RR = 1.032, 95% CI = [1.013, 1.051]), but not total substantiations for foster care entries. Neighborhoods with higher total volume of alcohol per 18- to 29-year-olds had more foster care entries when we used number of substantiations as the denominator (RR = 1.012, 95% CI = [1.0001, 1.023]) but were not related to foster care entries with alcohol misuse as a concern as a subset of all foster care entries. CONCLUSIONS: Higher estimated volume of alcohol use per capita among young adults (aged 18 to 29) was related to more children entering foster care due to alcohol-related concerns. Reducing alcohol supply in alcohol outlets, specifically through off-premise establishments, might reduce rates for all entries into foster care or other out-of-home placement and substantiated child abuse and neglect.

Sequencing drinking events and use of punitive, nonpunitive, and positive parenting behaviors with ecological momentary assessment.

BACKGROUND: The relationship between alcohol use and parenting is primarily predicated on use of both past year drinking and parenting behaviors, making it difficult to develop prevention and intervention efforts that target alcohol-related maltreatment. Here, we assess the sequencing of parenting behaviors in relation to alcohol use (e.g., whether punitive parenting and alcohol use occur simultaneously). METHODS: Using Ecological Momentary Assessment, a convenience sample of parents was asked to take three brief surveys daily (at 10 a.m., 3 p.m., and 9 p.m.) for 14 days. If the parent was with the focal child, they were asked to identify whether they had used one of six randomly assigned parenting behaviors (punitive, nonpunitive, or positive). Alcohol use was queried at the 9 p.m. survey on days 7 and 14. Logistic multilevel models were used to analyze the data. FINDINGS: Parents reported less nonpunitive parenting during the time in which they reported drinking, and less positive parenting behaviors on the morning after the drinking occurred. CONCLUSIONS: Parents may be less attentive to children's behavior while drinking, or they may be less inclined to find that behavior needing correction. Drinking may reduce the likelihood of positive parenting the next day if parents are feeling hungover or have negative aftereffects from drinking. These parents may want to explicitly have another adult provide caregiving duties during the drinking event or plan drinking when it is less likely to cause the least amount of harm (e.g., when children are in bed).

Prescription Drug Misuse Among U.S. Mothers of Minor Children in 2015-2019: Trends, Profiles, and Behavioral Health Comorbidities.

OBJECTIVE: Despite the persistent and elevated risks of prescription drug misuse (PDM) among parenting mothers in the United States, few population-based studies of this phenomenon have been conducted. To address this gap, the present study examined the latest PDM trends and patterns among parenting mothers and assessed their behavioral health comorbidities and treatment utilization. METHOD: Data were derived from a nationally representative U.S. sample of parenting mothers recruited for the 2015-2019 National Survey on Drug Use and Health. After examining PDM trends since 2015, we conducted a latent class analysis to identify distinctive PDM patterns among mothers reporting past-year PDM (n = 3,042). Associations between class membership and behavioral health comorbidities/treatment receipt were tested. RESULTS: We found increasing PDM trends among unmarried Hispanic mothers since 2015, whereas no notable changes were observed for other racial/ethnic groups. Of the mothers reporting past-year PDM, nearly 50% were likely to misuse prescription stimulants with alcohol/marijuana (17.9%) or multiple prescription drugs (31.7%). Specifically, the Poly-Prescription Drug Misuse group reported greater risks of illicit drug use and mental disorders than the Prescription Opioids Misuse group. CONCLUSIONS: Our findings suggest that special attention is needed for PDM among unmarried Hispanic (for recent increasing trends) and White (for persistently higher rates) mothers as well as mothers misusing multiple prescription drugs. Their distinctive PDM patterns as well as heightened behavioral health comorbidities and low treatment receipt suggest the need for a screening and treatment referral system that addresses the unique treatment needs and barriers facing parenting mothers.

Examining how the geographic availability of alcohol within residential neighborhoods, activity spaces, and destination nodes is related to alcohol use by parents of young children.

BACKGROUND: Alcohol outlet density and drinking behaviors have been assessed based on where people live, but exposure may differ based on where people spend time. We assessed the relationship between alcohol outlet density (using three measures of geographic availability), frequency of use, and continued volume of alcohol among parents. Parents are a unique population of drinkers where the risk for harm to others can be higher as they are caring for minor children. METHODS: We conducted a cross-sectional telephone and web-based survey of 1599 parents in 2015 across 30 cities in California. Participants provided information on drinking, residential addresses, and locations of daily activities. We created three measures of alcohol availability using residential neighborhoods, convex hull polygons, and destination nodes. Data were analyzed using zero-inflated negative binomial models. RESULTS: Density of bars in residential neighborhoods were related to more frequent drinking (b = 0.0139, 95% CI = 0.0016, 0.0261) and higher continued volume (b = 0.0295, 95% CI = 0.0067, 0.0522). Density of bars (b = 0.0070, 95% CI = 0.0019, 0.0121) and restaurants (b = 0.0018, 95% CI = 0.0003, 0.0033) in destination nodes were related to drinking a higher continued volume of alcohol. Higher off-premise outlet density was related to a lower continued volume (b = -0.0026, 95% CI = -0.0049, -0.0002). CONCLUSIONS: Outlet densities in residential neighborhood and destination nodes are related to frequency of drinking and continued volume of alcohol. Future work should seek to determine why and how residential neighborhoods and nodes are related to alcohol use behaviors and if they differ for parents compared to other adults.

Families in Crisis: The Relationship Between Opioid Overdoses and Child Maltreatment in Neighborhood Areas.

OBJECTIVE: The increase in the use of opioids in Ohio is believed to have contributed to a crisis within county child welfare agencies throughout the state. Prior research has found a connection between opioid use and child abuse and neglect, but no previous studies have examined the relationship between opioid overdoses and child maltreatment rates at the neighborhood level. METHOD: The sample is 9,231 Census block groups in Ohio for 2015. Bayesian conditionally autoregressive models were used to examine the relationship between naloxone administrations (as a proxy for overdose) and child maltreatment. We controlled for variables representing social disorganization characteristics including unemployment, racial/ethnic heterogeneity, and vacant housing rates. We specifically examined child maltreatment referrals per child population and child maltreatment substantiations per child population. RESULTS: Higher rates of naloxone administration by emergency medical services were related to higher rates of referrals for child welfare investigations (relative risk = 1.0026) and substantiations (relative risk = 1.0027) at the block group level. Neighborhoods located in Appalachia with higher rates of overdoses were at greater risk for experiencing more referrals for child welfare investigations (relative risk = 1.0043). CONCLUSIONS: As communities continue to struggle with containing opioid misuse and reducing opioid overdose deaths, they must also contend with addressing problems that may arise from overdoses, including child abuse and neglect. Our findings suggest that the relationship between overdoses and maltreatment occurs at a much smaller spatial scale than has previously been observed. This may allow resources to be targeted more effectively within counties and communities.

Medical Marijuana Dispensaries and Referrals for Child Maltreatment Investigations.

The changing legal status of marijuana in the United States has increased access to the drug through medical marijuana dispensaries. Limited research exists that examines the effects of these dispensaries on social problems including child maltreatment. The current study examines how medical marijuana dispensaries may affect referrals for child abuse and neglect investigations. Data are analyzed from 2,342 Census tracts in Los Angeles County, California. Locations of medical marijuana dispensaries were obtained through Weedmaps.com. Using conditionally autoregressive models, local and spatially lagged dispensaries show a positive relationship to rates of referrals in the unadjusted models. However, when we adjust for alcohol outlet density and measures of social disorganization, this relationship is no longer significant. Although this study does not find a relationship between medical marijuana dispensaries and referrals for investigations of child maltreatment, it should not be considered a definitive finding of this relationship. The increasing number of states that are allowing marijuana to be used for medical and recreational purposes is resulting in more people using the drug and the effects on parenting are still unknown.

Contrasting Methods of Measurement in Spatial Analyses Examining the Alcohol Environment and Child Maltreatment.

Child physical abuse is a major public health issue in the United States. Environmental child welfare research has focused on neighborhood characteristics and the influence of alcohol and marijuana establishments. To our knowledge, child welfare studies have singularly examined the outcome in terms of victims, that is, at the level of child population, and have not considered the parent population. Thus, in this exploratory study, we use spatial scan statistics to analyze patterns of child physical abuse at the child and household level, and we use Bayesian hierarchical spatial conditional autoregressive models to determine the relative influence of alcohol availability and other environmental factors. We find that household clusters are nested in child clusters and that controlling for alcohol establishments reduces cluster size. In the Bayesian regression models, alcohol availability increased risk slightly, while neighborhood diversity (measured using Blau's Index) elevated risk considerably. Immediate implications for child welfare agencies are discussed.

Daily Stress and Use of Aggressive Discipline by Parents during the COVID-19 Pandemic.

To assess the relationship between stress throughout the day and aggressive discipline practices by parents during COVID-19 stay at home orders. For this study, participants took baseline survey online, then provided data three times a day (10 a.m., 3 p.m., and 9 p.m.) for 14 consecutive days using Ecological Momentary Assessment procedures. Data were collected from 323 participants, covering 9,357 observations from April 13 to May 27, 2020 in Central Ohio during stay-at-home orders due to COVID-19. Use of aggressive discipline, including corporal punishment and psychological aggression, was measured using the Dimensions of Discipline Inventory. For each higher level of stress, parents had 1.3 greater odds of using aggressive discipline. Having used aggressive discipline at baseline was related to three times greater odds of using it during the study period. Higher situational stress was associated with use of aggressive parenting. When combined with less contact with mandatory reporters, this places children at risk for abuse and neglect that may go without detection and intervention for longer time-periods. First responders and medical professionals become more important in identifying and reporting suspected child maltreatment, as this may be a child's only contact with a mandated professional for six months to a year. Well child visits, routine vaccinations, and problem-focused care are important opportunities to assess parents' stress and discipline practices that may be suggestive of abuse or neglect.

Stress, alcohol use, and punitive parenting during the COVID-19 pandemic.

BACKGROUND: Emerging research suggests that parents are experiencing heightened stress during the COVID-19 pandemic. Parental stress is a risk factor for harsh or punitive parenting, and this association may be exacerbated by the use of alcohol. OBJECTIVE: We examine whether parental stress is associated with use of punitive parenting, as well as whether this association is modified by drinking pattern. PARTICIPANTS & SETTING: We used advertisements and word-of-mouth to recruit 342 parents living in Central Ohio during the initial stay-at-home order for COVID-19. METHODS: We used geographic ecological momentary assessment (gEMA) to measure parental stress and punitive parenting during three time periods (10 a.m., 3 p.m., and 9 p.m.) over a period of fourteen days using an app downloaded to their cellular telephone. Participants also completed a longer baseline survey. We used nested multilevel ordinal regression models, where at-the-moment assessments (Level 1) were nested within individuals (Level 2) to analyze data. RESULTS: Higher levels of parental stress [OR = 1.149 (95 % CI = 1.123, 1.176)] and later time of day [OR = 1.255 (95 % CI = 1.146, 1.373)] were positively related to odds of punitive parenting. Drinking pattern was not significantly related to punitive parenting in models with demographic covariates. Parents who drank alcohol both monthly and weekly and had higher levels of stress had greater odds of punitive parenting than parents with high levels of stress who abstain from alcohol. CONCLUSIONS: Alcohol may be an accelerant in the use of punitive parenting for parents experiencing stress. As alcohol use increases during COVID-19, children may be at higher risk for punitive parenting.

Understanding at-the-moment stress for parents during COVID-19 stay-at-home restrictions.

RATIONALE: In spring 2020, many states in the United States enacted stay-at-home orders to limit the spread of COVID-19 and lessen effects on hospitals and health care workers. This required parents to act in new roles without much support. Although studies have asked parents about stress before and during the pandemic, none have examined how stress may have fluctuated throughout the day and the characteristics related to those daily changes. OBJECTIVE: Our study assesses how time-varying (e.g., presence of a focal child) and day-varying (e.g., weekend vs. weekday) factors were related to parents' level of stress. METHODS: We use Ecological Momentary Assessment to examine stress three times a day (10 a.m., 3 p.m., and 9 p.m.) for 14 days. We include two different dates hypothesized to be related to parents' stress levels: (1) when Ohio announced schools would go virtual for the rest of the academic year and (2) when most retail businesses were allowed to re-open. Our sample of 332 individuals, recruited via Facebook, Craigslist, and word of mouth, completed 13,360 of these brief surveys during April-May 2020. Data were analyzed using generalized ordered logit models. RESULTS: Parents report lower levels of stress when completing the 9 p.m. survey, but higher levels when they were at work, during weekdays (compared to weekends) or when they were with the focal child. COVID-19 milestone dates were not related to stress levels. CONCLUSIONS: Parents need some form of respite (e.g. child care, child-only activities) to reduce stress, especially during the week when parents are juggling their outside employment and their child(ren)'s schooling. Providing parents with skills and tools to identify and reduce stress, such as apps monitoring heart rate or providing deep breathing techniques, may be one way of helping parents cope with extremely stressful situations.